How to Prevent a Substance Use Disorder Relapse

Substance use disorder (SUD) is frequently described as a brain disease with many patients returning to substance misuse at high rates after treatment. “Substance use disorders are chronic, relapsing conditions,” writes Lloyd Sederer in The Addiction Solution. “We have to expect relapse.”

Although we have to expect it, we should not accept it as unavoidable, of course, because any relapse can be life-threatening. That is why so many addiction professionals put so much effort into enabling clients to recognize the warning signs early on before the relapse becomes dangerous.

According to addiction expert, Terence T. Gorski “relapse is the process of becoming dysfunctional in recovery.” This is a very important point, said Barbara Mardigian, the deputy clinical director of the Virginia Judges and Lawyers Assistance Program in her recent presentation as part of the Williamsburg Place Lecture Series. “It’s a process and using is only the last step.” 

Gorski was one of the first addiction professionals who explored how to interrupt this relapse process. In order to better understand it, he divided the relapse process into 11 distinct steps, ranging from “unhealthy emotions” in step one to the actual relapse, i.e. using (10) and its aftermath (11). “This level of detail is helpful to clinicians but can sometimes be overwhelming to clients,” says addiction expert Steven Melemis who finds it more helpful to think in terms of three phases of relapse: emotional, mental, and physical. 

“During emotional relapse, individuals are not thinking about using,” writes Melemis. “They remember their last relapse and they don't want to repeat it.” At this stage, they may display “early-warning” symptoms such as bottling up emotions, isolating, not going to meetings, or poor eating and sleeping habits. 

“In mental relapse, there is a war going on inside people’s minds. Part of them wants to use, but part of them doesn’t. […] Finally, physical relapse is when an individual starts using again. Some researchers divide physical relapse into a “lapse” (the initial drink or drug use) and a “relapse” (a return to uncontrolled using).” 

Both Gorksi and Melemis focus on psychological and behavioral symptoms. Researchers at the University of Washington’s School of Medicine are looking at a different approach. A study published in Neuropsychopharmacology reported that relapse can be prevented by controlling cells in a brain region called the nucleus accumbens. The study was conducted among 90 rats with genetic diversity.

“We used a tool called chemo-genetic receptors to act as a light switch on the cells,” said senior author Susan Ferguson, director of the Alcohol and Drug Abuse Institute at the University of Washington and associate professor of psychiatry and behavioral sciences at UW’s School of Medicine. “When we changed activity of neurons in the nucleus accumbens, we were able to control relapse behavior.”

The tool only worked on rats considered to be at “high risk” for addiction-like behavior but Dr. Ferguson hopes this process could eventually “be used to prevent relapse for any addiction – including compulsive gambling and overeating – because they affect the same brain regions as drug addiction.” The research confirms the influence of chemo-genetic receptors, Ferguson said, and shows how technology can target specific cell populations in the brain rather than the entire brain.