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Heroin Relapse: Why Does It Happen & What Are the Signs?

8 minute read

Relapse can be a normal part of recovery. Addiction is a chronic disease with similar relapse rates as other chronic conditions like diabetes and heart disease. In general, around 40-60% of people who get sober will abuse substances again at some point in their lives. Heroin relapse rates are among the highest. One study found that 91% of people with opioid addictions relapsed after getting sober, and 54% of those who did, relapsed within one week. Another study found 72 to 88% of people relapsed between one and three years of quitting heroin.

Though these recovery statistics seem bleak, it’s important to know that addiction is a disease that’s treatable, and people do get better. With the right substance abuse treatment, a desire to change, and dedication to putting sobriety first, it’s possible to beat the heroin relapse rates.

Why Are Heroin Relapse Rates So High?

Opioids are some of the most addictive substances of abuse. You can develop a chemical dependency on opioids quickly, and once you do, cravings for them can be intense. You will also start experiencing withdrawal symptoms without opioids. Heroin relapse may stem from a combination of physical, psychological, and situational challenges. These include:

Heroin Is Highly Addictive

Heroin and other opioids are considered highly addictive. They can hijack the brain, making it believe it needs opioids for your survival. In high doses, opioids flood the brain with dopamine, which produces an intense feeling of euphoria. Heroin users often describe it as the most intense high they’ve ever felt. Heroin addiction can develop as users begin to “chase the high” of the drug, increasing doses in hopes of achieving the euphoria felt in early uses.

Heroin Withdrawal

With repeated heroin use, the brain’s receptors become depleted of dopamine and unable to produce normal amounts on its own – they’ve become dependent on opioids to do the work. Without proper amounts of neurotransmitters like dopamine, the body can go into withdrawal, producing painful or dangerous symptoms as the central nervous system tries to rebalance itself. After a while, heroin abusers need opioids just to ward off heroin withdrawal and feel “normal.” People who try detoxing from heroin on their own are at high risk of relapse because the urge to stop withdrawal symptoms can feel overbearing. Heroin detox should always take place among medical professionals who can ease withdrawal symptoms and keep you safe.

Co-Occurring Disorders Mental health disorders commonly co-occur with substance abuse and addiction. This is known as a dual diagnosis or co-occurring disorders. One study specific to heroin and co-occurring disorders found 47% of people addicted to opioids had an anxiety disorder or mood disorder. Without ongoing mental health treatment to help manage psychiatric symptoms, people in recovery may feel the urge to self-medicate these issues with drugs or alcohol.

Unaddressed Trauma

People struggling with trauma are at greater risk for substance abuse and addiction. Drugs and alcohol can become a way to numb difficult feelings or memories. One study found 92% of people in a drug rehab center for heroin had past trauma and 41% had lifetime PTSD. Another study found that the more adverse childhood events (ACEs) an individual experienced, the greater their chance of heroin relapse.

The Nature of Addiction

Addiction is a disease that can rewire the brain. Your reward center begins thinking it needs opioids to survive just as it would food, water, or companionship. Its focus above all else is getting more heroin, making it feel nearly impossible to resist cravings and urges to use.

When you have a substance use disorder, your brain develops strong associations to places, feelings, people, and situations tied to drug abuse. When you encounter these triggers, it sometimes feels like heroin is right in front of you. Addiction triggers can be extremely hard to resist in early recovery and difficult times.

Poor Support System

People to lean on in sobriety like loved ones, peers in recovery, and behavioral health professionals are critical for relapse prevention. Studies show isolation and feeling like you don’t have support in recovery puts you at greater risk for relapse.


Loneliness and boredom are proven to put people at higher risk of relapse. Sobriety often means saying goodbye to friends and acquaintances who use drugs. It also means finding ways to fill the space that drugs used to occupy with other activities. Recovery can feel lonely in the early days and drugs can feel like an old friend that helped you deal with boredom in the past.

What Makes Heroin Relapse So Dangerous?

People who quit abusing heroin and then relapse are at high risk for heroin overdose — even more so than newly addicted heroin users. When you use heroin and other opioids regularly, you quickly develop a tolerance to the drug, requiring increasing amounts of heroin to get the desired effect. People who relapse on heroin often misjudge the amount they need to achieve a heroin high. They have less tolerance to heroin after being off the drug. Smaller doses can cause a heroin overdose.

Signs of Heroin Relapse

For people concerned that their loved one may be using heroin again, the signs of heroin relapse are similar to what you may have seen when they began using initially. Your loved one may return to the same type of lifestyle as when they were in active drug addiction like seeing old friends, not taking care of themselves, and slacking off at work, school, or with family responsibilities. They may also show physical and emotional signs of heroin relapse.

Look for these signs of relapse if you’re concerned about a loved one:

  • Hanging out with former friends with whom they used drugs or alcohol
  • Changes in mood, personality, and sleeping habits
  • Neglecting family, work, and school obligations
  • Skipping therapy and 12-step meetings like Narcotics Anonymous
  • Lack of interest in former hobbies or friends
  • Alertness followed by extreme drowsiness or “nodding off”
  • Constricted (small) pupils
  • Teary eyes, sniffling, and runny nose
  • Skin abrasions from needles (track marks)
  • Changes in eating habits
  • Weight loss
  • Wearing clothes to disguise track marks and weight loss
  • Yawning and extreme lethargy/tiredness
  • Dark circles or puffiness around eyes
  • Gastrointestinal issues
  • Financial problems
  • Stealing from family and friends
  • Selling personal items or gifts
  • Secretive behavior
  • Slurred or confusing speech

Preventing Heroin Relapse

Preventing relapse from heroin involves addiction therapy, lifestyle changes, a dedication to sobriety, working a recovery program, and support from others. Some ways to prevent relapse include:

Behavioral Therapy

Counseling that draws on approaches like cognitive behavioral therapy and contingency management support healthy changes in people with co-occurring addiction and mental health issues. Cognitive behavioral therapy has been shown to be particularly effective at changing maladaptive thoughts and behaviors that fuel mental health disorders and addiction. Contingency management draws on applied behavior analysis principles to reinforce positive behaviors and discourage negative ones.

Peer Groups

Group therapy and recovery support groups can help you feel connected and accountable in sobriety. Hearing from others sharing similar struggles decreases feelings of isolation and shame. Building a sober network of peers to draw social support from is an important part of long-term recovery.

Addiction Treatment

Detoxing from heroin is not the same thing as treatment. Without an addiction treatment program that addresses the underlying reasons you use drugs or alcohol and teaches you healthy coping skills, relapse is almost certain. Inpatient substance abuse treatment followed by outpatient treatment and a strong continuing care plan can prevent relapse and support long-term recovery.

Family Therapy

Addiction impacts everyone in the family. Loved ones must learn how to support each other without enabling unhealthy behaviors. They must also learn to communicate effectively. Research confirms that people who feel supported by loved ones are less likely to relapse.

Medication-Assisted Treatment (MAT)

The FDA has approved three prescription drugs for medication-assisted treatment in opioid abuse: buprenorphine, methadone, and naltrexone. These drugs can help decrease intense cravings and painful withdrawal symptoms in people recovering from opioid use disorders. It is imperative that they are used in combination with medical care, counseling, and support groups. The goal of MAT is to stabilize people trying to recover from opioid addictions so that they can:

  • Focus on addressing the underlying issues that fuel their addiction
  • Acquire healthy coping skills
  • Repair relationships
  • Regain independence through employment, school, and other endeavors

The three MATs approved by the FDA are:

Buprenorphine (Suboxone)- Suboxone is a partial opioid agonist that combines the drugs naloxone and buprenorphine. Buprenorphine activates opioid receptors in the same way that heroin does. This helps prevent cravings and withdrawal symptoms that occur when people who are dependent on opioids go without them. The addition of naloxone helps prevent people from feeling high from buprenorphine.

Naltrexone (Vivitrol) – Naltrexone is an injectable opioid antagonist. It binds to the brain’s opioid receptors in a way that prohibits people from feeling high if they take heroin or other opioids while on naltrexone. People in opioid recovery must be extra cautious when on naltrexone because if they do take heroin or other opioids, the risk of overdose is high due to their decreased tolerance.

Methadone – Methadone is a long-acting opioid that works on the same receptors as heroin and can prevent withdrawal symptoms and cravings. A full opioid agonist, methadone must be administered in a licensed methadone clinic. The Drug Enforcement Administration (DEA) classifies methadone as a Schedule II drug, which means it has high potential for abuse. Many addiction experts are moving away from methadone treatment and opting for buprenorphine and naltrexone for treatment of opioid use disorders.

Recovery Is Possible

Recovering from heroin addiction is difficult, but not impossible. We’ve seen plenty of people take back their lives from the devastating effects of opioid abuse. You can too. If you’re struggling, reach out to us. Our approach to heroin addiction treatment is evidence-based and compassionate. With a focus on relapse prevention and healthy coping skills, we’ll help you make lifestyle and behavioral changes needed to support long-term recovery. Learn more about our addiction treatment programs today.


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