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Alcohol use disorder (AUD) is a common problem. Even with treatment, relapse happens often. Some people spend their entire lives battling alcohol use disorder and are never successful at preventing relapse. Some treatment programs even consider relapse a normal part of recovery.

Understanding relapse and how to deal with it makes it easier to get the help you need when battling alcohol use disorder. It also helps loved ones who are experiencing a relapse.

What is Relapse?

Relapse occurs when a person drinks alcohol again after a period of sobriety. Intense cravings or thoughts about alcohol might trigger someone to relapse. Stress or other problems in life often precede these cravings and urges to use.

After relying on alcohol to help you cope with problems in life, it can be difficult to not use it when faced with these challenges again.

According to the National Institute on Alcohol Abuse and Alcoholism, the relapse rate among those who complete treatment is approximately 90 percent. Because of this, many consider alcohol use disorder a chronic, relapsing disease. Some even believe alcoholics are powerless in preventing relapse and require ongoing treatment, even when things seem to be going well.

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What Causes Relapse?

The answer to this question varies as much as the individuals experiencing the relapse.

For many, relapse occurs after a series of events, including individual problems and negative situations, takes place. As the person becomes overwhelmed by emotions and events, he or she feels out of control and turns to alcohol for relief.

Other studies have indicated that shame and embarrassment play a role in relapse.

A 2013 study published in the journal Clinical Psychological Science, discovered that some people relapse because of their negative feelings about themselves. These people have an intrinsic belief that they are unable to change. Preventing relapse is impossible when a person believes he or she will fail.

Relapse Risks

Several things increase someone’s likelihood to relapse or indicate a relapse is about to occur, including:

  • Physical withdrawal symptoms
  • Anxiety
  • Stress
  • Dysphoria, which is a feeling of being dissatisfied with life
  • Anhedonia, which is the inability to experience pleasure in life
  • Limited or no support from family or friends
  • Failure to participate in recovery aftercare, including counseling and/or 12-step programs
  • Falling back into old habits
  • Not using coping skills to redirect thoughts or urges to use

What to Do If You Experience Relapse

Medical professionals recommend anyone experiencing a relapse avoid self-criticism and seek support. Support might include:

  • Attending a 12-step meeting or increasing how frequently you attend meetings if you are currently involved in a program
  • Beginning individual and/or group counseling
  • Remaining objective and honest about your situation

There is a certain degree of shame that occurs when someone relapses. However, thinking “I’m a bad person because I started drinking alcohol again,” is all-or-nothing thinking that does not help. Whether or not relapse is a normal part of recovery is debatable, but there is no debate that it does occur. It’s best to accept it and seek the help that is needed for preventing relapse from occurring again.

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Relapse Prevention for Alcoholism

One of the best tools available for preventing relapse is treatment for alcohol use disorder. Treatment is effective for preventing relapse and for helping a person when it does occur. The support system in place after a relapse (counselors, psychiatrists, psychologists, sponsors, friends, and family) should advocate for treatment following the relapse.

Someone with alcohol use disorder should see treatment not as a sign of weakness, but as a tool for recovery.

Despite the effectiveness of treatment, some people struggling with addiction don’t want to participate. There are several reasons for this:

  • Denial and believing help is not necessary
  • Assuming treatment won’t work, either because of their flaws or flawed programs
  • Making excuses for attending treatment by claiming they can’t afford it or don’t have time
  • Giving in to negative feelings and self-talk

Creating Effective Relapse Prevention Strategies for Alcoholism

Adopting a plan for preventing relapse is one of the best ways to avoid relapsing. There are different schools of thought on what to include in a relapse prevention plan. According to T. Gorski, a comprehensive plan should include:

  • Stabilization. The person must be sober and focus on remaining sober each day.
  • Assessment. This involves looking at a person’s history and considering drug and alcohol use throughout his or her lifetime.
  • Relapse education. This includes learning that relapse is normal and should not provoke shame.
  • Warning sign identification. This involves identifying a person’s triggers and understanding that it’s typically a combination of factors.
  • Recovery planning. This includes attendance at AA meetings and working with a sponsor. This includes increasing AA attendance or getting in touch with a sponsor.
  • Inventory training. This includes taking a daily mental inventory to look for warning signs of relapse.
  • Family involvement. This involves asking family members and friends for support. This might include attendance at Al-Anon meetings.
  • Follow up. This includes reviewing the plan periodically, especially during the first few weeks of sobriety.

Marlatt’s Cognitive-Behavioral Model, another relapse prevention model, is based on identifying potential risks or triggers for relapse. It requires working with a therapist to create the best response to those high-risk situations. This process includes a careful examination of each trigger and a plan for targeting weaknesses when faced with those triggers.

Finding an effective strategy for preventing relapse is an important part of recovery and should be a goal of anyone who is struggling with alcohol use disorder or trying to support someone with AUD.

Treatment Options for Alcohol Abuse & Addiction

  • Inpatient Programs — Inpatient treatment is the most intensive and effective option for alcohol addiction treatment. These prograInpatient treatment is the most intensive and effective option for alcohol addiction treatment. These programs usually last 30, 60, or 90 days. However, they may be longer in some instances. Throughout an inpatient program, you will live on-site in a safe, substance-free environment. You will go through medically supervised detoxification first, then behavioral therapy and other services will be added to your regimen. Many of these treatment programs will assist you with an aftercare program afterward.
  • Partial Hospitalization Programs (PHPs) PHPs are the second most intensive alcohol addiction programs. They are sometimes referred to as intensive outpatient programs (IOPs). Partial hospitalization programs provide comparable services to inpatient programs. These may include detoxification, medical services, behavioral therapy, support groups, and other holistic or custom treatments. The main difference between PHPs and inpatient programs is that you return home and sleep at your house during a partial hospitalization program. Some PHPs provide food and transportation. However, this varies by program. PHPs are ideal for new patients, as well as patients who have completed an inpatient program and still require intensive treatment.
  • Outpatient Programs Outpatient programs are less intensive than inpatient programs and PHPs. They are best for people who are highly motivated to achieve sobriety and have responsibilities at work, home, or school. Outpatient treatment programs customize your treatment sessions around your schedule. Outpatient programs can help new patients achieve success. They may also be a part of aftercare programs once a patient completes an inpatient program or PHP.
  • Medication-Assisted Therapy (MAT) Certain patients qualify for medication-assisted therapy. Some medications can assist you throughout detoxification and withdrawal. Others can reduce cravings and normalize your bodily functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia and Vivitrol) are the most common medications used to treat AUD. MAT can help prevent relapse and increase your chance of recovery if combined with other therapies.
  • Support Groups Support groups are peer-led organizations made of people dedicated to helping each other stay sober. They can be the first step towards sobriety or a component of an aftercare plan. Many of these programs follow the 12-step approach.

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Resources

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“Alcohol Facts and Statistics.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 18 Feb. 2020, www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics.

Gorski, Terence T. The Gorski-CENAPS Model for Recovery and Relapse Prevention: a Comprehensive Overview of a Research-Based System That Works. Herald House/Independence Press, 2007.

Larimer, Mary E, et al. Relapse Prevention An Overview of Marlatt’s Cognitive-Behavioral Model. Vol. 23, no. 2, 1999, https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf

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