Why Relapse Happens in Addiction Recovery

We hear it time and time again, another celebrity, politician – addict falls off the bandwagon after years of recovery. Why? Typically, addicts who return to drugs nearly always do so in response to a drug related cue, such as seeing drug paraphernalia or visiting places where they’ve used drugs before.

These triggers are a byproduct of addiction’s two-stage formation process. In the first stage, the reward functions of the brain are hyper-stimulated—taking drugs makes users feel good, which encourages a repeat performance. In the second stage, repeated over stimulation of the reward centers causes long-term changes in how other areas of the brain function, including areas involved with memory, impulsivity, and decision-making.


We clearly see this in a two-stage process.

Stage 1: Studies show that rats will quickly learn to press a lever that delivers a drug in preference to levers that deliver food or water. The more “rewarding” a drug is, the more eagerly the rats will press the bar. We shouldn’t be surprised, then, that when presented with a drug like cocaine rats display behaviors endemic in addiction, foregoing normal activities such as eating and sleeping in favor of getting high.

Stage 2: In addition to going crazy for the drug, rats “remember” and “like” the places where they received it. For instance, when cocaine-addicted rats are placed in an environment where they receive only food and water, they accept that no drug is available and they push only the food and water levers. However, when placed back in the cage where cocaine had been available, they immediately engage in a drug-bar-pressing frenzy. They recognize the location and associate it with past drug use. They are triggered by the environment and they become incredibly agitated.


Human addicts react to drugs and develop triggers in similar ways. In fact, modern brain imaging shows that drug use literally alters the connections between the ventral tegmental area (the reward center) and memory hubs in the brain (the hippocampus). Meaning, for addicts, triggers to use become hardwired as part of the brain damage of addiction. This is why addicts are highly reactive to cues associated with previous drug use, and also why treatment programs consistently recommend avoiding people, places, and things from the addict’s using past.


Being in recovery rewires the triggers in the brain the same way using creates triggers. This is one of the many reasons Sierra by the Sea wants clients to stay longer than thirty days. Repeated attendance in group therapy, 12-step meetings, consistent meals and exercise results in cue-induced learning related to recovery. Over time the addict subconsciously dissociates the cue from the past reward of using and associates it with the new reward of sobriety.

Read more about addiction.

Recovering from substance use disorders is a challenging journey that feels more doable in an environment that tends to each individual’s complex needs and strengths. Our goal is to foster a treatment experience that is built on compassion, hope, and caring, and fueled by excellence in the provision of evidence-based and trauma-informed care.

– - Anonymous