When patients dealing with opioid use disorder (OUD) begin their treatment, relapse is always a possibility. Relapse occurs when a patient returns to active opioid use after abstaining or reducing their use as part of the treatment process. Relapsing can feel discouraging and may require the patient to go through detox again. It's also more common during OUD treatment than many people know—but relapse doesn’t mean the treatment is ineffective.
Understanding the stages of opioid relapse and why it occurs will help OUD care providers and patients alike reduce the chances of relapse. Learn the early warning signs of relapse below.
Why does relapse occur?
Internal and external factors can trigger a relapse. The reason one person relapses may be entirely different from another person's relapse.
Some possible triggers for OUD relapse include:
- Familiar situations or activities: For example, parties where the person used to use opioids and people a patient once used with may trigger relapse
- Physical health issues: Opioids have pain-relieving qualities, so persistent pain may tempt someone to use opioids again to self-medicate
- Mental health concerns: Likewise, dealing with mental illnesses—like depression and anxiety—and neurological conditions, including ADHD, may make someone more likely to relapse
- External stressors: Insecure housing, job loss, family strife, and other concerns can prompt unhealthy coping mechanisms, including returning to opioid use
- Social pressure: Being urged to use opioids by people in your life could lead to relapsing
- Withdrawal: Stopping opioid use can lead to unpleasant withdrawal symptoms, including vomiting, muscle aches, and fatigue, which OUD patients try to avoid by using opioids again
Some people are at a higher risk for opioid relapse than others. Intravenous drug users can be at greater risk due to a history of misuse, and older adults may be more susceptible to generally problematic drug use due to chronic health issues and changes to their social support network.
However, even when faced with these triggers and higher risk factors, patients may not relapse. Each person's treatment journey is different. There's no single right path.
What are the stages of opioid relapse?
Relapse doesn't happen all at once. It occurs in three distinct stages. Once you know the three broad stages of relapse, it's easier to identify warning signs and prevent a possible return to opioid use.
Emotional relapse
The first stage of opioid relapse is emotional. In this stage, you haven't started using opioids again and may not even be thinking about using them again yet. Your OUD treatment appears to be coming along well.
Under the surface, though, you're starting to experience negative emotions. You might feel depression, irritability, loneliness, anxiety, or even anger. Struggling with these feelings can make it more challenging to use your coping mechanisms and fight the urge to use opioids again. These negative emotions and the breakdown of your coping mechanisms pave the path toward the next stage of opioid relapse.
Keep an eye out for signs of emotional relapse, including:
- Isolating yourself from friends and family
- Feeling minimal motivation to take care of yourself
- Attending fewer support meetings or not going at all
- Worsening personal hygiene
- Binge eating or other unhealthy eating habits
- Falling into an irregular or insufficient sleep schedule
- Being less engaged in your OUD treatment
If you notice any of these signs, try to reach out to your OUD care team for help. Talking to a friend or family member may also alleviate some of these emotional stressors. It's common to be in denial during the emotional relapse stage, so identifying these signs and acknowledging that you're struggling is a crucial first step. From there, you can get help and implement self-care practices so that you don't move on to the second stage of opioid relapse.
Mental relapse
If you go through emotional relapse and don't get the help you need, you'll reach the next stage: mental relapse. This stage is when you start to consciously think about using opioids as a way to cope with the complex emotions from the first stage. You'll also begin to feel and acknowledge opioid cravings in this stage.
On some level, you still want to stick to your treatment plan, but another part of you is desperate to use opioids again. Your resistance wears down over time during the mental relapse stage.
These are some of the most common signs of mental relapse:
- Romanticizing your previous opioid use
- Thinking about people and places you associate with using opioids
- Bargaining with yourself to allow some opioid use
- Minimizing the harmful effects of opioid use
- Planning how to get opioids and where to use them
- Lying to your loved ones about thinking about opioids
Occasional cravings for opioids are a normal part of OUD treatment and don't indicate that you're in mental relapse. However, if you experience persistent cravings and notice other signs of mental relapse, contact your care team right away. Your clinicians will work with you and adapt your treatment to address these symptoms. If nothing changes, you may reach the third stage of relapse: physical relapse.
Physical relapse
The third and final stage of relapse, physical relapse, is when the patient starts using opioids again. This might be a single lapse, meaning a one-time use of opioids before returning to treatment, or a full relapse that involves a return to habitual opioid use.
Loved ones may notice someone they care about is in physical relapse if they exhibit these behaviors:
- Lying and acting suspiciously
- Going to places where they previously used opioids
- Hanging out with people they previously used with
- Contacting dealers to arrange purchases
- Buying drug paraphernalia like needles
- Appearing hungover or under the influence of drugs
Even if you reach the physical relapse stage, you can still get help from your care team. It's a normal part of OUD treatment that many people experience, so don't be ashamed to reach out. Being honest with yourself and your clinicians will help you get back on track after a physical relapse.
Proactively preventing opioid use
The best way to prevent opioid relapse is to know the warning signs and proactively keep an eye out for them. Enlist the help of trusted friends and family members to look out for these signs, too. At the first sign of emotional relapse, talk to your clinicians. They know how to address opioid relapse and will help you deal with your struggles in the treatment process.
It's also helpful to identify the triggers most likely to lead to relapse for you. For example, if you work with someone you used to use opioids with and have to see them every day, that could make you more likely to relapse. In that case, you should put a plan in place for navigating that trigger and dealing with the feelings it brings up before they lead to a relapse. Being proactive in identifying and managing your triggers is critical.
Personalized OUD treatment with dedicated support
A solid treatment plan and supportive care team make all the difference in your treatment journey. If treatment gets tough, you need to know that your clinicians have your back and will help you through any challenges you're facing. That's precisely what Ophelia provides.
Our customized OUD treatment plans combine medication, a dedicated care team, and telehealth support accessible from the comfort of your home. If our clinicians find that medication is the right approach for you, we’ll send a Suboxone® prescription to your local pharmacy (important safety information) and set up a virtual meeting schedule. Find out if you're a candidate to get started.
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