Why is Relapse So Common in Heroin Addicts and How Can You Find Treatment that Works?

Addiction is a chronic and relapsing disease, so relapse is a normal part of recovery for many people. In fact, approximately 40-60% of people who seek substance abuse treatment will relapse at some point in their recovery.[1]

Relapse can happen with any kind of addiction, but relapse tends to be extremely common in people recovering from heroin addiction. Heroin is one of the most addictive and powerful opioids that can be extremely challenging to stop using, but with the right treatment, anyone can recover from heroin addiction. If you or someone you love is struggling with heroin addiction, it is vital that you receive effective treatment that will carve the way for long-term sobriety.

How Common is Heroin Relapse?

Even after finishing rehab and being sober for several weeks or months, many former heroin users struggle with cravings or desires to use heroin. If people don’t have healthy ways to cope with these cravings, they can relapse.

Studies have found alarming rates of relapse among people struggling with opioid addiction, including heroin. In fact, one study found that up to 91% of opiate addicts relapse, and 59% relapse within the first week after completing treatment, suggesting relapse is more common in people who abuse opioids than it is in people who abuse alcohol or other types of drugs.[2] Another study found that between 72-88% of former heroin users relapse within 1-3 years after quitting the drug.[3]

Why Do So Many Heroin Addicts Relapse?

People may relapse for a variety of reasons, and relapse is often unique to the individual. However, there are many common causes of relapse that may explain why heroin relapse rates are so high. These include:

• Heroin’s extremely addictive nature – Heroin is so addictive that many people get hooked after trying it just once or twice. The drug floods the brain with dopamine, a neurotransmitter that produces intense feelings of euphoria and pain relief. Users may chase this high in hopes of achieving the euphoric effects.
• Painful heroin withdrawal – After regular use, heroin is physically habit-forming. People who stop using heroin suddenly will experience painful, flu-like withdrawal symptoms. These withdrawal symptoms can be so uncomfortable that people would rather continue using heroin than proceed with withdrawal because they know that taking more heroin will make them feel better. Unfortunately, some heroin users develop post-acute withdrawal syndrome (PAWS) where mood-related symptoms can persist for several weeks or months. Without proper treatment, acute and post-acute withdrawal can result in relapse.
• The cunning nature of addiction – Addiction is not a choice–it is a disease that rewires the brain, changing the way people think, feel, and behave. After regular heroin use, the brain develops a positive association with heroin, and heroin users feel tempted to turn to the drug in a variety of situations. Even in recovery, triggers can appear that evoke the desire to get high.
• Unresolved trauma or mental health issues – Most people start abusing heroin and other drugs to cope with trauma or mental health problems like anxiety or depression. If these conditions are left untreated, people are likely to return to heroin use again in the future as a means of coping.
• Failure to follow through with aftercare – The goal of rehab is to separate people from drug use, treat underlying conditions, and provide the tools and resources necessary to stay sober. However, it is up to each individual to follow through with their aftercare by attending meetings, taking medications, and practicing self-care. Individuals who do not follow through with aftercare may be more likely to relapse on heroin.

Understanding the Danger of Heroin Relapse

Relapsing on heroin is extremely dangerous and can be life-threatening. After a period of abstinence, a person’s tolerance to the drug decreases, but they may return to using the same dose they took before, putting them at high risk for a fatal overdose.

The risk is even greater today due to the widespread presence of fentanyl in the illicit drug supply. Fentanyl, a synthetic opioid 50 to 100 times stronger than heroin, is often mixed into street heroin without the user’s knowledge. Even a tiny amount, about the size of a grain of rice, can be fatal—particularly for individuals who no longer have an opioid tolerance. According to law enforcement data from 2017, over 52% of seized heroin contained fentanyl, and this percentage is likely much higher now. This combination of reduced tolerance and unpredictable potency makes heroin relapse one of the most dangerous scenarios in opioid addiction.

Warning Signs of a Possible Heroin Relapse

Usually, there are ways to spot the warning signs that indicate a relapse is in the near future. Common warning signs of heroin relapse include:

• Preoccupation with thoughts of using heroin – A person who is about to relapse may become fixated on thoughts of using heroin. They may talk about it frequently, make jokes about it, or seek out people or places associated with drug use.
• Changes in mood or behavior – People who are about to relapse may exhibit changes in mood or behavior. They may become irritable, anxious, or withdrawn.
• Spending time with old drug-using friends – Returning to old friends or places associated with heroin use is a common warning sign of relapse. If a person is spending time with old drug-using friends, it may indicate that they are at risk of relapse.
• Engaging in high-risk behaviors – People who are about to relapse on heroin may engage in risky behaviors, such as driving under the influence or having unprotected sex.
• Social isolation – People may withdraw from supportive relationships, such as family members or addiction support groups.
• Neglecting responsibilities – A person who is about to relapse may neglect responsibilities such as work or school or may stop caring for their personal hygiene.

Seeking treatment before a relapse occurs can prevent life-threatening overdoses and other serious consequences.

How to Prevent Heroin Relapse

Preventing a relapse on heroin is a matter of life and death, so it’s important to be armed with a comprehensive relapse prevention plan. Relapse prevention plans typically involve:

• Addressing the root cause of heroin use in behavioral therapy and counseling
• Regularly attending peer support groups
• Taking any medications that are prescribed as directed by the prescribing physician (such as Suboxone or Vivitrol)
• Staying in a sober living home after rehab
• Working with a sponsor or recovery coach
• Practicing self-care
• Learning how to identify and cope with triggers in a healthy way