Recovery from an alcohol use disorder and living a sober life requires daily work and discipline; and it is ultimately about making progress and moving forward in one’s life without the negative consequences of alcohol use, not perfection. Relapse prevention is a pivotal component of any treatment plan for alcoholism or any other substance abuse disorder.
Both recovery and relapse are influenced by the severity of a person’s alcoholism, co-occurring mental health conditions, and a person’s coping skills, motivation, and support system.1,2
Alcohol relapse, like addiction itself, doesn’t occur in a vacuum. During treatment for alcohol use disorder, a person works to learn about what motivated them to drink and is prepared to handle similar moments in the future in a different, more positive way.1,2
To better understand alcohol relapse and relapse prevention strategies, we’ll dive deeper than the moment of relapse, but explore the way thoughts and emotions can lead to a person to “slip up” and how this can trigger a return to heavy alcohol use that may threaten to offset recovery efforts. We will also outline some of the common warning signs of alcohol relapse as well as what to do when an alcoholic relapses.
What is a Relapse?
Alcohol relapse can be seen as both a process and an event.1 The relapse process does not begin when someone in recovery has a drink, it starts long before a “slip up” that may lead an individual to bend the rules of their recovery program before fully reverting to old patterns unhealthy, heavy drinking.1
Prior to a relapse, one must first have a lapse; let’s look more closely at these 2 words:3
- Lapse: Lapse refers to the everyday nature of slipping up when trying to change your behavior. This word tends to have fewer negative connotations attached to it. It can provide a person with an opportunity to learn what motivated the lapse in an effort to avoid repeating the lapse (i.e., relapse).
- Relapse: This refers to the total reversion to heavy drug or alcohol use and often brings with it a personal sense of failure in someone’s recovery program.
Recognizing a lapse and learning from it can be a powerful tool in changing future behavior. Self-forgiveness and being able to recognize risks to one sobriety (and adjust subsequent behavior) is an important aspect of recovery.1
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How Common is Alcohol Relapse?
Lapses and relapses are common for those battling a substance use disorder. The Journal of the American Medical Association estimates that approximately 40-60% will experience a relapse at some point during their recovery.4 This means that relapse is common and many others in recovery have faced it before. A relapse shouldn’t be seen as a failure in treatment, but it does serve as a sign that you might need to change, modify, or reexamine your treatment strategy. With professional help, a strong support network, and a continued understanding that your recovery is a process that requires daily work, you can in fact maintain abstinence and keep the chronic illness of addiction and alcoholism at bay.
What Can Trigger a Relapse from Alcohol?
A goal of being in a treatment program is to learn and recognize the thoughts or emotions that drive you to drink, and to acquire a healthier coping strategy in order to avoid a return to drinking or a relapse.1,3 Relapse is multifaceted. It not only involves the body and our behavior, but also our emotions and our thoughts.
Our emotions influence our thoughts and can be a big driver of how our minds and bodies react. Understanding your emotional needs and meeting them (or finding support to help you meet them) is important. The biggest sign of an impending emotional relapse is poor self-care which includes emotional, psychological, and physical care.
Some warning signs prior to experiencing an emotional response that may trigger a lapse or relapse include:1
- Ignoring or trying to bottle up emotions.
- Isolation or no longer attending 12-step or recovery meetings (e.g., Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
- Focusing too much on others and other people’s problems.
- Poor eating, exercise, hygiene and/or sleeping habits.
The Role of Emotions in Relapse
A common relapse prevention strategy used during treatment is learning what self-care means and understanding how a negative affective or emotional state can contribute to relapse. A common acronym heard in 12-step recovery meetings regarding self-care is HALT: Hungry, Angry, Lonely, Tired.5 Learning to identify when one of these components becomes overwhelming (i.e., “too lonely” or “too angry”, etc.) and thus threatens a well-balanced emotional state will allow you to apply an alternative coping strategy that doesn’t involve drinking.
Emotions may prompt thoughts of using but so can external cues or stimuli. Even though you don’t necessarily want to drink, the emotions and thoughts can be a warning sign of an impending lapse or relapse.6 Being in a high-risk situation, like a get-together with friends you used to go drinking with, can further trigger feelings, thoughts, and cravings for alcohol.
Types of thoughts and thought-based behaviors that may precede relapse include:1
- Thinking about or reassociating with things associated with past use such as people or places.
- Minimizing, rationalizing or romanticizing the consequences of past use (e.g., “I wasn’t really hurting anyone.”).
- Bargaining, or otherwise plotting ways to have a drink but better control use.
- Seeking or planning opportunities where you might drink again.
Thoughts of using are normal and do not mean that relapse is inevitable.6 You cannot erase the memories of using or what’s happened in the past, but you can use alternative coping strategies to help you let go of past ways of thinking, control or eliminate stimuli associated with thoughts of using, and avoid high-risk situations that might threaten your sobriety.6
The moment when a person lapses is when they have a drink of alcohol. It is a response to being unable to cope with thoughts or emotions and greatly increases the risk of eventual relapse.6 This progression doesn’t have to be inevitable; the emotional response you have to a lapse and the causes you attribute to the lapse are crucial factors that can predict whether or not a lapse becomes a relapse:6
- Attributing the lapse to personal failure typically leads to guilt and negative emotions that can lead to increased drinking to avoid guilt or feelings of failure.
- Attributing the lapse to internal factors beyond one’s control (e.g., a lack of willpower— “I will never be able to stop drinking.”) all but guarantee a relapse.
- Attributing the lapse to an inability to effectively cope with a specific emotion, thought, or high-risk situation, however, allows you to learn from the mistake and a clear sign you need to find more effective ways to cope with similar situations, thoughts, or feelings in the future.
Risk Factors for Relapse
Identifying alcoholic relapse risk factors is important to keep relapse episodes at bay.7 Some of those risk factors include:7
- Negative emotional states such as struggling with anxiety, depression, frustration or boredom. These are often caused by intrapersonal perceptions such as reactions to environmental events or certain situations (e.g., “I feel alone in my home after work.”)
- Positive emotional states such as celebrations or alcohol-related cues like passing by a favorite bar which can elicit feelings of past pleasure.
- Interpersonal relations, particularly those involving conflict, such as an argument with a friend or family member. In one study, these triggers were shown to lead to more than one-half of all relapse episodes.
- Social pressures, whether direct or not, such as being at a party with friends who are consuming alcohol.
Risk factors alone don’t mean a person will relapse. It’s how you respond to these triggers that are the determining factor to experiencing a relapse or not.7 Having a strong support system and a well thought out relapse prevention plan can help you positively cope and can significantly decrease the probability of a relapse.
Early Warning Signs of Relapse
Other early warning signs of a potential alcohol relapse include:1
- Stopping prescribed medication used for managing alcoholism.
- Daydreaming about past use or thinking about drinking again.
- Avoiding their support system during times of emotional need or thinking they don’t need anyone to support them at all.
- Choosing to start reconnecting with individuals in their life who were linked to past substance use or going back to places where they used to drink.
- Exhibiting past behaviors that occurred when they were using.
Stress and lack of lifestyle balance, rationalizing and denying situations, and having strong expectations about alcohol or the drug are all factors in the above warning signs.7 Other risk factors associated with substance use include triggers associated with past substance use.1 These internal or external cues can lead a person to relapse since they activate an urge or craving to use.1
Triggers are typically unique to an individual and some can be obvious, such as a group of friends drinking in your presence or something more subtle, like a past memory of a time when you felt happy while drinking.1 Additional triggers that can lead you to relapse include the thought of a reward, recalling feelings of euphoria, or even feeling the need to alleviate boredom.8 During early recovery, fear of withdrawal, loss of control, or even obsessive behavior can be a trigger for some to relapse.8
Finally, isolation can be a trigger for many—with one study finding that living alone increased the probability for relapse.1 As we continue to experience the COVID-19 pandemic, isolation and social distancing can be huge triggers for some during these difficult times.9,10
What Do I Do If I Relapse from Alcohol?
You may not be in a position to know what to do when an alcoholic relapses. Remember, a lapse or relapse does not mean a personal failure, but rather an opportunity to learn and change your response and behavior. It may also suggest a need to modify your current treatment plan. This may involve returning to rehab or scheduling an appointment with a counselor or therapist. Remember, alcoholism is a chronic disease and like other chronic diseases, successful treatment requires continual assessment and making modifications when appropriate.11
For example, when someone is being treated for diabetes and their symptoms are reduced, treatment is considered successful, even though symptoms may recur in the future. In the same way, a relapse can signify the need to adjust treatment or determine whether an alternate approach is needed.11
If a lapse or relapse does occur, it is beneficial to get help or support as soon as possible. Be honest with yourself and with those in your recovery circle. This can include counselors, therapists, doctors, self-help groups, sponsors, family members, and friends who are there to support you in both the good and hard times.
Get Help for a Relapse
If you’ve experienced a relapse and are ready to seek treatment, American Addiction Centers (AAC) can help. Alcohol.org is a subsidiary of AAC, a nationwide provider of addiction treatment services and our admissions navigators are ready to discuss your treatment options with you.
Remember, a relapse doesn’t mean you have failed; it simply means you may need to adjust previous treatment plans. Additionally, if you’ve successfully complete 90 consecutive days at an AAC facility and experience a relapse, you are welcome back for a complimentary 30 days of our treatment.*
Call our hotline 24/7 at 1-888-685-5770 or get a text to speak with one of our admissions navigators. All calls are 100% confidential. Fill out the form below to see if your insurance covers treatment within an AAC facility.
. Zgierska, A., Burzinski., C. (2020, September 27). Reducing Relapse Risk. Whole Health Library. U.S. Department of Veterans Affairs.
. National Institute on Drug Abuse. (n.d.). Alcohol Dependence, Withdrawal, and Relapse.
. Australian Government Department of Health. (2004). Relapse Prevention Management.
. National Institute on Drug Abuse. (2020). Treatment and Recovery.
. Miller, Shannon; Fiellin, David; Rosenthal, Richard; Saitz, Richard. (2018). The ASAM Principles of Addiction Medicine.
. National Institute on Alcohol Abuse and Alcoholism. (1999). Relapse Prevention.
. Larimer, M. E., Palmer, R. S., & Marlatt, G. A. (1999). Relapse prevention. An overview of Marlatt’s cognitive-behavioral model. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism, 23(2), 151–160.
. Gielen, N., Krumeich, A., Tekelenburg, M., Nederkoorn, C., & Havermans, R. C. (2016). How patients perceive the relationship between trauma, substance abuse, craving, and relapse: A qualitative study. Journal of Substance Use, 21(5), 466–470.
. Alcohol and Drug Foundation. (2021, July 28). Isolation and Relapse.
. Kurosch Yazdi, Isabella Fuchs-Leitner, Jan Rosenleitner, and Nikolas W. Gerstgrasser. (2020, December 16). Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse. Frontiers in Psychiatry.
. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (third edition): How effective is drug addiction treatment?
*Terms and conditions may apply; results may vary.