Understanding Relapse in Alcohol Dependence

Relapse is a complex phenomenon and a significant challenge in the treatment of Alcohol Use Disorder (AUD). Despite advances in psychological and pharmacological treatments, a considerable portion of individuals return to drinking after a period of abstinence. Estimates indicate that up to 60–70% of people may relapse within the first six months after treatment.¹ Understanding what characterizes a relapse, which factors increase its risk, and how to prevent it is essential for promoting long-term recovery.

What is relapse—and how does it differ from a lapse?

Although often used interchangeably, relapse and lapse represent different situations in the recovery process. A lapse is an isolated episode of alcohol use that may occur during recovery but does not necessarily imply a return to previous patterns of problematic drinking. A relapse, on the other hand, is understood as a broader process involving a return to a sustained and problematic pattern of alcohol consumption.

Studies highlight that relapse should be analyzed both as a discrete event (e.g., any alcohol use after a period of abstinence) and as a more complex process influenced by multiple factors over time. This distinction is important, as not every lapse leads to a relapse—and recognizing this can help avoid feelings of failure that might discourage continuation of treatment.

Factors that increase the risk of relapse

Research points to specific factors that significantly raise the risk of relapse.¹ One such factor is anhedonia, or the inability to feel pleasure in daily activities. Individuals with high levels of anhedonia are more likely to return to drinking after treatment. Another important factor is smoking: people who continue smoking during treatment for AUD have a higher risk of relapse compared to former smokers or non-smokers.

Additionally, the amount of time a person has been abstinent before starting treatment plays a relevant role. People who had stopped drinking more recently before beginning treatment showed higher relapse rates over the following months.

A study that monitored individuals in real time using Ecological Momentary Assessment (EMA) found that everyday stress is a direct trigger for relapse.³ Participants who reported high stress levels were more likely to drink in the hours that followed, indicating that stress acts as an immediate trigger—not just a general risk factor. The research also observed that as stress increased throughout the day, so did the craving to drink, suggesting that alcohol may be used as a way to relieve momentary tension, which reinforces the risk of relapse.

Prevention: What works?

Relapse prevention involves strategies that address the aforementioned risk factors. Interventions that treat depressive symptoms (such as anhedonia), encourage smoking cessation, and strengthen coping skills in stressful situations are especially effective. Ongoing support after the end of formal treatment is also crucial, helping to identify early warning signs and prevent a lapse from progressing into a full relapse. Understanding relapse as a process—rather than simply a “failure”—allows professionals and patients to develop more realistic, empathetic, and personalized recovery plans.

Relapse in alcohol use disorder is a common and multifaceted phenomenon that can be prevented with evidence-based strategies. Understanding the difference between a lapse and a relapse, identifying risk factors such as anhedonia, smoking, and short prior abstinence, and offering continuous support are key steps to building a more solid recovery. Relapse does not mean the end of the road—with the right support, it’s possible to get back on track with confidence and self-awareness.

References:

1. Nguyen, L. C., Durazzo, T. C., Dwyer, C. L., Rauch, A. A., Humphreys, K., Williams, L. M., & Padula, C. B. (2020). Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking. Journal of psychiatric research, 126, 1–7. https://doi.org/10.1016/j.jpsychires.2020.04.003
2. Reyes-Huerta, H. E., Vacio, Á., Pedroza, F., Salazar, M., & Martínez, K. (2018). The Recovery from Alcohol Consumption: Analysis of the Construct of Relapse. International journal of psychological research, 11(1), 70–82. https://doi.org/10.21500/20112084.3252
3. Eddie, D., Barr, M., Njeim, L., & Emery, N. (2021). Mean Versus Variability: Disentangling Stress Effects on Alcohol Lapses Among Individuals in the First Year of Alcohol Use Disorder Recovery. Journal of studies on alcohol and drugs, 82(5), 623–628. https://doi.org/10.15288/jsad.2021.82.623

Low Demand for Treatment Is One of the Obstacles in Combating Alcohol Dependence, Study Finds

Despite the wide availability of evidence-based treatments for mental and substance use disorders, most affected individuals still do not receive adequate care. The situation is particularly critical in the case of Alcohol Use Disorder (AUD), a highly prevalent condition marked by low treatment-seeking behavior, poor-quality care, and significant stigma.

Low Coverage of Effective Treatment for Alcohol Dependence

Recent data from the World Mental Health Survey, published in JAMA Psychiatry, reveal that only 1.4% of people with Alcohol Use Disorder received effective treatment in accordance with clinical guidelines.¹ The study analyzed information from more than 56,000 adults in 21 countries, using representative population samples and standardized household interviews based on the Composite International Diagnostic Interview (CIDI).

The methodology considered three levels of assessment in the so-called “coverage cascade”: (1) perceived need for treatment, (2) contact with health services, and (3) receipt of effective treatment, defined according to criteria of frequency, duration, and adherence for both psychotherapy and pharmacotherapy. In the case of AUD, the data indicated that only about one-third of affected individuals perceived a need for help, and an even smaller fraction actually sought or received treatment of a quality consistent with international guidelines.¹

Inequality of Access and Underutilization of Services

Low perception of the need for treatment, combined with social stigma and insufficient training among many health professionals, contributes to the undertreatment of AUD. A review published in The Lancet Psychiatry in 2022 reinforces this scenario, noting that fewer than 10% of patients with AUD in Europe receive any type of specialized intervention, even when they have a prior history of contact with health services.²

Impact of Simple and Timely Interventions

Studies also suggest that even brief interventions carried out during hospitalizations for other causes can reduce mortality and readmissions among people with alcohol and other substance dependence. One study showed that this type of approach can generate clinically relevant benefits, even when the patient does not subsequently gain access to specialized services.³

Conclusion and Implications for Public Policy

Given the large treatment gap for alcohol and other substance dependence, an urgent response is needed that goes beyond simply expanding service availability. Primary care must be trained to identify and initiate treatment, ensure continuity of care, and address the stigma that still keeps many patients away from health services.

In many Brazilian cities, basic medications for the treatment of alcohol dependence are still lacking, which directly compromises the effectiveness of interventions. Public policies should focus not only on access, but also on treatment quality, ensuring professional training, regular availability of medications, and integration between mental health care and primary care.

References:

1. Vigo, D.V., Stein, D.J., Harris, M.G., et al. (2025). Effective Treatment for Mental and Substance Use Disorders in 21 Countries. JAMA Psychiatry, 82(4), 347–357. https://doi.org/10.1001/jamapsychiatry.2024.4378
2. Rehm, J., Manthey, J., Shield, K.D., Ferreira-Borges, C. (2022). Barriers to treatment for alcohol use disorders in Europe: a literature review. Lancet Psychiatry, 9(2), 89–100. https://doi.org/10.1016/S2215-0366(21)00485-6
   
3. Lee, M.T., Gordon, A.J., Williams, J.T., et al. (2023). Association of Brief Inpatient Alcohol Interventions With Mortality and Readmission Among Adults With Alcohol Use Disorder. JAMA Network Open, 6(5):e2311507. https://doi.org/10.1001/jamanetworkopen.2023.11507