[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Addictive behavior](https://durgical.com/en/behavioral-science/areas/substance/) › Cues, craving and relapse

# Cues, craving and relapse

- Concept

People, places and moods linked to past drug use can trigger craving long after stopping; relapse is common and is a reason to adjust treatment.

Updated Nov 5, 2026

## Key points

- Cue reactivity: conditioned cues alone trigger craving, arousal and drug seeking (classical conditioning).
- The three classic relapse triggers: drug-associated cues, stress, and re-exposure to the drug itself (priming).
- Relapse rates in substance use disorders (about 40–60 %) are similar to other chronic diseases such as hypertension and asthma.
- Relapse means treatment needs to be resumed, adjusted or changed; it is not proof that treatment failed.
- After abstinence (detoxification, hospital, prison), tolerance falls: using the old amount can cause fatal overdose, especially with opioids.
- Lapse (a single slip) is different from relapse (return to the previous pattern); the reaction to a lapse shapes what follows.

## What it is

Through classical conditioning, cues repeatedly paired with drug use (people, places, objects, times of day, emotions) come to trigger craving and body responses on their own; this is cue reactivity. Together with stress and re-exposure to a small amount of the drug, cues are the main triggers of relapse. Addiction is a chronic, relapsing condition: relapse rates are similar to those of other chronic illnesses such as hypertension and asthma. Relapse prevention teaches people to recognize high-risk situations and to cope with them, and after a period of abstinence tolerance is lost, which raises overdose risk.

## Key facts

- Drug-cue associations last for years, which is why craving can return suddenly in a familiar setting.
- The abstinence violation effect: after a slip, thinking ‘I have ruined everything’ makes full relapse more likely.
- Craving can grow during the first weeks to months of abstinence before it fades, shown in animal studies and in people.
- Extinction of cues in the clinic does not always transfer to the real world, because extinction learning is context-dependent.
- Relapse prevention, mindfulness-based relapse prevention, contingency management and medications for opioid, alcohol and tobacco use disorders lower relapse.

## Relapse triggers and responses

| Trigger | How it works | Coping example |
| --- | --- | --- |
| Drug-associated cues | Conditioned responses to people, places, objects and times | Change the route home that passed the old bar; remove paraphernalia |
| Stress and negative emotions | Stress systems drive use for relief (negative reinforcement) | A planned call to a support person, exercise or a brief breathing practice |
| Priming (a small amount) | A single use reactivates drug seeking | Treat a slip as information and contact the treatment team quickly |
| Positive emotions and celebrations | Social cues and lowered vigilance | Plan alternatives in advance for parties and holidays |

## Clinical notes

- People leaving detoxification, hospital or prison after opioid abstinence are at high risk of overdose; naloxone and fast linkage to treatment save lives.
- Asking a patient ‘what were the hours before the relapse like?’ often reveals a concrete trigger to plan for.

## Memory aid

Three keys reopen the door to use: the Place (cues), the Pressure (stress) and the Pinch (a small dose).

## Test yourself

Think of the answer, then tap the question to see it.

## What is cue reactivity?

Craving and body responses triggered by stimuli previously paired with drug use, through classical conditioning.

## What are the three classic triggers of relapse?

Drug-associated cues, stress, and re-exposure to the drug (priming).

## How do relapse rates in addiction compare with other chronic diseases?

They are similar to rates in hypertension and asthma, which supports treating addiction as a chronic illness.

## Why is overdose risk high after a period of opioid abstinence?

Tolerance is lost, so the previously used amount can now be fatal.

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## Elsewhere in DurgiPedia

- [Learning and memory](https://durgical.com/en/physiology/learning-and-memory/)
- [The limbic system, emotion and reward](https://durgical.com/en/physiology/the-limbic-system-emotion-and-reward/)

## Connections

## Related 8

- [Addiction concepts: reward, tolerance, dependence and withdrawal](https://durgical.com/en/behavioral-science/addiction-concepts-reward-tolerance-dependence-and-withdrawal/)
- [Classical conditioning](https://durgical.com/en/behavioral-science/classical-conditioning/)
- [Habituation, extinction, learned helplessness and modelling](https://durgical.com/en/behavioral-science/habituation-extinction-learned-helplessness-and-modelling/)
- [The stages of change (transtheoretical model)](https://durgical.com/en/behavioral-science/the-stages-of-change/)
- [Screening and brief intervention (SBIRT) and harm reduction](https://durgical.com/en/behavioral-science/screening-and-brief-intervention-and-harm-reduction/)
- [Dialectical behavior therapy, ACT and mindfulness](https://durgical.com/en/behavioral-science/dialectical-behavior-therapy-act-and-mindfulness/)
- [Cognitive behavioral therapy and cognitive distortions](https://durgical.com/en/behavioral-science/cognitive-behavioral-therapy-and-cognitive-distortions/)
- [Stress: the general adaptation syndrome and allostatic load](https://durgical.com/en/behavioral-science/stress-the-general-adaptation-syndrome-and-allostatic-load/)

## Related conditions 5

- [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/)
- [Opioid use disorder, overdose and withdrawal](https://durgical.com/en/conditions/opioid-use-disorder-overdose-and-withdrawal/)
- [Tobacco use disorder](https://durgical.com/en/conditions/tobacco-use-disorder/)
- [Stimulant use disorder (cocaine, amphetamines)](https://durgical.com/en/conditions/stimulant-use-disorder/)
- [Opioid overdose](https://durgical.com/en/conditions/opioid-overdose/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Drugs and the Brain](https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain) (National Institute on Drug Abuse (NIDA), 2020); [Treatment and Recovery](https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery) (National Institute on Drug Abuse (NIDA), 2020).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/cues-craving-and-relapse/