Alcohol Relapse: A Complete Guide to Relapse Prevention

Last Updated: April 9, 2020

Authored by Nena Messina, Ph.D.

The hope of every person who is recovering from alcohol addiction is that alcoholism relapse won’t happen. In this guide we’ll investigate what alcohol relapse is and how to avoid it effectively.

Some say that the biggest struggle begins once the former alcoholic leaves the alcohol rehab center. The minute that the patient walks out the door of the rehab facility, he or she is faced with familiar situations and triggers that can lead to a relapse.

Alcohol Relapse Overview

One’s perspective of relapse depends on one’s definition of recovery. Any kind of substance use following a period of abstinence can be considered a relapse. In the past, old-school treatment models sometimes considered relapse as grounds for termination of treatment. This would mean failure and implied the alcoholic was hopeless, but that is not usually the case anymore.Alcohol Addiction Relapse
Currently, the definition of relapse means to slip back into a former state or practice after a period of abstinence from substance abuse. However, the meaning of relapse in recovery-oriented systems of care is getting a make-over. In fact, it is now recognized that for some recovering alcoholics, relapse is part of recovery.
These days, less than 20% of patients remain abstinent for a full year. This is in treatment facilities for people with alcohol use disorder. Those with 2 years of sobriety under their belts have a relapse rate of 40%. In addition, those with 5 years of sobriety, while likely to remain sober, are still at risk for relapse.

Quick Answers About Alcohol Relapse

What are the warning signs of alcohol relapse and how to prevent it?

Warning signs of a relapse include anxiety, anger, defensiveness, mood swings, and isolation.
Medical professionals recognize that there are three possible aspects to an alcoholic relapse: emotional, mental, and physical. The emotional relapse involves the familiar compulsion to drink due to stress and emotional triggers. The mental relapse involves seriously thinking about drinking. Finally, physical relapse involves actually returning to alcohol use and dependence.
To prevent a relapse, one should be aware of warning signs and create a relapse prevention plan. If one is prepared, they will be able to quickly identify when they are in a poor mental state and should ask for help. One will have a strong support network to rely on.

What is a relapse prevention plan?

A relapse prevention plan is a set of guidelines designed to help prevent relapses. A good relapse prevention plan will help to recognize possible triggers and warning signs and prepare for what to do if one experiences triggers or cravings. Begin by building a support network of family, friends, and groups. Know who to call if one gets into trouble; and maintain an active, healthy lifestyle.

Stages of Alcohol Relapse

It is very important to note that a relapse is not an event but rather a process.
More than likely, a person will not spontaneously decide to start drinking again without any warning signs. Initial symptoms will emerge and show that the person is heading towards a relapse. Early symptoms of an oncoming relapse may include anxiety, anger, defensiveness, mood swings, and isolation. The sooner these manifestations are recognized, the higher the chances that a relapse can be avoided. While working with alcohol abusers, professionals differentiate between the three following stages of relapse:

  • Emotional relapse
  • Mental relapse
  • Physical relapse

Prevention is easiest and most effective during the emotional relapse stage. During this period a person’s emotions, usually triggered by stress, have begun to direct the person’s mindset towards familiar unhealthy coping mechanisms.

What To do To Set The Life Back On The Right Track?

To prevent a relapse, first and foremost, take care of physical health. Eat well and make sure to get enough sleep. Try to identify the reasons for turbulent emotions and feelings of stress. Ask for help from others in recovery or from addiction professionals.
If the negative feelings persist, they can lead to the second stage—mental relapse. During a mental relapse, a person begins to seriously think about using again. In this stage, the person may start questioning why they quit in the first place.

So, what course of action to take?

  • To constantly remind oneself that there is no such thing as “just one drink.” Saying “No!” will require a lot of self-control but, ultimately, refusing the drink is the only way to help prevent the urge to drink in the future.
  • One method for refusing to drink is to make a list of pros and cons. Write down every positive and negative effect of drinking to help to realize that the drawbacks far outweigh the benefits.
  • Additionally, opening up about the inner struggle with a loved ones, a counselor, or an AA support group can be very beneficial.

One of the policies of AA is to go through just one day at a time without drinking. This policy, though obvious, is the best advice one can get at this point. Start each day by making a conscious decision not to drink for the next 24 hours. Additionally, try not to think about alcohol—occupy oneself with constructive and time-consuming activities that will distract from focusing on alcohol use.
If a person fails to conduct any of these strategies, a physical relapse is bound to take place. At the point of physical relapse, the urge to drink is almost impossible to resist. Once an addict has relapsed, the only thing left to do is restart the recovery process from scratch. To mitigate the situation, contact the counselor or the support group. The support of professionals will help to achieve sobriety and minimize the damage.

Planning for a Relapse: Creating Alcohol Relapse Prevention Plan

relapse prevetion plan creation
The purpose of planning what to do if one starts to have signs of relapse is to build awareness of triggers that may cause to revert to former behaviors. Make a plan on how to deal with these triggers in advance. By doing this, one will be able to cope if or when they occur and work through the triggers. Indeed, recovery plans that include relapse prevention are most likely to succeed.
Once starting the rehabilitation process, a person has to think ahead and create a relapse prevention plan. They can do it by themselves, or with the help of counselor.
Here are some guidelines for making a good relapse prevention plan:

  1. Look out for patterns, triggers, and situations that have caused to relapse in the past. Think about all the bad consequences of a relapse, and how that would make one feels. Write it down, so it can be a reminder if one ever starts to think about drinking again.
  2. Look out for warning signs. This step requires to identify small changes in the life that cause a butterfly effect and push a person down the hill. Make a plan to avoid these types of changes. If one tends to relapse after experiencing stress, try to avoid specific stressful situations.
  3. Build a support network. The counselor or AA group can help with this. Surround a recovering person with people who love them and who can help in a time of need. It can be helpful to find a sober companion or sponsor—that one person who will constantly remind to stay on the right track.
  4. Make an emergency relapse plan and give it to the sober companion, sponsor or someone else whom a recovering person can trust. This person will be the emergency contact.
  5. And lastly, get busy! Engage in activities, take care, find a hobby or join the gym. These new pursuits will cause the body to release endorphins and make a recovering person to feel much better.

Recovery planning

  • Approach alcohol recovery as whole health recovery.
  • Involve treatment team and support others.
  • Write down the recovery plan and distribute copies to those who will be offering support. Currently, there are many examples of recovery plans online that can serve as a guide.

Build protective factors

  • Expand recovery focus to include whole health and wellness.
  • Assess the recovery capital. This is to determine the resources at the disposal and resources one needs to build upon.
  • Increase the circle of support to include those who actively support the recovery.
  • Build proactive coping skills.
  • Increase the self-efficacy by recognizing success in all areas of wellness.

Recommendations for family members

  • Participate in the evaluation of relapse incidents without judgment. Do this by separating the person from alcohol misuse.
  • Help the person in recovery focus on what they did right.
  • Encourage them to persevere.
  • Help them focus on what they can learn from a relapse incident.
  • Supporting someone through recovery can be taxing. Make sure to have a support network and self-care system.

Who is Likely to Relapse to Alcohol?

First, anyone can relapse. Recovery is a tough journey. Recovery from alcohol misuse can be very challenging.
Some risk factors for relapse:

  • Easy access and availability of alcohol.
  • Early initiation of alcohol use.
  • A family history of alcohol misuse and/or genetic predisposition.
  • Not obtaining treatment or outside support.
  • Co-occurring mental health problems, mood disorders, and depression.
  • Fewer years of education.
  • Medical issues
  • Smoking
  • History of trauma

Incidentally, a person may be in treatment and doesn’t have any of the risk factors mentioned above, it does not mean they’ll soar through recovery without experiencing a relapse. Expect that it may happen. Plan for it to happen.
Anyone can relapse, but people who experience the following are most likely to relapse:

  • Early initiation of alcohol use
  • No treatment
  • No outside support
  • Co-occurring mental health problems
  • Medical problems
  • People who smoke

What are the early signs of a relapse?

The signs of impending relapse include:

  • Remembering the past when a person was still an addict.
  • Canceling visits to support group meetings.
  • Reaching out again to former drinking companions.
  • Thinking of enjoying the taste of liquor again.
  • Ignoring people who help to stay sober.
  • Rejection of constructive criticism

Dealing With Alcohol Relapse

what to do in case of relapse
Relapse is a part of alcohol addiction. Alcoholism is like any other chronic health condition. A medical doctor figured out the best regimen for chronic disease management. In this case, it was through trial and error. As a result, we can say the evaluation of relapse incidents is an important part of recovery.

  • Assess incidents of relapse without judgment or bias.
  • Involve as many supportive others as possible in the evaluation.
  • Focus on what we can learn from the incident.
  • Learn from mistakes and plan for them.
  • Consider what went well during the relapse incident. Indeed, celebrate victories, no matter how small.
  • Write down new strategies in the recovery plan.
  • Keep on keeping on. Stay with it. Don’t give up.

Alcohol Relapse Treatment

Presently, alcohol use and misuse is widespread and even encouraged in American culture. However, recovery is possible. This is despite the many who find themselves struggling with alcohol addiction. Recovery has the most opportunities for success when one focuses on overall health and treat alcoholism as a chronic condition. For many people, relapse is a natural part of recovery.
In summary, some things can ease difficulties associated with a relapse. They are proactive planning and nonjudgmental assessment, which can increase the likelihood of recovery success.
If the relapse does occur, do not despair; this only means that the relapse prevention plan needs some changes, and a recovering person can learn from their mistakes. Pay attention to warning signs of possible relapse, and ask for help when there is a feeling of a need to pick up a drink. Relapse doesn’t mean failure; it just means there is more to learn on the road to recovery.

Page Sources

  1. Melemis SM. Relapse Prevention and the Five Rules of Recovery. Yale J Biol Med. 2015. 325-32.
  2. Durazzo TC, Meyerhoff DJ. Psychiatric, Demographic, and Brain Morphological Predictors of Relapse After Treatment for an Alcohol Use Disorder. Alcohol Clin Exp Res. 2017 Jan;41(1):107-116.

Published on: March 9th, 2018

Updated on: April 9th, 2020

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.


Leave a comment

  • Nima
    Hi I have a friend who had a relapse. She was clean for a year and all of a sudden she started drinking and smoking . When this happens her anger is so high … raising voices and everyone has to live by her rules . How can I assist her over anger ?