Why do people relapse? Here's what we know

Why can some people use recreational drugs controllably whereas others get compulsively drawn to it? Why do some individuals get strongly addicted after using drugs like marijuana, exhibiting the drug-seeking habits typical of substance abuse disorder? And what causes relapse in most people in addiction recovery even after weeks-months of abstinence?

It’s been over six decades, yet these questions remain unanswered. If scientists could discover why people relapse, they might be able to manufacture drugs that target that cause. And perhaps, that could be the end of relapse, and curing addiction would become much easier.

Fortunately, it seems that we may be nearer to the answer now than ever before.

Why people relapse to drugs and alcohol while on recovery

Understandably, we've always believed that people fall into relapse and take drugs again simply because the brain can no longer do without them.

But a new study shows that it's more about drug-seeking than drug-taking. The study suggests that people relapse because it serves as a way to release the internal distress built up over the period of abstinence. They derive satisfaction from the violent behavior they exhibit while seeking out the substance, rather than from the substance itself.  

The "drug-seeking" becomes even more seemingly pleasurable than drug-taking.

The researchers conducted the study on rats. They stimulated and maintained drug foraging in the rodents just as it is with people living with drug abuse disorder. And in these rats, just like in people, the foraging behavior becomes satisfying in its own rights.

"When they are prevented from enacting their drug-seeking behavior, in conditions for instance like incarceration in humans, individuals experience the building of internal distress that results in explosive behavior at relapse, which is mediated by so-called 'negative urgency,'" says Dr. Belin.

Apparently, those compulsive behaviors during relapse are the relief individuals seek, not even the drug itself. The drug-taking becomes just the icing on the cake.

Relapse is also associated with hypocretin

Hypocretin, also known as orexin, is a chemical substance involved in regulating sleep and wakefulness. People who have narcolepsy -- a condition in which the individual gets suddenly drowsy by day -- is caused by a loss of the neurons that produce hypocretin.

Narcolepsy patients typically use addictive drugs to combat that sleepiness. And quite interestingly, these patients do not get addicted or experience withdrawal symptoms when they stay off the drugs. Why?

Because of the absence of hypocretin!

People who suffer addiction, withdrawal, and drug cravings leading to relapse have been found to possess about 54% more hypocretin than those who do not experience addiction or withdrawal. The same was true in mice.

When the researchers stopped giving mice opioids, the high levels of hypocretin remained, lasting up to four weeks. Obviously, the presence of hypocretin likely influences drug cravings during abstinence, leading to relapse.

The Bottom Line

Scientists have mostly focused on the negative emotions as trigger for relapse. For example, someone in addiction recovery who suddenly falls into depression or anxiety may crave alcohol or drugs to improve thier mood. But this new research suggests there could be more to it.

Negative emotional urgency and the inability to act on those habits may push someone on addiction recovery to forage for the substance. The presence of hypocretin could also be a posible risk factor and cause of relapse.

Author

Satu H. Woodland, PMHCNS-BC, APRN Satu Woodland is owner and clinician of Hope Mental Health, an integrative mental health practice located at Bown Crossing in Boise, Idaho. She sees children, adolescents, and adults.  Ms. Woodland with her background in nursing, prefers a holistic and integrative approach to mental health care that addresses the mind and body together. While Ms. Woodland provides medication management services in all her patients, she believes in long-lasting solutions that include a number of psychotherapies, namely cognitive behavioral therapy, exposure and response prevention therapy, attention to lifestyle, evidenced based alternative psychiatric care and spirituality. If you’d like to gain control over your mental health issues, call Hope Mental Health at 208-918-0958, or use the online scheduling tool to set up an initial consultation.