Relapse is a cardinal feature of addiction, and one of the most painful.
Most people who struggle with addiction will have one or more relapses - the return to drug use after a drug-free period - during their ongoing attempts to recover. This can be extremely frustrating for patients and for families, as they have already experienced great pain.
Multiple - and often interactive - factors can increase the likelihood of relapse. These are some of the commonly cited precursors:
The motivation to seek a drug, once triggered, can feel overwhelming and sometimes leads to very poor decisionmaking: the user will pursue the drug, despite potentially disastrous future negative consequences (and many past negative consequences).
Brain-imaging is helping us to understand the paradox of the decision to pursue a drug reward despite such consequences. For example, very recent imaging research shows that visual drug cues as short as 33 milliseconds can activate the ancient reward ("go") circuitry, and that this process does not require conscious processing - it can begin outside awareness.
By the time the motivation does reach awareness, and is recognized and labeled, the reward circuit has a strong head start. This head start means the frontal brain regions may be less effective. This area of the brain is responsible for weighing the consequences of a decision and for helping to "stop" or inhibit the impulses toward drug reward.
Imaging research also shows that some individuals have less effective "stop" circuitry. For these people, the job of managing the powerful impulses toward drug reward may be even more difficult.
When it comes to the vulnerability to relapse, and to addiction itself, we are not all created equal. We differ both in our brain response to drug rewards and in our ability to manage the powerful impulses toward drug reward.
Relapse is a long-term vulnerability, but intensive ongoing research is targeting the problem. The tools of brain imaging and genetics promise to help us understand our vulnerabilities - and our strengths - to help us realize more effective relapse prevention. Many different clinical research trials are underway, and new antirelapse interventions (behavioral or medication-based) may be available in a location close to you.