Why do people relapse?

According to the Substance Abuse and Mental Health Services Administration (SAMSHA), 48.5 million Americans struggled with a substance use disorder in 2023.

High-quality treatment is the most effective way for people to get the tools they need to succeed on their recovery journey. However, even when people can access treatment, relapses (also called “return to use”) are unfortunately common.

There’s a lot of stigma around substance use disorders to begin with, and many people view a relapse as a sign of failure. It’s not. It’s a well-documented and normal part of the recovery process, with research showing that anywhere from 40 to 60% of people with substance use disorders will experience at least one relapse.

It’s crucial to look at relapses with understanding—not judgment. The more you know about what commonly leads to relapses, the better equipped you are to support your employees on their recovery journeys. Here’s a look at seven of the most common reasons for relapses.

1. Stress and emotional triggers

For many people, substances are a coping mechanism. They use them to numb their emotions, deal with stressors, and temporarily escape feelings of anxiety, sadness, or overwhelm. So, understandably, stress is a risk factor in the development of substance use disorders in the first place, as well as in relapses.

This is complicated by the fact that recovery itself is stressful. People need to learn to cope with feelings they previously avoided, change old habits and routines, deal with the stigma related to addiction, and find new social circles and a new rhythm for their daily lives.

Without a solid support system, recovery itself (especially early recovery) can be overwhelming and trigger a relapse.

2. Environmental cues and triggers

For someone who has struggled with substance use, triggers are everywhere. Seeing drug paraphernalia, running into someone they previously used with, or even visiting a place they associate with substance use can all spark intense cravings and urges.

Research shows that “humans respond to such drug-associated cues with craving.” It’s called a conditioned response, which is a learned behavior in response to a stimulus (much like Pavlov’s principle).

Put simply, when a person is around places, people, or things they associate with substance use, they may feel triggered to use that substance again. This can make it challenging to avoid a relapse, especially during holidays, social events, or other milestones.

3. Lack of ongoing support or aftercare

Treatment isn’t the end of a substance use disorder—it’s the beginning of recovery. People face a long ongoing journey to manage their substance use disorder.

Unfortunately, the adjustment to life post-treatment can be jarring. Without the same structured schedule and access to resources, therapy, and peer support, it’s easy for people to feel socially isolated and alone. That sense of disconnection increases the risk of a relapse.

Plus, the stigma of substance use is challenging to deal with. Research shows that even physicians are hesitant to intervene with substance use, leaving people to feel even more ostracized and like they need to struggle alone.

4. Co-occurring mental health disorders

Substance use disorder is a mental health condition, so it makes sense that substance use and mental health are closely intertwined.

Many people experience a vicious cycle: untreated mental health triggers or exacerbates substance use. Substance use then worsens their mental health, which further increases their substance use.

It’s also common for a person with a substance use disorder to have a co-occurring mental health disorder like anxiety, depression, post-traumatic stress disorder (PTSD), or bipolar disorder. Recent statistics show that:

• 37% of people with alcohol use disorders have at least one serious mental health condition
• 53% of people with drug use disorders have at least one serious mental health condition
• Of all people diagnosed with a mental health condition, 29% currently misuse either alcohol or drugs

But while that experience is common, adequate treatment isn’t. Only 18% of substance use programs and 9% of mental health programs are equipped to effectively treat co-occurring disorders.

When treatment doesn’t recognize or address related mental health concerns, it doesn’t get to the root of the problem, and the risk of relapse remains high.

5. Overconfidence or complacency in recovery

Many experts believe that, while addiction can be successfully treated, it’s something that requires long-term vigilance. Instead, the person learns to manage their substance use disorder and prevent it from controlling their behavior and disrupting their lives.

In most cases, this is a lifelong process. Yet, after people have maintained their sobriety for an extended period, they can become complacent and overly confident.

By underestimating triggers or risks and putting themselves in situations where temptation is higher, they can potentially return to substance use.

6. Physical cravings and brain chemistry

Substance use disorders aren’t about a lack of willpower—it’s a physiological response. Exactly what happens in a person’s brain depends on the specific substance they use. Heroin, for example, mimics one of the body’s natural neurotransmitters, while cocaine causes a large release of natural neurotransmitters.

Regardless of the specific mechanisms at play, the vast majority of substances trigger endorphins and the reward circuit in the brain. This is what gives people a high, or a rush of pleasure, euphoria, and a temporary relief from pain or distress.

From there, dopamine (another neurotransmitter) pushes the person to seek that pleasurable feeling all over again. This is what leads to addiction, and this urge can be very strong—especially in early recovery.

Fortunately, cravings do become less intense as time goes on. However, people can still experience them for months (or even years) after quitting a substance, making relapses more likely.

7. Lack of access to quality, evidence-based care

Most Americans with substance use disorders don’t receive treatment. From cost to complexity to a significant lack of treatment beds, there are a variety of barriers that prevent someone from accessing care at all.

If and when they can pursue treatment, it’s often a low-quality treatment mill that prioritizes profits over patient care. In one 2017 study, only half (or fewer) of the facilities in online directories offered services indicative of higher quality addiction treatment.

It’s simple: When people can’t get the high-quality care they need and deserve, relapses are even more common.

Relapse isn’t a sign of failure—it’s a well-documented part of the recovery process. However, the more we understand why relapses happen, the more we can shift the focus from shame to support.

With evidence-based care, ongoing resources, and environments that prioritize compassion over judgment, a relapse can be seen for what it is: a bump in the road to recovery, rather than the end of it.

Learn more about Carrum’s Substance Use Program here.