Dr. Leonard is a Doctor of Medical Science and a clinical anatomist. He achieved his bachelor’s degree in human biology from the University of Miami. He received his Master of Science in anatomy from Barry University’s School of Podiatric Medicine, he then achieved his Master of Medical Science from Nova Southeastern University, and lastly, he achieved his doctor of medical science from Lincoln Memorial University’s DeBusk College of Osteopathic Medicine. He has practiced in both internal and emergency medicine at the University of Florida medical system. He has published several, peer-reviewed scientific articles, as well as a medical book chapter.
The Cycle of Addiction & Relapse and How To Stop It
Not all individuals who use prescription medications, drink alcohol, or partake in drug use for the first time intend on becoming addicted. Addiction rarely occurs immediately after the initial use of a substance.
Instead, there are a variety of factors likely to contribute to substance addiction along with repeated use and exposure to a drug. Some of the most prominent triggers and factors present with those individuals who are struggling with an addiction include:
- Unhealthy home or work environments
- Social isolation and feelings of loneliness
- Traumatic events, such as the loss of a loved one
- Depression, anxiety, and other mental health issues
- Neglect, physical abuse, and emotional abuse in the home
Once addicted, it can become a lifetime struggle for many to regain their sobriety. Often, a cycle of addiction and relapse develops, where sufferers find themselves returning again and again to substance abuse. Sometimes new triggers present themselves, and, in other circumstances, the craving gets the better of them.
It is possible to become addicted to drugs such as heroin, methamphetamines, and other opiates after first-time use. However, substances such as alcohol, tobacco, and prescription medications often require repeated exposure and a tolerance build-up before an individual becomes heavily reliant and dependent on the substance.
Substance abuse is the next step in the development of an addiction. An addiction to substances, such as drugs, is medically known as substance use disorder (SUD). Additionally, an addiction to alcohol is known as alcohol use disorder (AUD), and certain drugs and substances may have their own specific term, eg. an addiction to opioids is known as opioid use disorder (OUD).
Substance Use Disorder (SUD): The Clinical Definition
Addiction is clinically defined in the “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition” (also known simply as DSM-5) as:
“A chronic, relapsing brain disorder, characterized by compulsive drug-seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness.”
Furthermore, according to DSM-5, addiction is the most severe form of a full spectrum of substance use disorders and is a medical illness caused by repeated misuse of a substance or substances.
What Type of Substance Use Disorders Exist?
DSM 5 recognizes SUDs resulting from the use of 10 distinct classes of drugs; these are:
- Cannabis (marijuana)
- Hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD)
- Inhalants: Volatile substances that produce chemical vapors that can be inhaled to induce a psychoactive (mind-altering) effect; one classification system lists 4 general categories of inhalants (available as household, industrial, and medical products):
- Volatile solvents
- Gases, and
- Opioids, including opioid prescription painkillers, such as OxyContin, and heroin
- Sedatives, hypnotics, or anxiolytics, including:
- Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
- Barbiturates, such as pentobarbital sodium (Nembutal)
- Hypnotics, such as zolpidem (Ambien)
- Stimulants (including amphetamine-type substances, eg. crystal meth, cocaine, and other stimulants)
- Tobacco, and
- Other known or unknown substances*
*While some groupings are of known, specifically identified psychoactive substances, the use of other or unknown substances can also form the basis of a substance-related or addictive disorder.
Why Do Substance Use Disorders Develop?
Central to the development of an addiction arising from drug use is the brain’s “reward system,” and how a substance affects and activates the system. The pleasurable, often euphoric feeling that people experience as a result of taking drugs (the “high”) may be so profound that they neglect other normal activities in favor of continued drug use. The pharmacological mechanisms for each class of drug are different, but the activation of the reward system is similar across all substances.
The DSM 5 acknowledges that people are different, and not all are automatically predisposed to addiction or equally vulnerable to developing SUDs. Furthermore, some people have far lower levels of self-control that predispose them to develop problems if they’re exposed to addictive drugs.
What is the Diagnosis Criteria for Substance Use Disorders?
There are 11 different criteria that need to be present for a SUD to be clinically diagnosed:
- Taking the substance in larger amounts or for longer than you intended to
- Wanting to cut down or stop using the substance, but you are not managing to
- Spending a lot of time either getting, using, or recovering from use of the substance
- Strong cravings and urges to use the substance
- Being unable to do what you should at work, home, or school because of your substance use
- Continuing to use, even when it causes problems in personal relationships
- Giving up important social, occupational, or recreational activities because of substance use
- Using substances again and again, even when it puts you in danger
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance
What are Substance/Medication-Induced Mental Disorders?
Substance / medication-induced mental disorders are mental disorders that have developed in people only after they started using substances – these people had no prior issues of this nature before beginning their substance use. Common substance / medication-induced mental disorders include:
- Substance-induced psychotic disorder, characterized by hallucinations and/or delusions due to the direct effects of a substance or withdrawal from a substance in the absence of delirium.
- Substance-induced bipolar and related disorders, eg. cocaine and amphetamines may mimic bipolar spectrum disorders, causing symptoms such as euphoria, increased energy, decreased appetite, grandiosity, and paranoia.
- Substance-induced depressive disorders, eg. benzodiazepines, opiates, and barbiturates can lead to depressive symptoms, as can cocaine withdrawal.
- Substance-induced anxiety disorders, characterized by feelings of nervousness, restlessness, or panic caused either by using a drug or stopping drug use.
- Substance-induced obsessive-compulsive and related disorders, characterized by obsessive-compulsive behavior – a group of seemingly uncontrollable and repetitive behaviors that are driven by obsessions.
- Substance-induced sleep disorders, eg. insomnia.
- Substance-induced sexual dysfunctions, eg. the loss of sexual interest or desire.
- Substance-induced delirium, caused by intoxication from a psychoactive substance.
- Substance-induced neurocognitive disorders (NCD), characterized by neurocognitive impairments, such as headaches, inability to concentrate or focus, short-term memory loss, and difficulty walking and balancing, that last beyond the usual duration of intoxication and acute withdrawal.
Why Do Individuals Use Addictive Substances?
Some of the reasons individuals repeatedly turn to using addictive substances include:
- Feeling of social isolation
- The inability to cope with high-stress situations
- Escaping from everyday stresses such as work and family life
While some of the reasons can be traced to mental disorders, others are motives evolved out of a desire to escape a present situation. Physically, addiction causes the same chemical dependencies in the brain regardless of why drugs or alcohol were consumed in the first place.
While treating the physical body addicted to drugs or alcohol through detoxification is the same, treating the psychological side of patients requires an individualized approach. Additionally, if a patient has a mental illness, this requires a completely different professional treatment program than those who have become addicted through recreational use. This is known as “co-occurring disorder” or “dual diagnosis” treatment.
Addiction and relapse cycles can increase the chance of patients developing clinical mental health disorders, even if they originally became addicted just through recreational use. Professional addiction treatment centers specializing in dual diagnosis provide solutions with higher success rates than those that treat only the physical dependency.
Tolerance and Dependence
As an individual’s addiction progresses, their brain and body build a tolerance to the substance. Repeated ingestion and exposure to drugs or alcohol reduces the overall effect a substance has on the body. In turn, individuals may need to consume the substance in higher quantities each time it is used.
As tolerance and dependence continues, individuals feel more reliant on obtaining the feeling of euphoria, calmness, or the high they achieved when they first began using the substance. Oftentimes, tolerance becomes an issue with individuals who are struggling with severe addictions to substances, prompting them to turn to even more dangerous and high-risk drugs.
Even after detoxification treatments have concluded, addiction and relapse can have sufferers seeking dosage levels similar to those of their last use. This presents a dangerous situation where a clean body may overdose on the higher dosage amount since the tolerance has subsided after treatment.
Addiction and Relapse
Once an individual is unable to cope without the use of the drug or substance of their choice, it is likely a full-fledged addiction to that drug or substance is occurring. Addictions are not always visible at first sight. Some individuals maintain their job and home life without showing blatant signs of addiction (known as a “high-functioning addict”), or those that are presented are subtle.
Psychological / Behavioral Signs of Substance Addiction
Understanding the signs to look for in an individual struggling with an addiction could very well help save their life. Although drug addicts can be fully functional, you or a loved one may have a substance addiction if one or more of the following psychological/behavioral signs exist:
- Change in personality
- Increased anxiety and irritability
- Inability to focus and concentrate
- Withdrawal from family members and friends
- Feeling depressed, possibly with suicidal ideation (thoughts of suicide)
- Preoccupation with obtaining the drug or substance
- Loss of interest in socializing, hobbies, and outings that were once a source of enjoyment
Individually, someone not abusing drugs or alcohol could present one of these symptoms. After all, each of us can have a “bad day.” However, the presence of an addiction is clearer when one or more of these traits present themselves consistently over time.
Most individuals may be anxious or irritable for a short length of time, perhaps resulting from an upcoming event or situation. When there is constant anxiousness or irritability from seemingly all situations, it may be a clue an addiction is behind the change in persona.
Physical Signs of Substance Addiction
Changes in appearance can be additional clues to possible drug use, and can include:
- Bloodshot or glazed eyes
- Dilated or constricted pupils
- Abrupt weight changes, either loss or gain
- Changes in hygiene
- Dental issues
- Skin changes
- Problems sleeping, eg. insomnia, or problems with sleeping too much
It is worth noting that signs and symptoms of substance addiction can vary based on the actual substance used, and the method of use, eg. smoking, injection, ingestion, etc.
Addiction & Its Effects on The Brain
Addiction to a substance can lead directly to structural changes within the brain that make controlling that addiction even more difficult. The brain is there to regulate your body’s basic functions, enable you to interpret and respond,, and create and form your behavior. In a nutshell, your brain is the best reflection of “you.” It is everything you think and feel, and who you are.
The brain functions as it does because it consists of billions of cells, called “neurons,” which are organized into circuits and networks. Each neuron acts as a switch, controlling information. Different brain circuits are responsible for coordinating and performing specific functions.
How Do Drugs Affect The Brain?
Drugs interfere with the way neurons send, receive, and process signals via “neurotransmitters.” Some drugs, like cannabis and heroin, will attach to and activate the neurons. Although these drugs mimic the brain’s own chemicals, they lead to abnormal messages being sent through the network. Drugs like opioids disrupt other parts of the brain, such as the brain stem, which controls basic functions that are critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses occur.
Additionally, drugs also “hijack” the brain’s reward system, fooling the brain into releasing a burst of dopamine (the brain’s happy chemical), in quantities much larger than normal – hence, the euphoric “high.” Dopamine also powerfully reinforces the connection between consumption of the drug, the resulting euphoria, and all the other factors linked to the experience. Regular drug use, and the large surges of dopamine that go with it, actually “teaches” the brain to seek drugs at the expense of other, healthier activities.
Relapse is a possible outcome of any chronic condition. It is when the addiction cycle repeats itself. For those who are battling substance addiction, a relapse can occur at any time. However, relapse happens most often when either withdrawal symptoms become too severe to overcome, or a triggering event occurs.
Relapse rates average about 50%, according to the National Institute on Drug Abuse. If an individual experiences a relapse while trying to get clean, it means an adjustment to their treatment regimen is necessary. If sufferers are trying to quit using drugs or alcohol on their own, a relapse may be an indication all contributing factors to one’s substance abuse have not been addressed, and it is highly likely either inpatient or intensive outpatient treatment is now necessary.
Rehabilitation centers and treatment facilities provide a zero-tolerance environment to help individuals regain control over their lives. A focus is brought upon by rebuilding relationships and personal goals. By treating the physical, mental, and psychological aspects of addiction, the odds of stopping the cycle before a relapse can occur increases.
The Most Common Relapse Triggers
Stress, understandably, is the top cause of relapse. Many people who struggle with addiction turn to their substance of choice as a coping mechanism to deal with stress. Additionally, research has demonstrated that there is an increased craving for the drug in question, including alcohol, during stressful situations.
One way to prepare for this trigger is to evaluate the stress you’re experiencing. Although you can’t eliminate everything stressful from your life, you can avoid certain situations that cause you extreme levels of stress. Furthermore, it’s vital to learn positive ways, eg. relaxation techniques, to successfully manage stress.
- People / Places Connected to Your Addiction
The people who participated in your addiction, even family members, especially if they were a cause of your reliance on drugs or alcohol, are potential triggers for relapse. Additionally, certain places that remind you of your addiction can be triggers, too.
- Difficult & Negative Emotions
People who struggle with addiction need better and more healthy coping mechanisms for everyday life, eg. tolerating, managing, and making sense of any negative feelings. Your aim should be to be pòsitive about the negative, and comfortable with the uncomfortable.
- Seeing / Sensing Your Substance of Choice
Sensory reminders of addiction can easily trigger relapse during recovery, such as seeing, smelling, or touching drugs or alcohol. You must learn about how to effectively deal with these reminders, as they will often arise when you least expect them.
It’s a reflection of how powerful addiction is to conquer that positive and happy situations, such as birthdays and holidays, can be powerful relapse triggers, too.
Breaking The Cycle
The cost of addiction throughout the U.S. alone is more than a staggering $740 billion annually. Overcoming an addiction is not a simple process, but it is possible with the right addiction treatment program.
Rehabilitation centers today are treating both the mind and body, but they cannot help if they do not know who needs assistance. If you or someone you know needs help for alcohol or substance abuse, call one of our treatment professionals today. Help is just a phone call away.
Frequently Asked Questions
1. What is Addiction?
When a person is suffering from an addiction, they are actually suffering from “a chronic, relapsing brain disorder that is characterized by compulsive drug-seeking behaviors,” according to its medical and clinical definition. They will continue to use their drug of choice regardless of the consequences. Addicts typically experience changes in their brain that can be long-lasting, and even permanent in some cases.
An addiction is considered to be both a complex brain disorder as well as a mental illness. Many experts subscribe to the theory that an addiction is a disease, and, like any other disease, it requires ongoing treatment.
2. Why Do People Relapse?
Because addiction is defined as a relapsing condition, it is to be expected that addicts in recovery will experience relapses. Some may spend their whole lives trying to get clean and sober, only to relapse over and over again. Others may relapse a few times before they are finally able to stop using and remain in active recovery.
People can experience a relapse for a variety of different reasons, such as:
- They never dealt with their triggers. A trigger is anything that can make people feel as though they want to use. It can be a relationship, a location, a situation, or even a feeling that makes them relapse. It is important for triggers to be dealt with during addiction recovery, and if they are not, the chances of relapsing only increase.
- They did not get treatment for a co-occurring disorder (also known as dual diagnosis). This term refers to the presence of a mental health issue alongside any type of addiction. About 50% of people with substance abuse problems also have co-occurring disorders. They should be treated simultaneously during rehab, and when this is done correctly, the chances of relapsing are much lower.
- They did not get further treatment after finishing their rehab stay. Alcohol or drug addiction does not simply go away after a person finishes rehab. It is important for people to continue to get the help they need through outpatient programs, 12-Step meetings, and other types of support groups.
- They lack the necessary coping skills to deal with their problems. A lot of people will start using again as a way to deal with stress (one of the most common relapse triggers). They may have every intention of stopping once their situation is under control, but that can be extremely difficult.
- They may be at the mercy of their genetics, which can lead to more relapses, according to Michigan Health, a part of the University of Michigan. For example, a person who has seen substance abuse as a coping strategy / model during their entire life, because a loved one was an addict, may see using as the only way to cope.
3. If Someone Relapses, Does That Mean Their Treatment Didn’t Work?
No, a relapse does not mean that treatment did not work. Remember, addiction is a chronic, relapsing brain disease, which means that it is highly possible, even probable, for people to go back to using before they are finally free.
Even so, it might mean that the individual did not get the right kind of treatment to help them remain in recovery. Not everyone responds well to the same types of treatment. Every effort should be made to help people get the type of help that will work best for them.
If the rehab program is professional and solid, the addict should simply do everything they can to get back into a recovery mindset. That might mean adding a support group or making some changes in their life that will make it less likely that they will go back to using in the future.
4. Is It Possible to Stop the Cycle of Addiction?
Yes, it is possible to stop the cycle of addiction, although it will not be easy. The best approach is to choose a treatment program that addresses both the physical and psychological sides of the substance abuse problem. Most people will find that they need to go through both detox and rehab in order to be successful in recovery.
Ongoing treatment is essential in order for people to remain in recovery. Those who continue to get the support they need are usually the people who manage to avoid relapsing.
5. Is There a Way to Cure Addiction?
Addiction is a “chronic, relapsing brain disorder,” meaning there is no known cure for addiction, unfortunately. Because it is a chronic disease, it requires ongoing treatment in order to help people remain in recovery. In this way, it is very similar to other types of diseases, such as asthma, diabetes and heart disease.
- NCBI: https://www.ncbi.nlm.nih.gov/books/NBK424849/figure/ch2.f3/
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-methamphetamine
- Google Books DSM-5: https://books.google.com.co/books/about/Diagnostic_and_Statistical_Manual_of_Men.html?id=-JivBAAAQBAJ&printsec=frontcover&source=kp_read_button&redir_esc=y#v=onepage&q&f=false
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/marijuana
- WebMD: https://www.webmd.com/drugs/2/drug-9824/xanax-oral/details
- National Institute on Drug Abuse: https://www.drugabuse.gov/drug-topics/trends-statistics
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
- Michigan Health: https://healthblog.uofmhealth.org/wellness-prevention/why-its-so-difficult-to-recover-from-substance-use-disorders
- Harvard Health Publishing: https://www.health.harvard.edu/blog/is-addiction-a-brain-disease-201603119260
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery