Relapse: rates, causes and what counts afterwards
also: return to use · lapse · recurrence
A relapse is treated in addiction medicine as a symptom of the condition rather than a failure of treatment. It is common enough that a plan for it belongs in the treatment, and what happens in the first hours often shapes what follows.
A relapse is a return to the earlier pattern of use after a period of abstinence. In addiction medicine it is treated as a symptom of the condition rather than a failure of treatment, and that holds across all substance use disorders.
Lapse or relapse?
Clinically a distinction is drawn between a single episode of use, often called a lapse, and a return to the earlier pattern. The distinction has immediate practical consequences.
Someone who treats a single episode as complete failure has little reason to stop that evening. Someone who treats it as what it is, an incident with a cause, can intervene before it becomes a pattern.
The largest risk factors in that situation are shame and secrecy. Both prevent anyone from finding out in time.
Terminology is shifting here. Some clinicians and advocacy organisations prefer return to use or recurrence, on the grounds that relapse carries moral weight. Relapse remains standard clinical usage.
How common is it really?
There are reliable German figures from the follow-up studies of specialist clinics. In the Fachverband Sucht follow-up of the 2014 discharge cohort, around 41 percent of the 11,033 people surveyed counted as successful one year after discharge under the internationally used DGSS 4 standard.
Successful there means continuously abstinent, or abstinent again for at least 30 days after one or more episodes of drinking. How that standard counts matters: anyone not reached or not responding is counted as unsuccessful, so the actual rate is likely more favourable than the figure suggests.
For a chronic condition an order of magnitude like this is not unusual. In other long-term treated conditions a substantial proportion of patients also do not maintain treatment as planned, without that being described as failure.
What leads up to it
A return to use rarely begins with the first episode. It usually has a run-up made of several factors reinforcing each other, and that run-up is the part that can be worked on.
Common triggers and warning signs
- Difficult feelings such as conflict, loneliness, humiliation or feeling overwhelmed
- Positive occasions such as celebrations, holidays or success, which are often underestimated
- Physical states such as lack of sleep, hunger or pain
- Withdrawing from appointments, groups and contact, usually weeks beforehand
- The thought that a single episode might be manageable again
What counts in the first hours
The most important step is telling someone. It is also the hardest, because shame works against exactly that. Having an emergency plan means the decision does not have to be made from scratch under pressure.
A workable plan is written down before it is needed and contains specific names and numbers rather than good intentions. After that the episode belongs in the treatment, not as a confession but as information that can be used.
A return to use is not a reason to break off treatment. It is a reason to adjust it. Where physical withdrawal symptoms appear, medical help is part of that.
For families
For families a relapse is often the moment when trust and patience seem to run out at the same time. Separating the person from the condition helps, however difficult that is in the moment.
What tends to work is naming calmly what has been observed and pointing back to the treatment, rather than negotiating or monitoring. Families are also entitled to support in their own right, and addiction counselling services are there for them as much as for the person who is using.
Common questions
How common is relapse after alcohol treatment?
In the Fachverband Sucht follow-up of the 2014 discharge cohort, around 41 percent of 11,033 people surveyed counted as successful one year after discharge under the DGSS 4 standard, meaning continuously abstinent or abstinent again for at least 30 days after one or more episodes. People who could not be reached count as unsuccessful in that calculation.
Is a relapse a failure of treatment?
No. In addiction medicine a relapse is treated as a symptom of the condition. It is a reason to adjust treatment, not to end it.
What should you do after a relapse?
Tell someone as early as possible, stop rather than writing off the day, and raise it in treatment. Shame and secrecy are the biggest risk factors for a single episode turning into a full return to the old pattern. Where physical withdrawal symptoms appear, medical help is needed.
What belongs in an emergency plan?
Specific names and phone numbers, your own typical triggers, two or three things to do in the first ten minutes, and an agreement about who to call and in what order. It should be written down before it is needed.
Please note
This glossary is for information and does not replace medical or therapeutic advice, diagnosis or treatment. If you think you or someone close to you may be affected, speak to a doctor or an addiction counselling service near you.
In an emergency
If there is immediate danger, call 112 anywhere in the EU, or 999 in the UK. In Germany, Telefonseelsorge is free around the clock on 0800 111 0 111 and 0800 111 0 222, and the addiction and drug helpline is on 01806 313 031. In the UK and Ireland, Samaritans is free around the clock on 116 123.
Support between appointments
The move from a clinic back into everyday life is a particularly demanding phase of treatment. coobi care accompanies people through aftercare in daily life and gives the treating team a picture of how the time between sessions is going. It does not replace treatment.