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