Heroin Relapse

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Heroin is a highly addictive and illegal opioid drug that can have both short- and long-term negative consequences on a person’s health and has the potential to cause fatal overdoses.1 Heroin addiction, known as opioid use disorder (OUD), is a chronic condition in which a person is unable to control their cravings and urges. As a result, they continue to use heroin even though it may negatively impact their life.10

Many people struggling with heroin addiction want to stop using and may even try to quit heroin on their own, or with the support of addiction treatment. Unfortunately, the uncomfortable withdrawal symptoms and strong cravings for heroin often lead people to relapse and use again.2, 9 In fact, 85% of people who stop using a substance after struggling with an addiction are known to start using again (relapse) within the first year.2

If you or a loved one are struggling with heroin addiction or have experienced a heroin relapse, this article will help you answer the following questions:

  • What is a heroin relapse?
  • What are the warning signs of a heroin relapse?
  • What type of treatment is available for heroin addiction and relapse?
  • What are the strategies for heroin relapse prevention?
  • How to get help after a heroin relapse?

What is a Heroin Relapse?

Relapse is when a person goes back to using heroin after they stopped or tried to stop using the substance.3, 11 Addiction to substances like heroin changes the way the brain works.4 This can disrupt a person’s ability to make decisions, control behavior, and manage stress, even long after substance use has stopped.1, 4 As a result, people who have previously struggled with addiction may be at greater risk of relapsing due to brain and behavioral changes.4

If a person relapses after receiving heroin treatment, it doesn’t mean treatment failed–but rather, that the treatment plan may need to be readjusted.4

People may experience cravings that can lead them to seek out heroin and use it again, increasing their risk of relapse. These cravings can occur because of:2, 3, 4, 5

  • Triggers. People, places, or things associated with heroin.
  • Stress. People may return to using heroin as an unhealthy coping mechanism when stressful events occur.
  • Physical pain or discomfort. Resulting from withdrawal symptoms or other types of pain that are eased with heroin use.
  • Self-medication. Untreated or unmanaged mental health conditions that are dangerously “self-treated” with heroin.

Stages of Heroin Relapse

A heroin relapse occurs in stages and therefore is a slow process, which can occur over weeks or months and often presents with many warning signs.6 Understanding these stages is important so that a relapse can be addressed in the earlier stages before a person has actually returned to heroin use.6

The stages are as follows:6

  • Emotional. In this stage, a person isn’t actively thinking about relapse and wants to avoid using, but may be demonstrating certain emotional cues and warning signs pointing to future relapse. Denial is a key factor in this stage, as a person may be engaging in behaviors and experiencing emotions that could put them at risk for relapse. These warning signs and behaviors include the following:
    • Expressing emotions in an unhealthy way (acting out, aggression, anger, denial, using poor coping mechanisms).
    • Socializing with peers who use heroin or other addictive substances.
    • Not attending recovery meetings.
    • Not practicing self-care.
  • Mental. In this stage, a person may feel a conflict between wanting to use and wanting to avoid using. They may start to crave an escape and lose sight of the reasons to not use heroin. Cravings often intensify and thoughts about people, places, and things involved with heroin use may recur. They may start to rationalize their drug use and may also start to:
    • Come up with bargains involving substance use (“if I use this one time then I will never use again”, etc.)
    • Tell lies.
    • Find unhealthy ways to better control substance use (using alcohol, unhealthy coping mechanisms, or self-harm to try to control the urges).
    • Seek out opportunities to use.
    • Actively plan a relapse.
  • Physical. This is the last stage of relapse, in which a person actively begins using again. If they use once, this may be called a slip or a lapse, but it can easily turn into a relapse when they start using regularly or cannot control their use. Just a single heroin use can cause a person to start thinking excessively about using. This may lead them to use heroin regularly again.

Signs of a Relapse from Heroin

While relapse is common, not everyone who is in recovery from addiction will experience a relapse. It can be difficult to predict whether someone will relapse on heroin once they stop using, but there are a few key signs of heroin addiction relapse that may indicate a person is at increased risk of returning to heroin use. Warning signs of heroin relapse can affect a person’s behavior, thoughts, or attitudes. Common heroin relapse signs include:7

  • Engaging in similar activities as a person did when using.
  • Experiencing boredom, or not having healthy hobbies.
  • Glamorizing or thinking a lot about past heroin use or heroin’s effects.
  • Having drugs or paraphernalia around and easily accessible.
  • Isolating from others.
  • Not addressing physical or mental health concerns.
  • Not practicing self-care, which may be referred to as HALT (getting hungry, angry, lonely, or tired).
  • Not taking addiction maintenance medications.
  • Pulling away from support groups, even when struggling emotionally.
  • Refusing all forms of social support.
  • Spending time with people or in places associated with past heroin use.
  • Staying in touch with people who sell drugs or use drugs.

Recovering from a Heroin Relapse

If you or a loved one has relapsed on heroin, treatment is available. Heroin treatment may need to be adjusted to include a more intensive form of treatment to address the relapse and co-occurring conditions. This could mean that if a person previously attended outpatient treatment, a higher level of care may be recommended, such as an inpatient program.5, 7

Common types of addiction treatment that are used when someone relapses on heroin include:1, 7, 8, 12

  • Detox is the first stage in addiction treatment and may include the use of medication and close monitoring to provide a safe and comfortable environment throughout heroin withdrawal. Detoxification services can be offered at both inpatient and outpatient facilities.
  • Inpatient or residential treatment involves a person staying at a facility to receive around-the-clock care at various levels of intensity. A person may attend group and/or individual counseling sessions, receive medication, and have various amenities available to them.
  • Outpatient treatment allows a person to live at home and visit the facility throughout the week to receive care. This may include individual and group counseling, medication management, drug counseling, education, and other treatment services.
  • Behavioral therapy teaches people how to effectively cope with triggers, manage cravings, reduce stress, practice healthier behaviors, increase motivation towards sobriety, improve communication skills, and in some cases, provide incentives for positive behavior, such as staying sober and attending treatment.
  • Aftercare plays an important role in helping a person maintain their sobriety and set them up for long-term recovery. Many facilities will offer help with creating an aftercare plan before a person leaves treatment.

How to Prevent Relapse

Relapse prevention is used to lower the risk and lessen the severity of a relapse if one does occur.3 Techniques used in heroin relapse prevention help a person identify triggering or risky situations that may increase their chances of relapsing. These techniques also encourage behavioral changes.3

Relapse prevention can be used to address heroin relapse symptoms in the early stages or in the later stages when a person has started using again.3 Incorporating these skills may help prolong the benefits of treatment.3

Relapse prevention techniques should be tailored to meet a person’s unique needs and may be combined to provide increased benefit.

Develop a Relapse Prevention Plan

A relapse prevention plan is an individualized, written strategy to help a person maintain sobriety and decrease the risks of relapse when an individual is experiencing cravings. It also may offer treatment solutions if an individual does relapse.7

Having a heroin relapse prevention plan is an important part of recovery and should be tailored to meet a person’s unique needs. Many treatment facilities will assist people in developing a plan before they leave the facility.7

While a relapse prevention plan is different for each person, the following are common themes that are often included:3, 7

  • Delete contact information for people associated with previous heroin use, such as dealers or people that used heroin with you.
  • Identify triggers that make a person want to use heroin, whether internal (thoughts, feelings, actions, or expectations about drug use) or external (people, places, things, or situations).
  • Identify healthy coping skills to practice when triggers arise.
  • List the names and contact information for people in a sober support network that can be contacted when struggles arise.
  • List the specific steps to take if triggers arise, such as calling a friend or a sponsor, going to a meeting, exercising, practicing mindfulness techniques, or engaging in a favorite hobby.
  • Remove any drugs and paraphernalia from around the house, workplace, car, etc.
  • Learn strategies to manage stress such as yoga, meditation, or relaxation skills.
  • Write down positive activities to participate in when boredom occurs.
  • Write down self-care practices to include in a regular routine. These are different for everyone but may include taking time for oneself on a regular basis, eating properly, adequate sleep, and regular exercise.

Get Help for Heroin Relapse

If you or a loved one is dealing with a heroin relapse, American Addiction Centers can help. Our caring admissions navigators are available 24/7 to answer questions about treatment, help you find the right treatment facility, and check your insurance for AAC facilities so you can start the road to recovery today.


Sources

  1. National Institute on Drug Abuse. (2021, June). Heroin DrugFacts.
  2. National Institute on Drug Abuse. (2019, April 8). Cues give clues in relapse prevention.
  3. Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian journal of psychiatry, 60(Suppl 4), S473-S478.
  4. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (Third edition).
  5. National Institute on Drug Abuse. (2020, July 10). Drugs, brains, and behavior: The science of addiction.
  6. Melemis, S.M. (2015). Relapse prevention and the five rules of recovery. Yale journal of biology and medicine, 88, 325-332.
  7. U.S. Department of Veterans Affairs. (2020, September 27). Reducing relapse risk.
  8. National Institute on Drug Abuse. (2019, January). Treatment approaches for drug addiction DrugFacts.
  9. National Institute on Drug Abuse. (2021, June). Heroin research report.
  10. American Psychiatric Association. (2020). What is a Substance Use Disorder?
  11. National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction; Treatment and Recovery.
  12. American Society of Addiction Medicine. (2015). What Are the ASAM Levels of Care?

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