Introduction: Substance use relapse after successful detoxication and rehabilitation is one of the most important aspects of addiction worldwide. This study aims to examine the current prevalence of relapse and to determine the factors associated with relapse among patients with substance use disorder (SUD) in a rural population. Methods: This single-centered retrospective observational study enrolled a total of 915 patients with SUD who visited Banna hospital, Nakhon Nayok province, Thailand, from January 1, 2019, to December 31, 2021. Multiple logistic regression models determined the factors associated with relapse among the patients with SUD. Results: The substance use relapse rate in this rural Thai population was 24 % (95%CI 21.16-26.70). Multivariate analysis revealed that being over 40 years of age, single, and unemployed, and having no legal history were associated with relapse among the patients with SUD. Furthermore, family disputes, addicted friends, and addicted close relatives resulted in a major significant increase in the risk of substance use relapse. Conclusions: The current study confirmed that family disputes, addicted friends, and addicted close relatives were the main associations with addiction relapse. Therefore, addiction rehabilitation programs based on the findings of the current study may reduce and contribute to preventing the risk of substance use relapse.