What is Alcoholic Relapse and What to Do After

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If you or someone you know has alcohol use disorder (AUD) and has relapsed, this is a common occurrence. You can take steps to get back on track after an alcoholic relapse has occurred, and you can watch for warning signs that you might need more intensive intervention.

In this article:

• What is the Difference Between Sobriety and Recovery?
• Alcoholic Relapse Defined
• Warning Signs of Alcoholic Relapse
• Is Relapse Part of Recovery?
• What to Do After an Alcoholic Relapse
• When to Seek Help

What is the Difference Between Sobriety and Recovery?

Sobriety

While they may seem like two simple and very similar words, there is a significant difference between being sober and being in recovery. In short, being sober simply means not using alcohol or other substances but not necessarily recovered in other ways.

You may have heard of the term “dry drunk.” Created by one of the founders of Alcoholics Anonymous (AA), this term often is reserved for people who have made the decision to stop consuming alcohol but have yet to work on both internal and external factors that might have caused the AUD. You may find—besides stopping alcohol consumption—other negative behaviors and feelings still exist because they have not been addressed in a healthy way. Your relationships may become even more strained, as some friends and family members who considered you to be “fun” while you were drinking now perceive you unpleasantly.

Recovery

If you are in recovery, it will look very different from simply being sober. Being in recovery means you understand the disease of addiction and are taking the steps to address factors that led to alcohol misuse. This requires active participation. Most people in recovery will be in some sort of support group, whether that be AA, SMART recovery, or some equivalent. You may also engage in prosocial behaviors that could include:

• Volunteer work
• Advocacy
• Public speaking

In recovery, you will understand what led you to consume alcohol in the first place and work to rectify maladaptive behaviors. Although many people in recovery are abstinent from all substances, some people take a harm-reductive approach to recovery, which means they may not be abstinent from all substances (e.g., someone in recovery from alcohol misuse may smoke marijuana or drink in moderation).

While no path in recovery is a straight line, a person in recovery actively attempts abstinence, harm-reduction education, and application of said education.

Alcoholic Relapse Defined

Often, the initial image of relapse you may imagine is when a person either in short– or long-term recovery starts drinking again. While this is true, much more goes into a relapse than just drinking or using substances again.

What is Relapse Under an Abstinence Model?

The term abstinence refers to a situation when you have decided to refrain from all substances as part of your recovery journey. This includes all drugs, even ones that can help with substance or alcohol misuse, such as Vivitrol.

When you relapse under an abstinence model, it means you have returned to using a substance, which usually is your previous drug or alcoholic beverage of choice. The abstinence model is most known and is referred to outside of the treatment community, but treatment facilities will vary their stances regarding abstinence-based models. It is, however, an effective strategy in the achievement of long-term recovery.¹

What is Relapse Under a Harm-Reductive Model?

The term harm reduction is becoming more accepted in the world of recovery. Harm reduction usually implies that you still desire sobriety; however, you seek it in a different fashion. For example, you could be using marijuana to combat an opioid addiction, which is still being assessed by the Food and Drug Administration (FDA) to see if it is an appropriate treatment.² Another example could be using Vivitrol, Naloxone, or even Antabuse for alcohol use disorder treatment.

You may also put yourself under another kind of harm-reductive model when working toward sobriety by reducing severity or frequency of use. For instance, you might switch from hard alcohol to beer with lower alcohol content or maybe reduce your drinking from six days a week to two.

If you relapse while operating under a harm-reduction model, it usually means you have gone back to the previous substance you used with the same amount of frequency that you originally tried to reduce or replace.

Warning Signs of Alcoholic Relapse

The process of relapse usually begins well before the relapse itself takes place. Triggers and negative patterns of thinking may cause you to go back and forth: On the one hand, you do not want to pick up the substances you are trying to avoid, but on the other hand, you may experience intrusive thoughts or cravings.³ This is a normal situation to find yourself in, as persistent thoughts or cravings are the very nature of substance use disorders—so much so that professionals recognize three associated stages.

What are the Stages of Relapse?

Alcoholic relapse has both cognitive and physical components, borne out in three stages: emotional, mental, and physical.

Emotional relapse is closely related to denial. Persons who suffer from addiction avoid thinking about previous relapses to prevent themselves from repeating the incident. This struggle has a few associated signs to look out for: ³

• Isolation from others
• Emotional bottling or repression
• Inadequate sleep or eating habits
• Being physically or mentally absent from meetings
• Focusing on others’ problems or reactions

A critical step in overcoming this stage of relapse is to practice self-care in its physical, psychological, and emotional aspects. This means making time for eating, sleeping, and having fun, as well as behaving kind enough toward yourself that you permit yourself these necessities.

Practicing poor self-care tends to transition to the second stage, which is mental relapse. This stage is characterized by bargaining (e.g., “It is okay if I use while on vacation”) and a state of mental warring within oneself. Signs of this stage can include: ³

• Recollecting times, places, or people involved with past use
• Scheming how to control your use
• Cravings for substances
• Romanticizing past use or diminishing its negative consequences
• Making excuses or bargains for use
• Plans for relapse

This can result in a final physical relapse, wherein a person resumes their prior use habits. Often this is enabled by “opportunities” wherein a person feels able and willing to use substances without the consequence of being caught.³

Is Relapse Part of Recovery?

While many people in recovery are able to maintain abstinence in the long run, relapse can be a common part of the recovery process.⁴ When you are in recovery, you may feel shame or guilt during a relapse, as it may cause feelings of failure or letting down either yourself or someone else.⁵ That said, experiencing a relapse does not mean that you are any less committed to overcoming addiction, and it does not necessarily prevent a positive long-term outcome.

Working in recovery is hard. Many times, when you relapse, several factors are at play—thoughts, feelings, or situations that impacted you before picking up the substance again, leading to the relapse.³ For your recovery to be successful, you should identify what these factors are for your specific situation.

When you have been in recovery for a short time, you might relapse due to:

• Physical cravings
• Not knowing how to have fun with other activities
• Social pressure from peer groups

If you have been in recovery for a longer period, you might have different relapse triggers such as: ³

• In the effort to leave substance use disorders in the past, you may stop behaviors that help you in recovery, such as AA meetings.
• As you feel better in your recovery, self-care begins to take a less prominent role, placing more stress on you.
• You may begin to think there is nothing left to gain from being active in the recovery community, as you may assume you have learned all there is to know.

A relapse can be a one-off event or even a short-term situation, but it is a part of your recovery. Most, if not all, people who have relapsed will say that during each relapse they learn something about themselves. Each time you come back to active recovery, you implement what you have learned to continue on your recovery journey.

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What to Do After an Alcoholic Relapse

You almost certainly have heard of the term “falling off the wagon,” so how do you essentially get back on it, and what can you do to stay on it?

Immediately After a Relapse

If you have relapsed, stop using the substance as quickly as possible. The longer you continue to use, the more complicated it can become to stop using, especially if it is a substance on which your body can become physically dependent, such as alcohol.

Immediately after a relapse, you should contact your support network to assemble a game plan. If you do not have a network of supportive people, you should try to find one; fortunately, you have options. You may use AA, SMART Recovery, or other support groups to help you in this process. Alternatively, you may start to look into more formal treatment.

Another immediate need you should fulfill following a relapse is a safe living environment. If your living arrangements are neither safe nor conducive to recovery, please consider alternative arrangements.

Long-Term Goals

After you address the immediate needs of a relapse, you can begin the longer-term work. This may be weeks, months, and even years down the road. You should always work towards your goals in an achievable way. While it is fine to have long-term goals, making smaller achievable goals will be incredibly beneficial to your long-term achievement. There are five basic rules you can follow to help achieve long-term sobriety, including:³

• Change your life: Look at what is not working and work to change it.
• Be completely honest: This may require a hard look at current choices and behaviors.
• Ask for help: There is nothing wrong with asking your support network for help.
• Practice self-care: Self-care is critical to recovery.
• Do not bend the rules: This one can be difficult, but bending rules often leads to a relapse.

The idea behind these rules is that it requires honesty and the ability to understand the nature of addiction and what that looks like for you.

When to Seek Help

At times, excessive or prolonged relapses may not only threaten the success of your long-term recovery but may indicate that you need external assistance in maintaining your sobriety so you can be successful in recovery. Some indicators that might show you may need outside intervention include:⁴

• Intrusive thoughts or cravings
• Consistent depression, anxiety, or feelings of guilt
• Trouble finding or wanting support
• Unsafe living arrangements or living arrangements that do not support sobriety

This is a small list, but any of the points on it would be good signs that you may need outside intervention. You can start with AA. However, you may find that you need professional treatment and intensive care, such as through an inpatient treatment program. If you aren’t sure whether you need treatment or not, a provider can conduct an assessment to determine what level of care you need.

If you need help finding an alcohol addiction treatment program, call 800-948-8417 Who Answers? to speak with a treatment specialist who can help you navigate the treatment options appropriate for your situation.

Resources

1. Harrison, R., Van Hout, M.C., Cochrane, M., Eckley, L., Noonan, R., Timpson, H., and Sumnall, H. (2020). Experiences of Sustainable Abstinence-Based Recovery: an Exploratory Study of Three Recovery Communities (RC) in England. International Journal of Mental Health Addiction, 18, 640-657.
2. National Institute on Drug Abuse. (2021). Is Marijuana Safe and Effective as Medicine?
3. Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale Journal of Biology and Medicine, 88(3), 325-332.
4. National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for Alcohol Problems: Finding and Getting Help.
5. Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: a review. Substance abuse and rehabilitation, 10, 1–12. The association between perceived stigma and substance use disorder treatment outcomes: a review (nih.gov)