Understanding Relapse and How to Manage It

Relapse isn't about a lack of willpower—it's deeply connected to brain science, habit formation, and psychology. The brain becomes accustomed to certain patterns, and factors like stress or social cues can automatically trigger old routines. While the science behind this is complex, the tools to manage it don't have to be. We created the relapse calculator to translate the science of habit change into a simple, personal assessment. It helps you see how external factors connect to your brain's patterns, offering a clear and practical starting point for building a stronger, more informed plan for your journey with alcohol.

Relapse Risk Calculator

• How often do you drink alcohol?
  • Daily
  • Weekly
  • Monthly
  • Rarely
• How many units (oz) of alcohol do you consume per week?
• What is your current stress level?
  • Low
  • Medium
  • High
• How would you rate your support system?
  • Good
  • Average
  • Poor
• How intense are your cravings?
  • Mild
  • Moderate
  • Severe
• Do you have any relapse history before?
  • Yes
  • No

Calculate Relapse Risk

Start Your Journey of Mindful Drinking

Understanding Relapse in Sobriety

In the context of recovery from alcohol misuse, a relapse is a return to drinking after a period of abstinence. While the main trigger for relapse is holding on to the belief that alcohol serves you in some way, additional factors—such as stress or lack of support—can amplify the risk.

You said goodbye to alcohol and meant it. But then you said hello again. As Craig Beck writes in "Alcohol Lied to Me Again," "This journey backwards virtually always starts with the same sentence being uttered: 'Surely just one drink won't hurt.'"

First things first: you're not alone. Relapse is a reality for many people on the alcohol journey, and it doesn't mean you've failed. There's also no such thing as "going back to square one": once you set off on the path of recovery, you've been moving forward, even if that path involves a setback. As Reshma Saujani puts it, "There's no more powerful lesson than knowing that your setbacks will one day help you succeed."

That said, relapse is something we want to avoid if we can. And that's where our handy Relapse Risk Calculator comes in!

How Common Is Relapse?

If you're worried about relapse, looking at the data can actually be reassuring. Seeing the numbers helps demystify the experience and shows that it's a common part of the process for many people. It's not a sign of personal failure but a known challenge in a complex journey of change. Understanding that others face similar hurdles can connect you to a larger community of people who are also figuring things out one day at a time. This perspective allows you to Quitemate a setback as a data point—a learning opportunity—rather than a final destination. It's all about discovering what works for you, identifying your triggers, and adjusting your approach as you move forward.

Relapse Rates Over Time

Here's some encouraging news: the longer you maintain your new habits, the stronger your foundation becomes. Research shows a clear pattern where the likelihood of relapse decreases significantly over time. For people with less than a year of sobriety, about one in three are able to maintain it. However, once you reach the one-year milestone, more than half of people successfully avoid a relapse. For those who make it to five years, the chance of returning to old drinking patterns drops to less than 15%. This isn't just luck; it's the result of your brain and body adapting, building new and healthier neural pathways that eventually become your default.

Comparing Relapse to Other Chronic Conditions

It can be incredibly helpful to think about alcohol use disorder as a chronic health condition, not a moral failing. The relapse rate for addiction is around 50%, which is very similar to the rates for other long-term conditions like asthma or high blood pressure. Someone with asthma might forget their inhaler or encounter an unexpected trigger, causing their symptoms to flare up. This doesn't mean they've failed at managing their health; it simply means they need to review their management plan. Viewing relapse in this light helps remove the shame and self-blame that can be so destructive, allowing you to focus on what really matters: getting back to your wellness plan.

Relapse Rates for Different Substances

While changing your habits is a personal journey, data shows that the specific substance involved can influence relapse rates. Different substances affect the brain and body in unique ways, creating varying levels of physical and psychological dependence. This can impact the intensity of cravings and withdrawal, which are major factors in the recovery process. Understanding the specific challenges associated with each substance isn't about creating a hierarchy of difficulty, but about empowering you to seek the right kind of support for your unique situation.

Alcohol

When it comes to alcohol, the statistics reveal a hopeful trend over time. In the first year of changing drinking habits, more than 30% of people experience a relapse. That number drops to about 21% in the second year, and between years three and five, it falls again to under 10%. After five years, only about 7% of people relapse. These figures highlight that the initial period is often the most challenging, but with persistence, the path becomes more stable. It's a powerful testament to the brain's ability to heal and adapt, reinforcing that long-term, mindful drinking or sobriety is an achievable goal.

Opiates

Opiates, like heroin and prescription painkillers, have one of the highest relapse rates at over 60%. This is largely due to the intense physical dependence they create. Withdrawal symptoms can be severe, and the substance produces powerful changes in the brain's reward system, leading to intense cravings that persist long after use has stopped. Managing recovery often requires a comprehensive approach that includes medical support, psychological therapy, and strong community support systems.

Cocaine and Crack

Cocaine and crack also have relapse rates that can exceed 60%. While these stimulants may not create the same level of physical withdrawal symptoms as opiates, they produce an incredibly strong psychological dependence. The intense euphoria rewires the brain's reward pathways, leading to powerful cravings triggered by people, places, or emotions. Overcoming this requires developing strong coping mechanisms and strategies to manage these triggers, often with the help of behavioral therapies and a solid support network to help you track your progress.

Relapse vs. a Slip: What's the Difference?

Recovery from alcohol use disorder (AUD) can be a rocky road full of ups and downs. A relapse means we returned to drinking after a period of being booze-free. Here are the main things to understand about the science behind it:

• Slips and relapses are common in recovery. In fact, studies show that as many as 85% of patients who receive treatment for substance use disorder relapse within a year. But don't be discouraged! With some planning, relapse is avoidable. And even if it happens, it's completely possible to get back on track.
• Cravings don't disappear when we stop drinking. When we become dependent on alcohol, our dopamine-driven reward system gets hijacked, leading to cravings and withdrawal symptoms if we suddenly stop. And while acute withdrawal symptoms can get resolved within days of putting down the bottle, dopamine levels take longer to rebalance, so we might still find ourselves stuck in that "I need a drink feeling," especially in the early weeks.
• Habituated brain pathways make setbacks easy to have. It's kind of like walking a well-worn path through the woods or sliding down the same skiing trail—our brain likes efficiency and gets used to certain behavioral patterns, making them almost automatic. If we've been drinking for a long time or are used to having a drink in certain contexts—happy hour after work, weddings, our friend's famous Halloween bash, and so forth—we can find ourselves reaching for a drink almost on autopilot. This is where knowing our triggers becomes especially useful. Spotting them in time and changing our response eventually rewires the brain, getting us farther out of the relapse danger zone.
• Holding on to cognitive distortions about alcohol makes relapse more likely. By far the most likely "reason" for a slip or a relapse is the belief that alcohol does something for us. Whether we think it helps us relieve stress or helps us socialize (spoiler alert: both are common cognitive distortions that don't hold up to science), we might be holding on to the idea that we "need" or "want" booze to be part of our lives.
• A number of other factors play a contributing role. Especially if we haven't changed the way we see alcohol (and are still feeling deprived), additional factors in our life might contribute to a relapse. For example, stress or a lack of social support can play a role.

Want to know more? Check out "Defining Relapse: A Rehearsal for Success," and "How To Stay Sober After Recovering From Alcoholism" to learn about the signs of relapse and more. But now, let's get practical—ready to calculate your relapse risk and form a plan?

How Can a Relapse Calculator Support Your Journey?

Teasing out the factors that might set the stage for relapse can be tricky. Enter the Relapse Risk Calculator! By analyzing responses to questions about your history and current habits, it helps you pinpoint factors that might set the stage for a relapse. Think of these factors as relapse red flags marking the areas of your life where slight shifts can set you on the path to success.

Ready to "weatherproof" your recovery? Let's get started!

How Are Relapse Risks Formally Calculated?

While our calculator offers a personal snapshot of your current situation, clinicians and researchers use more structured tools to understand the potential for relapse. These formal methods aren't about predicting the future with a crystal ball; they're about using data to identify patterns and risk factors that can inform a recovery plan. By looking at specific aspects of a person's drinking history and current circumstances, these models provide a standardized way to assess where someone might need extra support. This approach helps professionals create tailored plans that address specific challenges, making the path to long-term change clearer and more manageable for everyone involved.

The High-Risk Alcoholism Relapse (HRAR) Scale

One of the key tools in a professional's toolkit is the High-Risk Alcoholism Relapse (HRAR) Scale. Think of it as a structured questionnaire designed to estimate the likelihood that someone will return to heavy drinking after a period of sobriety or treatment. It's not a judgment, but rather a data-driven assessment based on factors that research has consistently linked to relapse. According to medical resource QxMD, this scale helps estimate the chance of someone relapsing after receiving treatment. By quantifying the risk, it allows for a more proactive and personalized approach to aftercare and ongoing support, focusing efforts where they're needed most.

Factors Used in Clinical Relapse Models

So, what exactly do these clinical models look at? The HRAR Scale, for example, zeroes in on a few critical questions about your history with alcohol. It typically asks about the duration of heavy drinking, the average number of drinks consumed daily, and how many times you've been treated for alcoholism in a hospital setting. These specific data points help create a clearer picture of an individual's risk profile. In broader clinical studies, researchers often calculate the annualized relapse rate (ARR) to measure how often relapse occurs over a year within a group. This helps them evaluate the effectiveness of different treatments and support systems, ensuring that recovery strategies are backed by solid evidence.

Understanding Common Relapse Triggers

Congrats! You just took an important step to a lasting recovery by filling out the Relapse Risk Calculator and finding the factors that might lead you down the relapse road. Now, let's look at each one in a bit more detail.

1. Managing High-Stress Situations

Biologically, stress is the body's response to danger—the so-called "fight-or-flight" mechanism. The stress response is triggered by the amygdala, which stimulates the release of "stress hormones" such as adrenaline and cortisol. The result? Our body switches into "emergency mode": our heart rate and breathing rate increases, glucose gets pumped into the blood to provide fuel for our muscles, and functions such as digestion get put on hold.

While the stress response is a (literal) lifesaver when it comes to "fighting" or "fleeing" from actual danger (think raging fire or an angry buffalo), it leads to a host of health problems if it's triggered unnecessarily, especially on a chronic basis. And yet it's a modern-day reality for many of us: in 2022, over a third of American adults reported that stress was "completely overwhelming" for them on most days.

High stress is a known trigger for relapse. In fact, studies show that stress is a major factor in relapse because of how it affects the brain. For one thing, chronic stress lowers dopamine levels, making alcohol cravings more powerful. It also interferes with the prefrontal cortex—the decision-making hub of the brain involved in self-regulation and impulse control.

Lower your risk:

• Start a mindfulness practice. When it comes to dealing with stress, mindfulness is where it's at. Whether it's traditional sitting meditation or a practice such as mindful walking, mindfulness is all about being in the moment without judging it. Science says it lowers cortisol levels while strengthening our prefrontal cortex and enhancing resilience to stress.
• Learn in-the-moment stress management techniques. Progressive muscle relaxation, diaphragmatic breathing, and even splashing cold water on your face to stimulate the parasympathetic nervous system (which is responsible for relaxation), all work wonders when it comes to lowering stress in the moment. Sometimes that brief pause makes all the difference!

2. Leaning on Your Support System

Recovery is a journey, and having a strong support team to back us up is key. A network of trusted friends, family members, and others who support our booze-free life is an essential part of any relapse prevention plan.

While alcohol often gets credit for making us "more social," the reality is it does the opposite. We might feel less inhibited, but solid connections are unlikely to take root with alcohol in the picture. And when we leave behind our drinking days—and our weekend barhopping posse—we might feel more isolated than ever.

Science says that social support is crucial in recovery for many reasons. Our peers hold us accountable, share their experience and coping skills, celebrate our milestones, and cheer us on when things get tough. As a result, social support provides a powerful buffer against relapse.

So if your social support system needs a tune-up, it's time for some changes!

Lower your risk:

• Expand your support system. Start with a few people you trust and keep building. And don't forget that online support is an option! Communities such as Quitemate are a great place to meet like-minded people who've been where you are and know what it's like.
• Check in on a regular basis. Set up a system of daily check-ins with your support team members. They don't need to be long—a simple text or quick phone call will help you stay accountable while keeping the line of communication open.

3. How to Manage Intense Cravings

Even if we have a strong support system and keep our stress levels low, alcohol cravings can still creep in and lead to relapse. Remember how we said it takes the brain a while to adjust to being booze-free? The main reason for this is that alcohol disrupts the delicate neurotransmitter balance in the brain by boosting dopamine (the reward neurotransmitter) and GABA (an inhibitory one responsible for the downer effects of booze). It also lowers glutamate, GABA's excitatory counterpart. And while the brain will rebalance itself in time, the process can take a few weeks or even months.

In fact, studies show a strong correlation between dopamine levels and likelihood of relapse. One study found that participants who relapsed at various points after detoxification had less dopamine and less activity in the brain's reward circuit than those who didn't relapse.

Lower your risk:

• Quitemate your cravings. One of the most powerful ways to coast through cravings is to use cognitive restructuring to Quitemate our thinking around alcohol. A staple of cognitive behavioral therapy (CBT), this technique involves uncovering your subconscious beliefs about alcohol (for example, "I need booze to be social") and replacing them with ones that align with reality and goals ("Being disinhibited isn't the same as being social—authentic relationships thrive when I'm clearheaded and present in the conversation.")
• Learn urge-surfing techniques. There are many urge-surfing techniques out there, and they all have one thing in common—they're based on the fact that cravings are temporary and last at most 20 minutes. As a result