With some studies showing heroin relapse rates around 90%, it\u2019s no wonder that loved ones of people in recovery from heroin addiction frequently worry if they\u2019re using again. Heroin and opioid abuse can be one of the hardest addictions to kick. This is in part due to the way it acts on the brain\u2019s feel-good chemicals as well as the painful withdrawal symptoms in the absence of the drug. Without medication-assisted therapy to help counteract these challenges and strong relapse-prevention skills, the call of opioid and heroin can have a powerful lure. With the odds seemingly stacked against people recovering from heroin addiction, it can be difficult for you to stay hopeful, especially if you\u2019ve already seen your loved one through relapses. Rebuilding trust is a large part of recovery for both the addicted individual and their loved ones. How do you know if your loved one is relapsing or your imagination is having puppies because you\u2019ve been burned in the past? Heroin Addiction Relapse Signs Signs of heroin addiction relapse can look similar to relapses from other drugs. Signs that your loved one has relapsed or is in danger of relapsing include: Physical\/Emotional Changes \u2013 People who are on heroin often appear drowsy and \u201cout of it.\u201d They will likely have dilated pupils, move slower and respond more slowly to questions. They may seem emotionally numb or very calm and laid back. Sometimes they will nod off, habitually scratch their skin or slur their words. Secretive Behavior \u2013 If your loved one is using heroin or trying to obtain heroin, he or she may become vague about their whereabouts, guarded around phone use and become defensive or overly explanatory when you question them about these matters. Track Marks or Skin Infections \u2013 Obvious signs of opioid relapse are the physical characteristics of heroin abuse, which may include needle marks or bruises around veins that can\u2019t be explained away. Skin may become infected with abscesses or boils. Illness\/Withdrawal Symptoms \u2013 People abusing heroin may experience flu-like withdrawal symptoms between uses. This can include vomiting, diarrhea, sneezing and runny nose, difficulty sleeping, agitation, chattering teeth and emotional detachment. Discontinuing Recovery Activities \u2013 Your loved one may stop attending support groups like Narcotics Anonymous or SMART Recovery\u00ae. They may skip therapy appointments, doctor\u2019s appointments or drug tests. If they were participating in self-care measures like fitness, yoga, meditation and healthy eating, these may also fall by the wayside. Withdrawal From Support System \u2013 People who relapse may avoid family or social interactions for fear of being figured out or because they are ashamed of their drug use. They may begin hanging out with friends from when they were actively using or develop friendships with a new group of drug users. Denial \u2013 Your loved one may overcompensate for their relapse by being very outspoken about their recovery or judgmental of people who use heroin. They may become excessively vocal about how they will never use drugs again or how they are so thankful to be in recovery. This is a tricky one though, because some people are legitimately excited and proud of their recovery, as they should be. You should be concerned if these proclamations seem to arise out of the blue, are uncharacteristic of your loved one, or occur alongside other heroin relapse signs. Financial Problems \u2013 Another red flag is missing money or valuable objects, or requests from your loved one to borrow money. Heroin addiction clouds judgement. People may sell personal belongings and even steal from loved ones to get more opioids, doing anything to chase the heroin high and try to stave off withdrawal symptoms. Mood Swings \u2013 Your loved one\u2019s moods may swing on a pendulum from depressed to stable and irritable to apathetic. Because opioids work on the reward center of the brain that helps regulate mood, the presence or lack of the drug can wreak havoc on a person\u2019s emotional state. What Should I Do If My Loved One Relapses? You may have been down this road before. It\u2019s a heartbreaking one. The hard truth is that you can\u2019t force your loved one to stay sober. You can only support them by setting boundaries and being there for them when\/if they are ready to accept help. Some tips for dealing with a loved one\u2019s heroin relapse include: \tMaintain Your Boundaries \u2013 Healthy boundaries help you and the addict. If you\u2019ve already set boundaries, keep them, and if you haven\u2019t, now\u2019s the time to put some in place. Boundaries are different for everyone, but common ones include not allowing the addict to be in the house when using, not supporting them financially or bailing them out if they get into legal trouble, not tolerating disrespectful behavior and refusing to make excuses for them or play \u201cfixer\u201d when they mess up. \tDon\u2019t Use Shame Tactics \u2013 This is a tough one, especially when you\u2019re likely feeling immense anger and betrayal. However, shame researchers like Dr. Bren\u00e9 Brown have found that shame is not an effective motivator for change and some studies show it can even be a predictor of substance use. Shame puts a person on the defense: \u201cHow could you do this to yourself? How could you do this to me? What is wrong with you?\u201d The message this sends is: you\u2019re a bad person. If a person believes they\u2019re inherently bad, they may believe change is impossible. Instead try using \u2018I\u2019 statements and focus how their behavior is affecting you. \tKnow Your Limits \u2013 Intervention experts encourage you to recognize that feelings of betrayal, distrust and anger run high when dealing with an addicted loved one. Sometimes you simply need an objective party to step in and help navigate the situation. If you\u2019ve been racking up unsuccessful attempts at coaxing your loved one to get help, consider bringing in an addiction professional to intervene. \tTake Care of Yourself \u2013 Loved ones of addicts are at higher risk for depression and anxiety. Continue to tend to your own physical and mental well-being. Practice healthy eating and engage in regular physical activity, which can be natural protectors against stress and \u201cthe blues.\u201d See a counselor to help you sort out your feelings, and gain support from others sharing similar challenges by attending groups like Nar-Anon. While relapse can feel devastating for both the addict and their loved ones, it needn\u2019t be a death sentence. In fact, many addiction experts believe relapse to be a normal part of recovery. Because addiction is a chronic disease, it has similar relapse rates to other chronic conditions like diabetes, hypertension and asthma. Relapse can be a time to learn from one\u2019s mistakes and recommit to recovery with new insights into triggers.