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Want vs. Consequences

Relapse

Relapse prevention is crucial to an addict’s recovery.  Relapse, although it doesn’t have to be, is a prominent 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.  Even more interesting, researchers could prevent these relapses by treating rats with a molecule that blocks glutamate signals, suggesting that this chemical might be investigated as a new treatment to prevent relapse in former cocaine-addicts. “Since wanting a drug is more directly connected to relapse [than liking it], glutamate could prove a promising target for new drug developments designed to treat cocaine addiction,” Vorel says. “Considering all the social and economic aspects of drug abuse, pharmacological intervention alone may not solve the burden. But it could help cocaine abusers which number 1.8 million in the U.S. alone.”

Relapse happens with all addictive drugs not just cocaine there are multiple – and often interactive – factors can increase the likelihood of relapse. These are some of the commonly cited precursors:

• drug-related “reminder” cues (sights, sounds, smells, drug thoughts or drug dreams) tightly linked to use of the preferred drug(s) can trigger craving and drug seeking
• negative mood states or stress
• positive mood states or celebrations
• sampling the drug itself, even in very small amounts

The motivation to seek a drug, once triggered, can feel overwhelming and sometimes leads to very poor decision making: the user will pursue the drug, despite potentially disastrous future negative consequences (and many past negative consequences).  The most confusing part about relapse for someone who is not an addict, is that decision to relapse is made from a sober state of mind.  The importance of a strong program and a defined support group is the foundation upon which a better decision process can be made.

Brain-imaging is aiding the medical field to understand the paradox of the decision to pursue a drug reward despite knowing the 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 the reward circuit has a strong head start. This head start means the area of the brain is responsible for weighing the consequences of a decision and for helping to “stop” the drug thoughts is already behind in the process and without a sufficient block or contrary action the addict is well on their way to relapse.