The path to sobriety often winds through some wrenching battles with relapse. Slipping back into addiction is so common that at least 40-60 percent of people abuse drugs or alcohol in their first year after rehab.
But there’s encouraging news for anyone in recovery.
Neuroscience has advanced our understanding of addiction as a chronic but treatable brain disease. The research is driving more effective, evidence-based approaches to prevent drug relapse. And several vaccines are on the horizon that could reduce or eliminate dependence on cocaine, methamphetamine and other drugs.
Beating the Odds
“When we talk about addiction, we are dealing with a disease. It’s not just someone who is weak-willed or choosing to go down this particular path,” says Dr. Jack Stein, Director of the Office of Science Policy and Communications for the National Institute on Drug Abuse (NIDA). “The good news is that the longer someone is able to maintain their abstinence, the less likely they are going to relapse.”
The odds of long-term recovery increase significantly after that difficult first year of sobriety, Stein says. At three years of continued abstinence, a recovering addict has a 66 percent chance of sustaining long-term sobriety; if they avoid using substances for five years, the odds of recovery jump to 86 percent, he says.
Comparing Relapse Rates
Relapse rates for drug addiction are similar to other chronic diseases, according to NIDA studies. For example, the percentage of Type I diabetics who relapse — sabotaging their treatment by not taking insulin, for example — is 30 to 50 percent. Relapse rates for hypertension or asthma patients are as high as 50 to 70 percent.
“Compliance with treatment is not easy for any of us, and that goes the same for a substance abuse addiction,” Stein says. “Too often we hear about people coming out of rehab and then they relapse a few months later. Unfortunately, they don’t realize the chronicity of the problem. You can’t get a short-term fix on something that has such a significant effect on the brain.”
While the initial decision to use drugs is mostly voluntary, researchers say addiction takes over in many people — altering the neurochemical and molecular structure of the brain. Judgment and decision-making functions are impaired, often fueling self-destructive behaviors. “We can visibly see, through the use of imaging technology, where drugs bind in the brain and what impact they have on the brain,” Stein says.
When it comes to relapse, addiction shares the same daunting challenge as other chronic diseases: getting people to change deeply imbedded thoughts and behavior patterns.
Effective Treatment Approaches: What Works, What Lies Ahead
The science of addiction recovery has evolved rapidly in recent years, leading to more effective treatment approaches. Newer, evidence-based rehab programs offer a wider range of medical and support services. Typically, these include a combination of pharmaceutical therapies — such as using the drug Suboxone to prevent heroin relapse — and research-proven psychosocial therapies, such as Cognitive Behavioral Therapy (CBT) to break patterns of negative thinking.
Clinical research studies support a handful of FDA-approved medications to reduce cravings or block a drug’s euphoric effects. Three of these medications work in different ways to prevent alcohol relapse: Disulfiram (brand name: Antabuse), Acamprosate (brand name: Campral) and Naltrexone (sold under the brand names Revia and Depade). A monthly injectable form of Naltrexone — sold as Vivitrol — is also available to help prevent alcohol relapse and treat opioid addiction.
To be effective, researchers say addiction treatment should include a strong “after care” component that builds on the gains made in rehab. And the treatment plan should address more than just the substance being abused. If a person has a mood disorder that co-occurs with chemical dependency, interventions are needed for both.
This integrated, holistic approach is best for long-term recovery, according to a seminal report on addiction from Columbia University:
“Due to the complex nature of addiction and its physiological, psychological and environmental risk factors, a multi-pronged approach to its treatment that includes a combination of pharmaceutical and psychosocial therapies typically yields the best results” —Addiction Medicine: Closing the Gap between Science and Practice (National Center on Addiction and Substance Abuse at Columbia University, 2012)
Treatment Length Matters
Rehab length of stay makes a critical difference on the journey to a drug-free life. The most effective treatment programs are at least 90 days, Stein says. Generally, a stay of less than three months in residential or outpatient treatment is of limited or no effectiveness, according to NIDA research studies. Some recovering addicts will need much longer, and the recommendation for methadone maintenance is 12 months at a minimum.
Unfortunately, most people who need treatment for addiction are not getting help. An estimated 23 million Americans abuse alcohol and drugs but only about 1 in 10 seek treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The reasons are complex, ranging from lack of insurance coverage to social stigma and not being ready to quit alcohol and drugs.
Breakthrough Vaccines Could Prevent Relapse
One of the most promising scientific advances for addiction recovery is vaccine development. Human clinical trials are now in progress for vaccines against cocaine and nicotine; pre-clinical tests are underway for vaccines that target heroin and methamphetamine.
Anti-drug vaccines work by creating antibodies that bind to the illicit substance — making it too large to reach the brain, Stein says.
“Once drugs get ingested into the body — whether it’s smoked, inhaled, or snorted — they go to the bloodstream. In order for any molecule to go through the blood brain barrier, it needs to be the proper size,” Stein says. “The vaccine will literally find the drug molecules and bind to it, creating a larger molecule and preventing it from crossing the blood brain barrier.”
When the drug fails to reach the brain, the user gets no satisfaction or euphoric reward. Thus, while vaccines may not affect desire to use a drug, they eliminate its physical effects. And that, Stein says, may break the cycle of addiction.
“If in fact one is motivated to stay on the vaccine, eventually their cravings could be extinguished,” he says. “That is the hope.”
If you or a loved one is struggling with addiction, contact DrugRehab.org today. We can help you find the resources needed to help get your addictions under control.