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Patients participated in state-of-the-art, empirically based behavioral and pharmacologic therapies. Patients are classified here on the basis of their primary drug of abuse (eg, alcohol, opiates, cocaine, marijuana), excluding nicotine, as described in Dodge et al. Data from 878 patients entering a large, publicly funded, Yale University–affiliated addiction treatment facility in the New Haven, Connecticut, area acquired over a 1-year period were assessed for proportion of patients who were abstinent at discharge. For 1-year outcomes across alcohol, nicotine, weight, and illicit drug abuse, studies show that more than 85% of individuals relapse and return to drug use within 1 year of treatment. Recent estimates from clinical treatment studies suggest that more than two thirds of individuals relapse within weeks to months of initiating treatment. It has long been known that addictive disorders are chronic and relapsing in nature. Such markers may then be used to assess treatment response and develop specific treatments that will normalize these neural and biological sequelae so as to significantly improve relapse outcomes. Finally, significant implications of these findings for clinical practice are presented, with a specific focus on determining biological markers of relapse risk that may be used to identify those individuals who are most at risk of relapse in the clinic. Caveats pertaining to specific drug abuse type and phase of addiction are discussed. Among neural measures, brain atrophy in the medial frontal regions and hyperreactivity of the anterior cingulate during withdrawal were identified as important in drug withdrawal and relapse risk.

Among biological measures, endocrine measures such as cortisol and cortisol/corticotropin (ACTH) ratio as a measure of adrenal sensitivity and serum brain-derived neurotrophic factor were also predictive of future relapse risk. Clinical factors, patient-related factors, and subjective and behavioral measures such as depressive symptoms, stress, and drug craving all predict future relapse risk. Prospective studies examining relapse risk are reviewed, and clinical, biological, and neural factors that predict relapse risk are identified. This paper examines the new research on identifying biological factors that contribute to addiction relapse risk. Relapse is a highly prevalent phenomenon in addiction.