What Causes Opioid Use Disorder Relapses?

Medically Reviewed by Carol DerSarkissian, MD on June 07, 2024
5 min read

As you recover from an opioid use disorder, it’s harder on some days than others to avoid using. In fact, 40% to 60% of people with substance abuse disorder (SUD) have a relapse at some point. To keep this from happening to you, it helps to know your triggers and how to avoid them.

When you relapse with opioids, it means you return to using the drug after a period of sobriety. This might happen after you finish treatment for opioid use disorder. But it doesn’t mean your treatment was unsuccessful. Instead, it suggests you might need to restart treatment, try a different one, or add something to your treatment plan.

Why do people relapse after treatment? Because addiction is a lifelong disease and risk of relapse is part of it. When you’re addicted to opioids, your brain has developed a dependence on the drug.

Once you begin recovery and stop opioid use, you might have withdrawal symptoms – physical, mental, and emotional side effects that happen once you quit a substance. These symptoms make it difficult to feel normal without opioids. So you may feel a strong urge to use opioids again, leading to a relapse.

Many emotional and physical events tempt people to use opioids again. These opioid relapse triggers are unique to each person.

There are two main types of triggers: external and internal. External triggers include places, people, and activities that remind you of using opioids or tempt you to use them. Internal triggers are emotions that make you want to turn to opioids again.

It helps to think about what your own external and triggers are. Make a list of them so you know what your pitfalls are and can plan what to do if you encounter one of them.

A few common triggers include:

Stress. Any type of stress, whether short-term or long-term, can trigger an opioid relapse. Experts believe stress is one of the main reasons people start using drugs again.

The things that stress you out, such as work, family, or other relationships, may not be in your control, but you can learn how to reduce and better handle stress. A therapist can teach you techniques for stress management.

Difficult emotions. You might have begun using opioids to deal with hard emotions. If these feelings come back again, you may be tempted to resort to drugs. You can’t avoid all negative emotions, such as guilt, sadness, or anger. But you can learn ways to cope with your emotions so that they don’t trigger a relapse.

In therapy, you can learn healthier ways to soothe yourself so that you don’t turn to opioids when you’re feeling low.

Overconfidence. During recovery, you might feel that you don’t need to worry about triggers anymore. You may think you have control over the situation, so you’ll be able to use just once. But that’s not realistic. Addiction is a chronic condition. A one-time choice is likely to lead to a full relapse.

Mental or physical illness. Depression, anxiety, and other mental illnesses often occur together with substance use disorders. They may lead to feelings and situations that trigger you. Or the conditions themselves could be triggers for you. Physical conditions and pain also put you at higher risk of relapse because of the stress they put on your body and mind.

Treating any other mental or physical issues you may have can help keep your recovery on track. When you see a doctor for any condition, tell them you’re recovering from opioid use disorder. They can treat you with medications that aren’t addictive.

Isolation. When you don’t have others to hold you accountable, you may be more likely to relapse. Social anxiety is common in people in recovery. But it’s a lot easier to let yourself use opioids or other drugs again when you’re by yourself. Make sure you have a close friend or sponsor to call on to help you avoid isolation and keep you accountable on your recovery journey.

Romantic relationships. The ups and downs of a relationship can be triggering, especially if it ends in a bad breakup. During recovery, it’s important to focus on yourself. Some experts recommend avoiding new romantic relationships for the first year of addiction recovery. If you do go through romantic difficulties, it’s especially important to have the support of a sponsor, friend, or trusted health professional.

Celebrating accomplishments. Maybe you got a new job, graduated, or got a promotion. You might be tempted to use opioids as a means of treating yourself. But remember, even one time could lead to a relapse. It’s a healthier choice to plan sober celebrations for your next milestone.

Environments where drugs are available. Whether you planned it or not, you could find yourself in a situation where others are using opioids. You might be around someone who often uses opioids or triggers you in other ways. These situations will likely tempt you to use.

Think about people or places that might tempt you, and include them on your list of triggers to avoid. They could include:

  • Friends, family, or other people in your life who use opioids
  • People who don’t understand recovery or make unfair judgements
  • Certain neighborhoods or homes
  • Bars and clubs
  • Other locations where you used opioids (for example, hotel rooms)

Memories. Although you know that opioid abuse is bad for you, you may be nostalgic for the time when you used. You might crave the way you felt then. If you find yourself thinking a lot about past opioid use, talk to a sponsor, therapist, counselor, or loved one. They’ll help you remember why it’s important to stay on track with your recovery.

HALT. This acronym stands for “hungry, angry, lonely, tired.” When these four basic human needs aren’t met, they can trigger you or make other triggers worse. They also keep you from dealing effectively with stress, which could make you more impulsive.

To avoid these triggers:

  • Learn mindfulness or another technique to manage anger.
  • Plan and schedule meals so hunger never takes you by surprise.
  • Stay connected with your loved ones to avoid loneliness.
  • Stick to a sleep schedule.

If you relapse with opioids, don’t consider it a failure. See it as a sign that you need more treatment and as a chance to get back on track. It’s crucial to get treatment to overcome a relapse.

Start by reaching out to a sober loved one or a health care provider after your relapse. A trusted family member or friend can help you take the next step to a healthy recovery.

Talk to a doctor or therapist about detoxification or withdrawal management programs to deal with withdrawal symptoms after a relapse. Your symptoms may be strong at first, but after a few days, they’ll start to get better. Afterwards, you can move on to an outpatient or inpatient rehabilitation program.

If your relapse was severe, you may want to check into a residential rehab program so you can stay at the facility for the rest of your treatment. If you’ve already gone through a treatment program and your relapse was short, outpatient therapy may work. Outpatient programs let you go on with your usual daily activities while you receive treatment. Consider changing your treatment plan to include additional counseling, a self-help group, or medication management.

If you don’t know where to turn for help, call the anonymous SAMHSA (Substance Abuse and Mental Health Services Administration) helpline at 800-622-HELP (4357).