Alcohol Relapse: Stages, Risks & Treatment Options

Last updated on December 5, 2022

Since alcohol dependence is a chronic illness with social, psychological, and physical aspects, addressing it requires a proper combination of approaches. Finding the ideal combination of methods for each patient can take some time. There are no easy fixes for most of the underlying problems that lead to addiction, so relapses are a common occurrence.1

Each person has a unique experience with dependency, treatment, and recovery. For example, one person might only need a single treatment program to successfully quit drinking or using other drugs. In contrast, another one could need five, six, or more. This is why recovery management considers the unique requirements of each person attempting to achieve sobriety.1

Alcohol relapse rates for individuals who enter recovery are similar to those of other chronic illnesses. Some studies suggest that about 40-60% of individuals relapse within 30 days of leaving a residential substance abuse treatment center, and up to 85% relapse within the first year.2

Even though these alcohol relapse statistics may sound discouraging, acknowledging the elevated risk for relapse is essential for recovery. Understanding the reasons behind relapse, being aware of personal triggers, and learning to cope with the emotions they bring can help individuals prepare better for maintaining sobriety.3

What Is Alcohol Relapse?

Relapse occurs when a person gives up on their goal of cutting back or stopping the use of alcohol and resumes their prior levels of use. It’s a setback in one’s journey toward lasting recovery from alcohol abuse or addiction. Some people experience a relapse during their treatment, while others may achieve long-term sobriety before going back to the use of alcohol or drugs.2

Relapse usually occurs when a person is going through a particularly stressful or emotionally challenging period in their life. It can be caused by the death of a loved one, divorce, losing a job, or any other type of traumatic event or significant life change. People who suffer from co-occurring mental health conditions may be more prone to relapse due to the connection between the two. Worsening psychological issues may cause them to go back to drinking.4

What Are the Stages of Relapse?

Relapse doesn’t usually happen unexpectedly. People who have managed to maintain sobriety for a while generally adhere to a set of alcohol relapse prevention measures to keep their addiction under control. Starting to avoid some of them can gradually lead to a relapse. That’s why it’s essential to be able to recognize warning signs and stages of alcohol addiction, as well as those leading up to relapse. Some studies suggest that relapse happens gradually in several stages:5

The stage of emotional relapse doesn’t mean that the person in question intends to use alcohol again. On the contrary, during this phase, people are usually frightened of the possibility of using alcohol again. Still, other aspects of their life and behavior may set them up for failure. For example, they might not be taking good care of themselves, they could be isolating themselves from people, not expressing their emotions, and avoiding recovery meetings and support groups like AA. This lack of self-care may involve unhealthy eating habits, dysregulated sleeping patterns, or disregarding other needs and feelings.
Mental relapse is easier to recognize. During this phase, people start actively thinking about using alcohol, and resisting the urge to drink may become more complex. This phase is typically punctuated by moments of intense craving to drink again and thinking about people and places they associate with previous alcohol use. They may even start minimizing the consequences of prior use. Thinking about ways to drink alcohol in a controlled manner (only 1 or 2 drinks in certain situations, for example) is also typical of this phase.
Physical relapse is the final stage of this process, and it means that the person has actually started to consume alcohol again. People can have ‘slips,’ meaning they relapse for a brief period or drink only on a single occasion. But it may also lead to a full-blown return to alcohol abuse. When this happens, there is no more control over the amounts or frequency of drinking. As a result, the alcohol abuse patterns can become severe again and require additional treatment.

Signs and Symptoms of Alcohol Relapse

If you or someone you love is recovering from alcohol addiction, it’s essential to know how to identify the most common signs and symptoms leading to alcohol relapse. You can take steps to prevent a full-blown relapse if you can spot them. Patterns of behavior that can serve as red flags that someone has gone back to abusing alcohol include:6, 7

Attitude changes.
Heightened stress levels.
Withdrawal symptoms reappearing.
Isolating oneself from others and avoiding support group meetings.
Making excuses not to socialize.
Daily routine breakdown, poor self-care, unregular sleeping or eating patterns.
Poor personal hygiene.
Easily getting overwhelmed, stressed, or angry.
Having trouble controlling actions, making irrational choices.
Not going to therapy or counseling sessions, as well as AA or other support group meetings.
Stopping the use of maintenance medication.

What Are the Common Triggers of Alcohol Relapse?

Some people may experience the urge to drink for a long time after they complete their alcohol abuse treatment program. However, the rehab they completed equips them with the skills and tools to resist those cravings and fight off the triggers that are bound to appear in their everyday life. Controlling or avoiding those triggers can help prevent alcohol relapse and maintain lasting sobriety. To be able to do that, it is essential to know how to identify those triggers.8

A variety of different things can act as triggers when it comes to alcohol addiction. It could be a place, a person, an emotional state, and many other things connected to past alcohol abuse. This happens because prolonged substance use causes lasting changes to the brain by releasing a chemical called dopamine. Since dopamine creates a feeling of pleasure, the brain gets conditioned into paying attention to things connected to alcohol and the effects it produces.8

Some of the most common triggers to look out for are:6

People you used to drink with. It could be family members, some of your closest friends, or even a partner or a spouse.
Places or locations where you used to consume alcohol, like bars, clubs, or other social settings, like watching a sporting event with your friends.
Things can also be triggers, like seeing bottles of alcohol, for example.
Times like holidays, birthdays, anniversaries, and other special occasions when most people traditionally drink.
Emotions, particularly negative ones, cause stress. Arguments and disagreements are typical examples.
Other substances that you may have consumed together with alcohol, most commonly tobacco, cannabis, or other illicit drugs.

What Should I Do When I Relapse on Alcohol?

If you happen to relapse, you should try to fight the feeling of hopelessness and despair. Never forget that alcohol addiction is a chronic disease and needs to be treated as such. If you had an asthma attack, you wouldn’t hide it from the people in your life and give up on your health – you would seek professional help and do everything in your power to get better. The same goes for alcohol relapse.8

When it comes to your health, there’s no room for shame. Asking for professional help is the way to get better. Managing a relapse may require going back to treatment or, in less severe cases attending counseling sessions or participating in support groups like 12-step programs. It’s vital to keep reminding yourself of what you learned during your recovery treatment, if you attended one, and start applying those skills again to help you cope with distressing situations and emotions.8

If you’ve experienced a severe relapse, contacting a licensed substance abuse treatment provider is the best way to get help. You can get a recommendation from your primary care physician or call one of the addiction hotlines. Hotline representatives can perform an initial evaluation by asking questions and directing you to a suitable rehab center near you. You can also get general information about the treatment options and costs of addiction treatment.9

How to Prevent Relapse From Alcohol?

During any substance abuse treatment, people attend both group and individual counseling sessions. During those sessions, patients learn specific behavioral techniques and methods to help them prevent relapse after completing their recovery program. They usually include the following steps:10, 11, 12

Self-regulation consists of physical stabilization through suitable detox programs, but it also involves mental and emotional stabilization. This is achieved through a regular daily schedule, which includes therapy, physical activity, regular meals, and socializing.
Integration means identifying problematic thought patterns and behaviors and learning better ways to react to stressful situations, and integrating those new skills into your life.
Understanding the risk of relapse and that negative situations and emotions are bound to present themselves in one’s everyday life. The patient learns to recognize them and control the outcome, i.e., avoid relapse.
Self-knowledge is achieved by integrating the understanding of one’s emotional reactions and behaviors, which will, in turn, reduce the risk of relapse.
Coping skills are techniques the patient learns in therapy and uses to manage stress and negative emotions.
Change happens on behavioral, mental, and emotional levels as a result of acquiring self-knowledge and using coping skills to reduce the likelihood of relapse.
Awareness, sometimes called the daily inventory technique, is the time for reflection on everyday life experiences and how they affect one’s emotions and stress levels.
Significant others are friends and family who form the support system that helps the patient stay on track and continue with the positive changes. In addition, support groups, therapists, and doctors are also part of the support system.
Maintenance. All the above-listed techniques are practiced together as an alcohol relapse prevention plan. The plan can be revised and updated from time to time with guidance from the patient’s therapist or counselor. The patient can always go back to the plan to remember the necessary steps that help them stay healthy and sober.

How to Go Back to Treatment After a Relapse?

In case of a full alcohol relapse, a team of substance abuse and mental health specialists should perform an evaluation to determine the diagnosis and the best course of action. People with a long history of alcohol abuse and multiple attempts at recovery are usually referred to longer, inpatient treatment programs. The exact duration of the program and included services will depend on the severity of addiction and potential accompanying mental or physical health issues.3

Many people who are unable to maintain lasting sobriety are usually prescribed medication to help reduce cravings while they attend therapy sessions and other parts of treatment. Three FDA-approved drugs are used to treat alcohol use disorder (AUD). The most commonly prescribed ones are acamprosate and naltrexone. Both are used to stop alcohol cravings and should be taken consistently. They deter patients from drinking by preventing the pleasurable effects people get from alcohol.4

However, medication is just an additional tool, not the whole treatment itself.

What Are the Treatment Options After Alcohol Relapse?

After a thorough evaluation, treatment-seeking individuals undergo a detoxification process that can last anywhere from 2-3 days up to a week. Since the withdrawal symptoms are often unpleasant, sometimes even life-threatening, patients are usually medically monitored for a few days, and appropriate pharmacotherapy is applied to mitigate the symptoms.10

After the detoxification, patients are referred to appropriate substance abuse treatment programs that are personally tailored to their individual needs but commonly include:11

Therapy or counseling sessions.
Support groups that provide fellowship and the feeling of belonging.
AA meetings or other types of 12-step programs, including non-faith-based options.
Alternative types of therapy programs that could be beneficial for specific patient groups.