Is Relapse a Decision?

Author: Caitlin Boyd

People with alcohol addiction often relapse, especially during their early recovery.¹ Relapse doesn’t mean that treatment has failed, and it’s not a sign of personal weakness. It is possible, with help, to make positive decisions that support long-term recovery and make avoiding relapse less difficult in the future.

In this article:

How Does Alcohol Addiction Change the Brain?
Are Relapses Preventable?
How Can I Make Choices That Support My Sobriety?
What Should I Do if I Relapse?

How Does Alcohol Addiction Change the Brain?

Recovery is challenging, especially initially. Some people give up their jobs or change living situations to attend inpatient rehab. After leaving rehab, they might have trouble returning to their previous lives. People in this situation can feel alienated from their old social circle. They may feel lonely, uprooted, frustrated, or even bored. These emotional struggles can increase the risk of relapse.²

Neurochemical changes can also play a role. Addiction alters brain chemistry, and these changes can persist for several months.³ Alcohol use hijacks the brain’s reward pathways. With chronic alcohol use, the brain produces large amounts of serotonin and dopamine, which are chemicals related to mood and stress regulation.⁴ After entering recovery, you may experience lower levels of these chemicals.

Medication can help bridge the gap, but some people experience temporary depression or anxiety. You may vividly remember that alcohol use came with pleasant physical, mental, or emotional effects. You can experience physical cravings related to altered brain chemistry or psychological cravings relating to a desire to feel that way again. These symptoms are normal, and a recovery team can help you cope with these cravings.³

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Are Relapses Preventable?

Addiction is a medical condition.⁵ Psychological and physiological factors outside of your control can trigger a relapse, but treatment can help you regain sobriety. If you have a loved one in addiction treatment, it’s important to acknowledge that they will not avoid relapse through willpower alone and that a relapse does not necessarily mean anything about whether they want to recover.

If relapse occurs, you may feel discouraged and hopeless. Remember that relapse isn’t a sign of personal failure. You can recover from this setback and continue to abstain from alcohol and complete other harm reduction measures that help you progress in recovery.⁶ Your recovery team can help with this process. After a relapse, your recovery team can help you identify your unique risk factors, determine what triggered the relapse, and work with you to prevent future relapses.

People in recovery face a variety of challenges. While you can’t control chemical changes in your brain, you can come to control how you respond to feelings of loneliness, boredom, and sadness. Mental health treatment and support groups provide stability, especially during early recovery and times of crisis. Medication can help alleviate depressive symptoms, while recovery groups provide companionship.⁶ With the right coping strategies, people can learn to manage their cravings. They can reduce their risk of relapse by making positive decisions daily.

The Power of Seemingly Irrelevant Decisions (SIDs)

During addiction treatment, you may learn to watch out for SIDs that may jeopardize their recovery. SIDs can be deceptive since these decisions may seem unrelated to alcohol or drug use. But over time, SIDs might increase the chance of relapse.

Common SIDs include:^7,8,9

Maintaining friendships with people who are still using substances—Staying close with individuals who currently misuse substances increases your risk of relapse. In these relationships, you are more likely to be exposed to substances and paraphernalia.
Keeping alcohol, drugs, or paraphernalia in the house—You may decide to keep alcohol, mixology tools, or substance paraphernalia in your home for any number of reasons, including the simple fact that it belongs to someone other than you. However, having these items on hand reduces the time you have to make a different decision when you are at high risk of imminent relapse.
Visiting places where you once used drugs and alcohol—Returning to locations that have a powerful psychological association with alcohol use can be overwhelming, especially in early recovery. Triggering settings have been linked to a risk of relapse.
Keeping your addiction and recovery a secret—Secrecy is linked to an increased risk of relapse in some cases. When it is safe to do so, disclosing the fact that you are in alcohol addiction recovery to trusted loved ones can reduce the risk that they will inadvertently put you in a triggering situation, offer you alcohol, pressure you to use alcohol, or hold triggering conversations around you.
Keeping loved ones at a distance—If you have the ability to confide in supportive loved ones, these individuals can help you stay accountable, provide a buffer with less supportive friends or family members, and help you recover if you do relapse. While it can seem embarrassing or unnecessary to discuss your recovery with others, having no social support is associated with a higher risk of relapse.
Neglecting to build friendships with others in recovery—Even if you do not currently have a supportive social circle, you can build one in addiction treatment or peer support groups. Finding sober friends is an important safeguard against relapse.

How Can I Make Choices that Support My Sobriety?

People who are committed to their recovery can still relapse. Often, these individuals make one crucial mistake: they place themselves in a situation where staying sober becomes progressively more difficult, such as a location with an open bar.¹ People in recovery can support their sobriety by avoiding vulnerable situations. Relapse prevention plans and recovery activities can help with this process.

Relapse Prevention Plans

A relapse prevention plan outlines the choices you can make when you feel the urge to use alcohol.⁸ Each person’s relapse prevention plan will look different. Your relapse prevention plan might include items like:

Avoid the restaurants and bars where I used to drink.
Meet my friends and family at establishments that don’t serve alcohol.
Limit contact with people who are still using alcohol to excess.
Take a trusted sobriety partner with me when I attend parties.
Share the news of my recovery with friends and family.
Attend recovery meetings once a week, several times a week, or daily.
Speak to my Alcoholics Anonymous (AA) sponsor daily and reach out for support when I’m tempted to use alcohol.
Schedule sober activities on evenings and weekends.

Your care team can also help you create a personalized relapse prevention plan. Addiction specialists understand the factors that may increase your chance of relapse. They can discuss stumbling blocks that you might not have anticipated. The team can help you to make choices that support long-term recovery.

A clinician, such as your therapist, may help you learn relapse prevention skills you can add to your prevention plan. For example, some therapists use dialectical behavioral therapy (DBT) exercises for individuals in addiction recovery. The DBT concept of the opposite action acknowledges an urge you may be feeling, what might occur if you acted out the urge, and then involves taking an “opposite action” against the urge.

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Recovery Activities

As you pursue recovery, it may be helpful to play an active role in the recovery community, such as attending peer support groups. Newcomers sometimes feel nervous, shy, or embarrassed during recovery meetings. They may hesitate to speak up at meetings, seek out a sponsor, or find a friend. But over time, choices that keep you isolated in group situations may lead to relapse. People who fail to participate in the group may feel like outsiders. They may believe that they “don’t belong” in recovery. Sometimes, they may feel that other members don’t care about their struggles.¹⁰Support groups like AA encourage participation during meetings and your local AA community may hold additional activities as well.

Participating in recovery groups can help you develop a new social circle. You may feel more comfortable attending meetings after you have some friends in the group. Recovery groups are also a great resource for people who have a limited support system.¹⁰ They can offer a safe place to spend weekends, holidays, and special events. Many recovery groups schedule round-the-clock meetings during major holidays. Some groups may also schedule events on the weekends.

People in recovery can also reduce their risk of relapse by scheduling events and activities in advance. You may find hikes, lunches, or visits to a local coffee shop through your recovery groups.

In addition to recovery-focused activities, you can participate in any sober activity, especially if it helps you feel empowered, hopeful, connected, motivated, or inspired. Take a walk with a friend or visit a museum with a family member. Join a pottery class or sign up for second language lessons. Many public libraries offer free and low-cost activities.¹¹ Feeling purposeful and connected to your community can help prevent relapse and help you progress in your recovery.

What Should I Do if I Relapse?

Avoiding relapse isn’t easy. Most people with alcohol use disorder need external help maintaining their sobriety at some point in their recovery journey.⁶ If you relapse, reach out for support. A therapist, sponsor, rehab center, or support group can help.

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Resources

Melemis, S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale Journal of Biology and Medicine, 88(3), 325–332.
Hosseinbor, M., Yassini Ardekani, S. M., Bakhshani, S., & Bakhshani, S. (2014). Emotional and social loneliness in individuals with and without substance dependence disorder. International Journal of High Risk Behaviors and Addiction, 3(3).
National Institute On Drug Abuse. (2018). Drugs and the Brain.
National Institute On Drug Abuse. (2012, August 3). Brain and Addiction.
National Institute On Drug Abuse. (2015, July 29). Addiction Science.
National Institute On Drug Abuse. (2018). Treatment and Recovery.
Yale University School of Medicine. Chapter Six – Preventing Relapse to Risky Behavior: Recovery as a Journey. Introduction to Holistic Health Recovery Program (HHRP).
S. Department of Veterans Affairs. Reducing Relapse Risk. Whole Health Library.
S. Department of Health and Human Services. Alcohol and Drug Addition Happens in the Best of Families.
Dingle, G. A., Cruwys, T., & Frings, D. (2015). Social identities as pathways into and out of addiction. Frontiers in Psychology, 6.
Pew Research Center (2013). Part 4: What people want from their libraries. Library services in the digital age.
National Institute on Drug Abuse. (2019). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.