What is Alcohol Relapse?

Relapse is a return to substance use after a period of abstinence.6 Recovery from alcohol misuse involves creating new habits and addressing feelings that may have been ignored for a long time. Rehab treatment often focuses on recognizing and understanding these emotions and other internal and external triggers that have previously been coped with by drinking or using drugs. Treatment also helps people in recovery develop new coping skills to deal with difficult emotions or stress when they arise. 7  Experiencing a relapse does not mean that your recovery has failed.4 The Journal of the American Medical Association reports that 40% to 60% of people who seek treatment for substance abuse will relapse within 1 year.

Alcohol Relapse Prevention

A relapse is not necessarily a sudden decision. Warning signs may occur for days, weeks, or even months before a person ultimately makes the decision to use alcohol, again.7

However, in addition to what you learned about your drinking patterns and triggers during treatment, there are some general ways you can prepare for a potential relapse.  These strategies may include:1

  • Reaching out for help when you are struggling or feeling isolated.
  • Attending a support group like AA (Alcoholics Anonymous) or SMART Recovery.
  • Engaging in self-care activities like working out, breathing exercises, yoga, or meditation.
  • Establishing healthy boundaries with your family, friends, and others in your social group.
  • Rehearsing potentially triggering situations or finding alternatives to people, places, things, associated with drinking.
  • Working with a medical professional to manage medications.
  • Participating in evidence-based therapy for alcohol use disorder.
  • Working to improve your nutrition and other physical health habits.

Stages of Relapse

Addiction medicine physician Steven Melemis explains in his research that relapse tends to be a gradual process with three stages.5

  1. Emotional Relapse. During the emotional stage, it does not necessarily mean a person is thinking about using alcohol again, but they may be neglecting self-care and their coping strategies. For example, isolating, not reaching out for support, and bottling up emotions.
  2. Mental Relapse. During a mental relapse, a person may fantasize about drinking alcohol. This creates an internal struggle and bargaining where they may minimize the consequences of using drugs or alcohol to justify using again.
  3. Physical Relapse. At this point, drinking alcohol/or drug use begins and soon escalates to an uncontrollable level.

Triggers for Alcohol Relapse

One of the biggest indicators someone might be headed for relapse is when they abandon the new behaviors learned in early recovery, which can make you vulnerable to triggers.7

 The various reasons that caused you to misuse alcohol in the first place may likely still be triggers. For example, living near a bar or a place where you used to drink, being in a relationship with someone who is still using alcohol or other substances are risk factors that may trigger a relapse .5

Common triggers may also include:

  • Withdrawal symptoms.
  • Chronic stress.
  • Certain people or places.
  • Peer Pressure
  • Relationship problems.
  • Financial stress.
  • Uncomfortable emotions, such as loneliness, anger, and anxiety.

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What Happens After an Alcohol Relapse?

Treatment of chronic diseases, such as alcohol use disorder, involves changing deeply rooted behaviors, and relapse doesn’t mean treatment has failed. 7 When a person recovering from an addiction experiences a relapse, it’s important to communicate with your doctor. Treatment may need to be modified, added or otherwise adjusted.7

Having feelings of regret, shame, or guilt after a relapse is not uncommon, and while it’s important to acknowledge those feelings, it’s also important to move on and get back on track. 5 It may also be helpful to talk to the people in your support system (family, friends, and sponsors).6

Treatment for Alcohol Relapse

Stopping alcohol or drug use is just one part of a long and complex recovery process. When people enter treatment, addiction has often caused serious consequences in their lives. 7 Behavioral therapies help people in addiction treatment modify their attitudes and behaviors related to substance abuse. As a result, they can learn healthier ways to handle stressful situations and other triggers that might cause a relapse. Behavioral therapies used in the treatment of AUD and that may be helpful for those experiencing a relapse include: 7

  • Cognitive-behavioral therapy. This helps patients recognize, avoid, and cope with the situations in which they’re most likely to use alcohol or drugs.
  • Contingency management. Positive reinforcement is encouraged, such as providing rewards or privileges for remaining substance free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
  • Motivational enhancement therapy.  This type of therapy uses strategies to make the most of people’s readiness to change their behavior and enter treatment.
  • Twelve-step facilitation (TSF).  Typically delivered in 12 weekly sessions, this helps to prepare people to become engaged in 12-step mutual support programs. 12-step programs, like Alcoholic Anonymous, are not medical treatments, but provide social and complementary support to those treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.

Furthermore, it’s important to remember you are not alone, about half of people who seek treatment for substance abuse experience a relapse. 7 Re-entering a treatment program can help you to again stop using alcohol and reduce the risk of future relapses.7,8

Sources

  1. Zgierska, A. and Burzinski, C.A. (2020, September 17). Reducing Relapse Risk.
  2. National Institute on Drug Abuse. (2020, June 3). How effective is drug addiction treatment?.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  4. National Institute on Drug Abuse. (2020, July 10). Treatment and Recovery.
  5. Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332.
  6. Larimer, M., Marlatt, A., & Palmer, R. (1999). Relapse Prevention.National Institute of Alcohol Abuse and Alcoholism, niaa.nih.gov. Vo. 23, No. 2. p. 151.
  7. National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery.
  8. Mohammadpoorasl, A., Fakhari, A., Akbari, H., Karimi, F., Arshadi Bostanabad, M., Rostami, F., & Hajizadeh, M. (2012). Addiction relapse and its predictors: A prospective study. Journal of Addiction Research & Therapy, 3(1), 1–3.