Alcohol Relapse Prevention and Aftercare

Relapse Is Part of Many Recoveries

Relapse after alcohol treatment does not mean that the person's time in recovery was a failure, but rather that treatment needs to be reinstated or adjusted or that another type of treatment is needed. It also means that treatment is still necessary and that relapse prevention techniques can help prevent future relapses.

An individual's recovery can be frequently, if not continuously, interrupted by urges or cravings to drink or to use drugs. These are very difficult experiences for those who have recovered from alcohol dependence but they are also common and predictable. Recovery is a process, not an event.

If you experience an urge or craving, it helps to understand that this is not a weakness and you're not alone.

When drinking resumes after abstinence, clinicians often refer to a relapse. Treatment can be viewed as a series of episodes rather than a single episode, each one characterized by its own challenges and difficulties. Relapse is common in people who stop taking medications for conditions such as hypertension or asthma.

Early Warning Signs

Stress, people, places, and moods linked to drug or alcohol use can trigger a return to substance abuse. Early warning signs include:

• Increased depression
• Increased anxiety
• Irritability
• Changes in behavior (such as isolating from others)
• Unusual sleeping patterns
• Neglect of personal appearance

Cravings and high-risk situations show up before alcoholics go back to drinking. Alcohol relapse prevention involves recognizing these warning signs, and seeking support from family or friends who can help the recovering person through them.

Other relapse risk factors include:

• Poorly managed stress
• Inadequate aftercare planning
• Poor recovery support group involvement
• A return to the same environments that fostered drug use
• Continuing association with people who are still using drugs

Aftercare Programs

Continuing care plans name services to use after formal treatment. They also outline what a person should do if they relapse. Many continuing care programs are based on mutual-help groups. These offer support from others who have had similar problems, such as Alcoholics Anonymous or Narcotics Anonymous. People in these types of programs meet regularly with one another and share their experiences about life without drugs.

Continuing care plans may also include:

• Individual counseling
• Group counseling
• Aftercare treatment at a clinic
• Services from social workers, vocational counselors, or other health care professionals

Continuing care plans should be created early in your treatment. Make sure to include family members and friends so that they can help you maintain recovery.

Outpatient counseling after residential care is one common type of aftercare program. In these programs, a person meets with counselors regularly in group or individual sessions. They can help you stay on track and provide guidance during stressful times.

There are also support groups that meet after treatment. The most widely known support group for substance use disorders is Alcoholics Anonymous (AA). It's important to remember that no one approach will work for everyone, so it might take a little while to find what works best for you.

Medications That Lower Relapse Risk

Medications that lower alcohol relapse risk include:

• Naltrexone (ReVia, Vivitrol). Naltrexone is an opioid antagonist, meaning it blocks the effects of opioids on your brain. Taking naltrexone can lower your desire to drink and reduce your urge for alcohol when you feel like having a drink.
• Disulfiram (Antabuse). Disulfiram is a medication that causes nausea, vomiting, or other unpleasant symptoms if you take it with alcohol. Because of these side effects, disulfiram discourages drinking. Disulfiram doesn't directly reduce the craving for alcohol, but it helps to motivate people to avoid alcohol.
• Acamprosate (Campral). Acamprosate can help you maintain sobriety once you've quit drinking.

Acamprosate (Campral) is a pill that reduces negative symptoms that may occur during abstinence from alcohol. It should be used in combination with ongoing behavioral therapy.

Treatment for AUD should be tailored to an individual's needs. Some individuals may benefit from use of a medication alone, while others may do best with the combination of medication and counseling. The provider will help determine what type of treatment works best for you.

Support Groups and Peer Recovery

Alcoholics Anonymous and SMART Recovery are options for individuals who struggle with alcohol addiction. This is not a complete list of all the organizations that offer these types of programs; some exist on a smaller scale in communities or may be virtual-only services.

SMART Recovery: SMART stands for Self-Management And Recovery Training and refers to a self-empowering approach to addiction recovery. You can attend face-to-face or online meetings.

The only requirement for attendance at an AA meeting is the desire to stop drinking.

Mutual support groups add peer contact during recovery to the options available for professional treatment by medical providers or counselors. These groups are designed to encourage self-help and are typically run by volunteer members who share their own experiences of having used alcohol problematically.

Some people use mutual support groups in addition to more formal counseling or treatment. Mutual-support groups provide different kinds of contact than do one-on-one sessions with a counselor. Mutual-support groups vary greatly and you should look around to find one that fits your needs. You might try different ones before finding the right fit for you.

Peer recovery coaching and mutual help groups help you stay abstinent and avoid relapse after treatment for alcohol use disorder. Peer coaches and mutual help members support one another in achieving goals and sustaining recovery.

People in recovery can benefit from peer support for a variety of reasons:

• Peer coaches and mutual-help groups provide social support as well as practical information, skills, and resources that may help you avoid relapse and improve the quality of your life.
• Peer coaches and mutual-support group members often have had the same experience you are going through and can offer encouragement, hope, and a model for recovery.
• Peer coaches and mutual-help groups can provide continuity of support after formal treatment ends.

What to Do After a Slip

After a slip back into drinking, contact your health care provider or therapist immediately. Many people who have stopped drinking relapse after a lapse at some point in their recovery. This may happen because of a major stressor such as divorce or the death of a loved one, or because of the pressure of a work crisis. It is not uncommon for people to resume using alcohol at a time like this, but it doesn't mean that they will never recover.

Speak with a clinician to resume or change treatment. Ask about continuing care, aftercare, and discharge plans. These should include suggestions for services and activities that will support recovery, such as self-help groups and counseling.

Be aware of warning signs. If you have a slip, try to figure out what caused it so that you can avoid the same situation in the future. Make sure your plan includes ways to manage stress and prevent triggers. Avoid places where you would be likely to drink or use drugs.

The following strategies can help prevent relapse:

• Continue treatment and follow your doctor's instructions for medications.
• Identify situations in which you are most likely to slip back into drinking (such as around friends who also use alcohol or drugs) and take steps to avoid them. Talk with your health care provider about ways to handle these stressors, such as learning relaxation techniques.
• Build a support system by talking with family members, friends, and others about relapse prevention strategies.
• Be honest with yourself and your doctor. Recognize if you are having problems with using alcohol or other drugs and ask for help.

Recovery Support in Illinois

DBHR recovery support and Recovery Support Service (RSS) programs provide peer-to-peer services and support that are based on the lived experience of recovering from a substance use disorder.

An intervention license from DHS and DBHR authorizes organizations to operate Recovery Homes that provide a stable, supportive living environment for persons who are recovering from alcohol or other drug abuse.

Geographically distributed ROSC Councils in Illinois assist local communities with building the capacity to support people who want to live free from substances and/or co-occurring mental health disorders.

Anyone affected by substance use can ask Illinois Helpline counselors for information about available recovery support options such as recovery residences, peer support groups, social activities, and other recovery resources. Helpline counselors will help you understand what types of recovery support options are available through the state, and they can refer you to an organization that offers the specific service or program you need.