Vivid dreams involving drinking and drug use are common among individuals in recovery. A study from the Massachusetts General Hospital (MGH) Recovery Research Institute, published in the January issue of the Journal of Substance Abuse Treatment after online release in October 2018, finds these relapse dreams are more common in those with more severe clinical histories of alcohol and other drug problems.

"Anecdotally, the occurrence of drinking and drug-using dreams is a known phenomenon among people in recovery, but very little is known from an epidemiological standpoint about the prevalence of such dreams, their relation to relapse risk, and how they decay with time in recovery," says lead author John F. Kelly, PhD, founder and director of the Recovery Research Institute. "Given that these dreams can be deeply unnerving, more information could help treatment providers, those in recovery and their families know what to expect going forward."

Recovery from every kind of substance use disorder -- alcohol, heroin, cocaine, cannabis -- has been characterized by dreams that follow a common pattern: in the dream the person has a drink or ingests their primary substance. They experience disbelief and are overcome with fear, guilt and remorse until they wake up, relieved to realize it was only a dream.

Among a nationally representative group of more than 2,000 people who had resolved a significant alcohol or drug use problem, around one-third reported having experienced relapse dreams after entering recovery. The frequency of such dreams lessened the longer an individual was in recovery.

"We found that the individuals in recovery who reported at least one such dream had received help from treatment and mutual-help organizations in the past, reflecting a more serious clinical disorder and impact on the central nervous system," says Kelly, who is the Spallin Associate Professor of Psychiatry in the Field of Addiction Medicine at Harvard Medical School.

Reports of relapse dreams are so common in clinical and recovery support service settings that Kelly and co-author M. Claire Greene, PhD, of Johns Hopkins Bloomberg School of Public Health, were surprised that the majority of those studied reported never having experienced one. Those who did tended to have had more severe substance use histories.

"The association between the decreasing frequency of these dreams and the length of time in recovery suggests that, as the body and mind gradually adapt to abstinence and a new lifestyle, psychological angst about relapse diminishes," Kelly says. "REM sleep and deep wave sleep undergo important changes, even long after people enter recovery, and these relapse dreams may be indicative of the healing process and brain-mind stabilization that occurs with time in recovery."