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The risk of relapse is well-known across all forms of substance use disorder (SUD). Relapse is complicated, and important differences are recognized between relapses that occur early in recovery and those that take place later on.[2]
Understanding relapse is key to understanding how best to help people with SUD. Researchers at the Fralin Biomedical Research Institute at VTC looked into some of the factors that might influence the likelihood of relapse. Here’s what you need to know about the study.
Why quitting substance use is hard
SUD is a complex illness, with biochemical, neurological, genetic, psychological, social, and economic factors each playing their own role.[3]
Substances can affect the reward systems in the brain, causing physical dependency. Some people will turn to substances as a way of coping with past trauma. Some people are genetically predisposed to addiction, and many people within this group grow up in homes where a family member also had SUD. These factors interact to sustain substance abuse, perpetuate an ongoing cycle, and make recovery difficult.[4]
Shame and stigma can also create a vicious cycle with relapse, where individuals not only feel ashamed of relapsing, but also the shame makes relapse more likely.[5]
Understanding the study
This study recognized that there is relatively little data on how many times people with SUD typically relapse before achieving abstinence. It explored some of the factors that might influence how many unsuccessful attempts someone makes to quit before they are successful. [1]
How the study was performed
This study looked at 421 people with SUD who had successfully quit at least one substance from a list of 12 different substances:
- Nicotine
- Alcohol
- Cannabis
- Cocaine
- Opioids
- Prescription pain medications
- Hallucinogens
- Anesthetics
- Tranquilizers
- Inhalants
Each person filled in a questionnaire about their substance use. They were asked the same questions about each of the substances they reported using.
Some of these questions were used to evaluate the severity of their SUD, rating it as mild, moderate, or severe. They were also asked which substance was their “drug of choice” and which substances they had attempted to quit in the past.
They were then asked questions about their experience with that substance:
- Age at first use
- Age they began using regularly
- Number of previous quit attempts
- Age at first quit attempt
- Whether they still use the substance
- Age at which they stopped using it
What the study suggests about quitting substance use
The majority of people in this study (86%) experienced SUD with more than one substance.
All substances showed skewed data, where a small number of people made a much higher number of quit attempts than others. This may suggest that there are some people for whom quitting is substantially more difficult than it is for others.
Pain medication and opioids took the most quit attempts, followed by stimulants and alcohol. Hallucinogens required the fewest attempts to quit in order to be successful. The substances that required the most quit attempts also tended to be the ones with higher levels of physical dependency and more withdrawal symptoms.
Unsurprisingly, more severe SUD was associated with more quit attempts. The number of quit attempts also increased as people had been using the substance for longer.
How this information may improve substance use disorder treatment
The results of this study suggest a number of adjustments that might improve the treatment of SUD.
Firstly, the high rates of relapse emphasize that SUD is chronic and requires ongoing care and monitoring. Short-term treatment might not be sufficient in many cases. The study highlights some groups who may benefit most from long-term support, including those using opioids or pain medications, those with a long history of SUD, and those whose SUD is classed as severe.
These results also advocate for early intervention. Length of use and severity were both directly associated with the number of attempts required to quit. Offering early-stage interventions, especially in cases of mild symptoms, may improve the chances of success.
This study might also offer comfort and hope to people with SUD and their friends and family. The findings were unambiguous that relapse is the norm, rather than an exception. Instead of viewing relapse as a failure, it might be possible to recognize that each quit attempt is a step towards success. This mindset could reduce the shame associated with relapse and help maintain support networks, which provide another vital pillar of recovery.
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