Why Relapse Is Common
Addiction is defined as a “chronic relapsing disease,” because drug abuse alters the brain’s structure and function.1 (Click here for more on the Definition of Addiction.) These brain changes remain “months and years after the last use of drugs.”2 The long-lasting nature of the changes in addicts’ brains leaves them vulnerable to relapse long after they’ve detoxed.
Sobriety requires significant behavioral changes that are extremely difficult because they require a wholesale change in attitude — from viewing drugs as “the solution,” the way to medicate away uncomfortable feelings, to recognizing that they’re the deadliest problem. It’s very challenging to be 100% successful at changing one’s long-held beliefs and behaviors after years of habitual use. It’s all too easy to slip back into old patterns of thought and behavior.
AA ascribes relapse to “triggers” which induce cravings, resulting in recurrence of addict thinking and conduct. Anger, resentment, hopelessness or other emotional stresses, for example, can be triggers precipitating a desire for relief, which to an addict means alcohol or drugs to medicate away those intolerable sensations.
Other powerful triggers, sober addicts say, include reminders of past use. For an intravenous drug user, a trigger might be the sight of a syringe while for an alcoholic it might be a beer commercial. These drug-taking reminders can prompt intense cravings which seem instinctive and nearly impossible to resist. Many addicts, myself among them, have faced this experience and relapsed.
What addicts call “triggers” scientists refer to as “cues,” powerful emotional memories of drug-taking. Dr. Anna Rose Childress, a psychiatrist at the University of Pennsylvania, reports that drug-taking cues cause the brain to release a small spurt of dopamine: “This increase in dopamine feels similar to a small dose of the drug itself,” she says.3 “They’re having a miniature high…” Dr. Childress adds.4 Once primed by that “miniature high,” the addict brain cries out for more in an attempt to satisfy the “new normal” of dopamine overstimulation required after an addict develops drug tolerance, just like it would after having a first drink or drug.
Dr. Nora Volkow, of the Brookhaven National Laboratory, conducted experiments demonatrating that these drug-taking cues work unconsciously,5 which is why “cue”-induced relapse feels so instinctive.
Scientists suggest that relapse frequently happens because the spike in dopamine the addict brain experiences after a “cue,” unconsciously overpowers the planning and decision-making portion of the brain, the frontal cortex, where rational decision-making takes place.6 (For more on this, click on Post-Withdrawal Cravings, Amnesia and Amnesia Explained. ) Addict’s thought-processes overstress the emotional short-term need of drug-induced relief over the rational long-term benefits of sobriety and the negative consequences of drug use. Drug cues can rekindle addict thinking and behavior no matter how long one has been sober. Cues operate swiftly and subliminally, explaining why relapse happens so automatically that many who’ve been through them say they were “struck drunk.”
As Dr. Alan Leshner, then the Director of the National Institute on Drug Abuse, wrote in a 1977 issue of Science Magazine, “Viewing addiction as a chronic, relapsing disorder means that a good treatment outcome, and the most reasonable expectation, is a significant decrease in drug use and long periods of abstinence, with only occasional relapses.”7
Dr. Leshner also told Time Magazine, “The occasional relapse is normal, and just an indication that more treatment is needed.”8