Redefining “Relapse”: 4 Strategies for Rebounding from Opioid Setbacks

On his road to recovery from opioid addiction, Joe, 34, an Ideal Option patient in Maryland, took many detours.

He’d tell himself, I don’t want to live like this anymore and I’m wasting my life, and he’d work hard at sobriety. But then, just like that, he’d return to using. Once, on the very day he left inpatient rehab, he spent a tax-refund check on heroin and crack, reasoning, “I never had my last hurrah.”

Another time, after six solid months at a sober-living house, he discovered his girlfriend was still using, and said, “Screw it. I’ll get some too.”

Virtually everyone in recovery from opioid use disorder (OUD) has relapse stories.

That’s because OUD is a disease of brain chemistry: Over time, opioid addiction rewires the brain in a way that will override good intentions, determination, and gains made in recovery. Even years into recovery, the sight of a needle or an encounter with an old friend can trigger cravings and restart the addiction cycle.

“Most of our patients have been down this road multiple times — dozens and dozens of times,” says Penny Bell, Director of Ideal Balance, which offers behavioral health services to Ideal Option patients. 

But what most patients have not received in the face of relapse is compassion.“People with opioid addiction don’t get cut any slack,” says Kirk Brownell, M.D., Ideal Option’s medical director. “If they have a use episode, people think: There’s no hope now. He’s back to his old ways. That’s it.’”

Of course, relapse is hardly the end of the story.

When patients are treated with understanding and, like Joe, prescribed medication such as Suboxone, they have strong odds of achieving sustained recovery.

“It’s no different than going to the doctor over and over for strep throat,” says Penny. “Patients who have relapsed should not be treated like they’re ethically challenged. They should be treated with respect and fairness.”

What’s needed, Dr. Brownell maintains, is for the recovery community to rethink relapse entirely — to view it not as a moral failure or catastrophe but as a learning experience and stepping stone toward sustained sobriety.

For starters, Dr. Brownell suggests, let’s ditch the term “relapse” itself and replace it with “return to use” or “use episode,” terms less weighted with emotional and cultural baggage.

The word “relapse,” he observes, often serves to discourage patients. They may internalize the disappointment expressed by family members or medical providers and think, I’m just an addict. I’m just a bad guy. I’m never going to get better.

“No one is harder on patients than the patients themselves,” says Dr. Brownell. “They’re always very disappointed in themselves, often desperately so. My job is to help them understand their disease and to stay engaged in treatment.”

Toward that end, Dr. Brownell and other Ideal Option providers emphasize four recovery strategies that make OUD patients less vulnerable to recurrence — and better equipped to bounce back if a use episode does occur.

Strategy #1: Take Medication — Correctly and Indefinitely

Opioid use reconfigures brain circuits so profoundly that without medication, more than 90% of people with OUD will return to use. But that grim statistic tells only part of the story. What’s overlooked: medication such as Suboxone (a combination of buprenorphine and naloxone) cuts that rate in half by suppressing the unbearable withdrawal symptoms — nausea, vomiting, diarrhea, anxiety — and the intense cravings that drive addiction.

In addition, buprenorphine binds to the brain’s opioid receptors, so if patients do have a use episode, they won’t get high. “If you have buprenorphine in your system and you take three or four Percocet, you don’t get the reward,” Dr. Brownell explains. “So, you realize you’re wasting your money.”

But Suboxone, a film placed under the tongue, can only work if patients take the medication every day, in a sufficient dose, and in the prescribed method. Some patients will give half their medication to a friend or relative in withdrawal, leaving themselves highly vulnerable to using again. Others will swallow the medication rather than allow it to be absorbed slowly.

Providers caution that Suboxone must not only be taken properly but also, for most patients, indefinitely, just as patients with diabetes must take insulin for a lifetime. Over time, Suboxone helps the brain heal from active addiction, a gradual process that can take years.

“Suboxone brings patients back to a state before they were addicted, and no other type of treatment — no amount of counseling or therapy — can do that,” says Penny.

Strategy #2: Steer Clear of Your Old Contacts

Though patients describe Suboxone as “a buffer” and “armor” against a return to use, the medication is no guarantee of lasting sobriety.

Shante, an Ideal Option patient, experienced a long period of sobriety and then a brief return to use. On a trip home to New Orleans, she instinctively sought out old friends. Before she knew it, she was shooting heroin.  

“As soon as it happened, I knew that’s not what I wanted,” recalls Shante. “Yeah, the first high was a great one, but by the third day, my energy was down, I was sweating. I was uncomfortable. I knew I was in the cycle and had to literally leave town.”

She called her sponsor, got on a plane, and shortly after that, enrolled in Ideal Option. Shante also managed to avoid getting down on herself. She had achieved so much during her recovery period — returning to school, paying her bills, parenting her daughter — that she was able to view the episode as a hiccup rather than a disaster.

Brownell advises patients in the early stages of recovery to avoid, as much as possible, their usual surroundings. “Go live with your aunt 50 miles away for a few weeks,” he says. “If you can just get a few weeks of sobriety in, you’ll build up some capital with yourself, and you’ll see you can really do it.”

Strategy #3: Stay Busy

As anyone with OUD knows, opioid addiction consumes your time, your thoughts, your money — your entire existence. So, recovery, for all its benefits, can leave you feeling lost.

“Suddenly, 16 hours just appeared in your day,” Dr. Brownell says. “You can’t fill it up sitting around watching TV.”

Boredom, he notes, is a recipe for a recurrence. Though OUD is primarily a disease of brain chemistry, addiction is also driven by habit, and unplanned time allows old habits to creep in. Joe knows this and makes a point of staying busy. He works as a restaurant server, goes to concerts, plays golf, and scours thrift shops for vintage décor and clothing. If he feels down, he won’t left himself mope around at home. “

“I’ll call a buddy up and go visit — something to get up off the couch and out of the house.”

Strategy #4: Stay Connected

Folks in recovery not only make a point of staying busy but also stay connected with supporters, through 12-step meetings, individual counseling, spiritual groups, or social organizations.

“The more connections you have, the better equipped you are to rebound from a relapse,” says Penny. “We don’t want medication to be our patients’ only tool. You also need community resources.”

Penny helps patients clean up their credit, pay overdue bills, get their driver’s license back, find employment, pursue education — essentially rebuild their lives piece by piece. “The more you have to lose,” she says, “the less likely you are to relapse again.”

But even if you do have a use episode, she emphasizes, it’s not the end of the world. “It’s not like all your clean days are gone. You still have tools from your previous recovery. Maybe you’ve found a support group or held a job or gotten housing or taken care of your medical needs.”

Penny notes that when patients stay on Suboxone, use episodes are shorter and recovery stretches are longer — until eventually, like Joe, patients stop using altogether.

“Life isn’t great all the time,” Joe says, “but I want to be around awhile. I know if I go back to using, it would kill me. I have that pretty embedded in my brain now.”

About Ideal Option

Ideal Option is one of the nation’s largest providers of evidence-based medication-assisted treatment for individuals with substance use disorder. Founded in 2012 by two emergency medicine physicians, Ideal Option’s mission is to provide underserved populations with low-barrier access to proven treatment – saving lives, healing families, and helping communities.
Ideal Option has seven locations in Maryland, including two in Baltimore. To learn how Ideal Option can help you or your loved one or to make an appointment, call 1-877-522-1275 or visit www.idealoption.com/.

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