Addiction neurobiology research has demonstrated that there are 3 fundamental pathways in the brain that moderate the risk for relapse with any behaviour whether involving substance use or not. These pathways will be explored in more detail in this post. Keep reading below if you would like to improve your awareness around relapse triggers.
The three main triggers for relapse are as follows:
- Stress
- Exposure
- Environmental Cues
Stress
This first brain pathway that moderates the risk for relapse is fairly intuitive for most people. Essentially, there is an inverse relationship between stress and capacity; when stress is high, capacity is low. This means that when stress levels are high, people will find that they do not have the same wherewithal or resourcefulness to follow through on things despite their best intentions. It is hard to follow through on something when stress is high.
What can also happen within the brain of someone living with addiction is that over time their brain can become more sensitized to the effects of stress where it may not take as much in order for the brain to become overwhelmed. When stress is high, the midbrain (where the reward and emotion circuitry exist) can take over and “run the show” while the parts of the brain responsible for functions like impulse control, decision making, judgment, emotional regulation, etc. (ex. the pre-frontal cortex) can have their activity diminished.
Exposure
Our brains work largely off of association and automaticity. This can be understood as the idea that our brains are constantly taking in so much information that we cannot possibly be conscious of it all and that when we are exposed to certain things–in this case manifestations of addiction, this exposure will activate circuits in the brain related to memory, motivation, learning, and reward, which will ultimately feed into developing craving for whatever that ‘thing’ is.
For example, if someone has addiction involving gambling and they are watching their spouse place bets on an online casino, this exposure to gambling will trigger circuits in their own brain related to when they would gamble and they will find a craving to gamble arise, if not at least feelings of restlessness, irritability, and discontentment.
These same feelings of unease can further feed forward into an impulsive drive to seek reward, or a compulsive drive to seek relief or escape, from those uncomfortable feelings. The impacts of exposure can be cumulative and time-delayed. This means that someone can be exposed to a trigger and not act out within that same hour, or day, however if you follow that person along they will often in retrospect identify how in the days or weeks after a significant exposure that they found the feelings of restlessness, irritability, discontentment, and obsessive thinking or desire to use or re-engage with that behaviour noticeably increase. In the most severe cases, they will experience a relapse.
Environmental Cues
Environmental cues can be broken down into 3 main categories: people, places, and things. Similar to exposure, environmental cues can also feed into the generation and perpetuation of cravings. Once again, as the brain works largely off of association, being around “using buddies,” places where one used (ex. bars, casinos, family gatherings, etc.), or being in certain situations (ex. stressful scenario at work, going through a breakup which may have been a potent trigger for them in the past, being exposed to paraphernalia associated with prior substance use, certain holidays, etc.) can all also be significant factors in aggravating cravings for a person living with addiction.
The Way Forward
With the awareness of the 3 main pathways in the brain that moderate the risk for relapse, an opportunity arises for someone living with addiction to consider how they can approach situations differently in order to reduce their risk for relapse. Fundamentally, this is why an essential component of recovery involves the need to establish and uphold boundaries.
If nothing changes, nothing changes.
What are you willing to do differently in order to prioritise, promote, and protect your recovery?
