A person struggling with alcohol use disorder (AUD), formerly called alcoholism or alcohol addiction, has a chronic brain disease that affects the reward system, leading to compulsive behaviors around alcohol, increased abuse of the substance and riskier behaviors while intoxicated, and other side effects. People who seek help to overcome AUD have many options for evidence-based treatment, which focuses on safely detoxing from the drug and changing behaviors through counseling at a rehabilitation program. However, one of the aspects of addiction as a disease involves relapse, which is a feature of many chronic illnesses, including hypertension, asthma, and diabetes.
Unfortunately, because of social stigma associated with addiction, treatment, and relapse, people who go through AUD treatment and suffer a relapse may delay seeking further help because they feel guilty or worthless, as though their willpower was not enough. This is untrue, and it prevents a true understanding of how treating chronic illnesses works.
Between 40 percent and 60 percent of people who struggle with addiction, including alcohol use disorder, will relapse. This is similar to rates of symptom relapse for other illnesses. About 30-50 percent of people with type I diabetes will experience a symptom relapse; 50-70 percent of people with hypertension will experience a relapse in symptoms; and 50-70 percent of people with asthma will experience symptom relapse. People with these chronic illnesses will go back to their doctor to adjust their treatment plan, which includes medications and lifestyle changes. People who struggle with AUD or other addictions can think of relapse the same way – a recurrence of symptoms of the disease, which requires returning to treatment to adjust some aspects of the care plan or the creation of a new treatment plan.
To properly treat relapse, it is important to understand what it is. When potential symptoms are recognized, individuals can seek treatment as soon as possible.
What Is Relapse?
Attending therapy, peer support groups, finding new enjoyable activities other than drinking, getting emotional support from friends and family, and finding ways to manage stress and avoid triggers will help people just out of rehabilitation stay sober. However, it is important to know that a lapse or a relapse can happen, and recognizing the symptoms is the best way to prevent a full-blown relapse.
A lapse is the first time a person consumes alcohol after they have gone through detox and rehabilitation. This may happen by accident, or the individual could seek out alcohol and compulsively consume it. While a lapse may be brief, it is a sign that the individual is at risk of relapse.
Relapse is the term for the inability to remain sober over time. For people struggling with AUD, this may involve a return to escalated consumption of alcohol or consuming another drug that acts similarly to alcohol (mouthwash, benzodiazepines, etc). It is a pattern of lapses that worsen over time.
A lapse, or a relapse, does not mean that treatment did not work. It indicates that a person needs more help returning to sobriety, which could include medications like naltrexone to prevent cravings after detox, better social support, or different techniques to reduce daily stress.
What Are the Signs of Relapse?
- Emotions that feel extreme or uncontrollable: People who have used substances like alcohol to change their brain chemistry will have to adjust to life without the aid of self-medication. They may worry about returning to daily life with new behaviors and habits but the old stresses. Adjusting to a job, family responsibilities, and social pressure can be hard. A person just out of a rehabilitation program may be able to take these tasks on and feel good about the results, but they may also be in denial about how stress or worry wears on them.
- Trouble accepting life and its changes: Sometimes, it is easy to take stressful changes in stride, but other times, it may feel like everything is falling apart. People who are in recovery may feel the stress of schedule adjustments, illness, or criticism more intensely than others. They may have a harder time seeing the positive side. Feeling sad, down, or guilty may lead to a relapse.
- A belief that relapse is impossible: In some cases, people believe that they have worked so hard that they will never relapse. Despite the statistics, they think they are immune from this risk. Falsely believing that relapse cannot happen to them conversely increases the risk of relapse.
- Loss of commitment to recovery: People who fall out of their mutual support group, therapy, or relapse prevention plan are at a greater risk for relapse. Without emotional and psychological support, there is a greater risk of returning to compulsive and negative behaviors.
- Visiting old haunts or hanging out with old drinking friends: Returning to old patterns, including going to places where a lot of drinking occurred or spending more time with friends who continue to drink compulsively or binge drink, puts a person at risk of returning to problem drinking.
- Missing alcohol
- Bottles or detritus from drinking
- Clothing or breath that smells like alcohol
- Being visibly intoxicated
- Money going missing
- Being gone at random times or for long periods, or skipping work or school
- Medicine like cough syrup going missing
Making a Relapse Prevention Plan
Relapse may not be avoidable, but this does not mean that treatment does not work. Part of treatment should include relapse prevention planning and strategies. Understanding relapse means identifying symptoms and finding ways to avoid relapse when some initial symptoms are present.
People recovering from AUD may benefit from a prescription medication to ease cravings. Acamprosate and naltrexone are both prescribed in some instances to lessen cravings after the person has successfully detoxed from alcohol. Reducing cravings helps the person focus on changing their behaviors around alcohol and learning new coping mechanisms. Disulfiram is another prescription drug to prevent relapse, but it is an older drug that has negative side effects, including physical illness, if the person drinks, so it is rarely prescribed anymore.
Cognitive Behavioral Therapy (CBT) is one of the most important forms of therapy, often used in rehabilitation and mental health treatment. This form of therapy focuses on understanding the root causes of behaviors, identifying how behaviors do not line up with values, and learning new behaviors. Working with a CBT specialist can help a person recovering from AUD learn about the signs of relapse, and practice new skills and coping mechanisms in advance of a lapse or relapse.
Other ways to reduce the risk of relapse include:
- Getting social support through a peer support group, such as Alcoholics Anonymous
- Befriending positive people who can help to elevate one’s mood
- Minding HALT (hungry, angry, lonely, or tired), as these can influence stress levels and bad decisions
- Learning new coping mechanisms, such as mindfulness
- Knowing relapse symptoms and keeping a diary to monitor for them
- Reaching out for help in the event of a lapse or relapse
Working with a therapist or counselor to develop a relapse prevention plan is extremely useful. This includes creating a daily schedule for meals, journaling experiences, engaging in supportive exercise, and finding friends who can lend an ear during stressful times. A relapse prevention plan may include a daily checklist, a list of reminders (for appointments, chores, etc.), and ways to identify triggers when they pop up. A relapse prevention plan should also include a section to manage stress and triggers.
Peer support is a very important component of recovery. Social support from those who have gone through similar struggles can help to put stress and cravings in perspective. For those seeking recovery support groups, the Substance Abuse and Mental Health Services Administration (SAMHSA) provides a list of a few.
Online support is also becoming increasingly important, especially for people with very specific stories or who live far away from options for groups. People working to manage AUD and stay sober can use several mobile phone apps or search for online chat rooms that support recovery.