Why Risk Factors for Opioid Relapse Differ Between Men and Women

Substance abuse has increased dramatically since COVID-19 emerged. As more people report feeling stressed, anxious and uncertain about the future, many have turned to drugs or alcohol to find some form of relief and started self-medicating just to get through the day. Consequently, fatal overdoses are also on the rise, surging to over 81,000 deaths over a 12-month period, according to the CDC. While these numbers had been increasing prior to 2019, mainly due to the growing presence of fentanyl, the onset of the pandemic seems to have added fuel to the fire and worsened the situation.

Although people report using various substances during lockdown, the increase in opioid abuse is particularly concerning due to its addictive nature, the dangers of relapse and risk of overdose. As many as 40 to 60 percent of individuals relapse while in recovery, but this number is much greater for opioids like heroin or fentanyl. And when someone relapses, they might misjudge the amount they need to get high and take too much, not realizing they’ve lost their tolerance. As opioids increase in potency, this often has fatal consequences.

At Choice House, we know that comprehensive treatment for an opioid use disorder is key to helping individuals get clean and sober, but their very lives can also depend on understanding different relapse triggers and how to avoid them. A recent study by the University of Southern California (USC) found that the risk factors for relapse vary significantly by gender, a discovery that can help us develop more targeted treatment options with better results to increase the odds of lasting recovery.


Studies have shown that men are more likely than women to abuse opioids, but this gap has narrowed in recent years. Today, opioid overdoses are a leading cause of death among men and women alike, killing nearly 50,000 Americans in 2019 alone. That number has only risen since the pandemic, impacting individuals from all walks of life. Unfortunately, many of these overdoses happen during a relapse, making it crucial to understand why some people backslide and start using again after months or even years of sobriety.

A younger age is greatly associated with opioid relapse among all individuals, but other risk factors have been found to vary widely between men and women. Researchers have found that one of the biggest relapse triggers among women is withdrawal, which they tend to experience more strongly than men. Mental health problems like depression or post-traumatic stress disorder (PTSD) are also a considerable risk factor for women, complicating the treatment process and making a return to drug use more likely after rehab.

In comparison, the most significant risk factor for men who relapse is polydrug use and addiction to multiple substances. Men are more likely than women to abuse several different kinds of drugs at once, but might only seek help for one, most often opioids. Throughout treatment, men might continue to use other drugs and rationalize their behavior by asserting that substances like marijuana, alcohol or cocaine aren’t nearly as harmful.

It goes without saying that continuing to get high during or after treatment is a bad idea, as it keeps individuals immersed in a drug-oriented environment and exposes them to relapse triggers. This can increase cravings and addictive behaviors, jeopardizing any meaningful progress toward recovery. Studies have repeatedly shown that secondary drug use while in treatment compromises its therapeutic effects and is associated with consistently poorer outcomes, particularly among men.

UCLA found another risk factor for opioid relapse in men is a history of conduct disorder, a behavioral condition seen in children and teens that’s characterized by a disruptive attitude, rule-breaking and violence or aggression toward others. Without treatment, children with conduct disorder can carry these behaviors into adulthood, predisposing them to drug or alcohol abuse and creating problems in almost every other facet of life. For men in recovery, it can also cause them to rail against the rules or structure of rehab, decreasing the effectiveness of applied modalities.


Understanding the factors that drive opioid relapse in men and women can help treatment providers address these vulnerabilities more effectively and develop relapse prevention programs that work. The results of the UCLA study suggest, for example, that women are more likely to benefit from an approach that utilizes medication-assisted treatment and proven psychotherapies to better manage opioid withdrawal symptoms and mental health concerns. Men, on the other hand, might get more out of mutual-help interventions that address polydrug use and cognitive behavioral therapy, which aims to improve interpersonal problem solving while reducing emotional distress and distorted ways of thinking.

These techniques can be applied throughout the treatment process to help individuals achieve lasting recovery. By acknowledging specific risk factors for patients and developing an aftercare plan or model that successfully addresses these concerns, we can help individuals better respond to triggers or cravings and avoid mental, emotional or physical relapse. A number of other variables are also involved when a patient relapses, and understanding these interactions can further improve treatment outcomes.

The researchers also noted that their findings might point to gender-specific programming as a solution for addressing the unique needs of those in recovery for opioids and other drugs. Since the approaches that would be most beneficial are different for men and women, gender-targeted treatments can provide a more personalized experience that supports the development of effective coping skills. While relapse will always remain a challenge when it comes to addiction, we believe that lasting recovery is possible with the right care.

At Choice House, we provide gender-specific treatment for men in the Boulder, Colorado, area struggling with addiction to opioids and other substances. We provide comprehensive care and dual diagnosis services to help men address their issues and achieve recovery without relapse, targeting the risk factors that may jeopardize their sobriety. If you or someone you love needs help kicking opioids for good, contact or call us today at 303-578-4977 to learn more about treatment programs.

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