Addiction Alcohol Use Withdrawal and Relapse Alcohol Relapse and Cravings By Buddy T facebook twitter Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Learn about our editorial process Buddy T Medically reviewed by Medically reviewed by John C. Umhau, MD, MPH, CPE on December 21, 2020 John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Review Board John C. Umhau, MD, MPH, CPE Updated on December 22, 2020 Print Getty Images Recent evidence has shown that 50% to 90% of people with an alcohol use disorder will likely relapse at least once during the four-year recovery period following their treatment. The relapse rate for alcohol is similar to those for nicotine and heroin addiction. Some researchers believe the high rate of relapse for alcohol and drug addicts is due to impaired control caused by chemical changes that have taken place in the brains of alcoholics and addicts, changing the brain's reward system. Some researchers believe this impaired control is responsible for an alcoholic picking up the first drink of a relapse, while others believe impaired control kicks in after that first drink, making it difficult for the alcoholic to stop drinking once they start. For severe alcoholics, it can be impossible to stop drinking after the first drink. When an alcoholic stops drinking, withdrawal symptoms and alcohol cravings can set in. The Role of Craving in Relapse The concept of drug and alcohol craving is somewhat controversial, with some investigators believing that environmental stimuli play a larger role in relapse than physiological urges. But research in 1974 by Arnold M. Ludwig and LH Stark found that the best way to determine if alcohol craving actually exists is to simply ask alcoholics. They asked study participants if they felt a need for alcohol, in the same manner as you would ask if someone was hungry. Further research by Ludwig found that alcoholics display classic Pavlovian conditioning to internal and external stimuli to the reinforcing effects of alcohol. For example, driving past a familiar bar or experiencing a negative mood, could both set off a craving for alcohol. Euphoric Recall and Appetitive Urges Internal and external cues that evoke the memory of the euphoric effects of alcohol set off an appetitive urge, similar to hunger, in the alcoholic. Similarly, the memory of the discomfort of alcohol withdrawal could also produce a craving for alcohol. Other studies have found that exposure to alcohol, without consumption, can stimulate a salivary response in alcoholics. A 1987 study by Zelig S. Dolinsky found that alcoholics had significantly greater and more rapid insulin and glucose responses to the consumption of a placebo beer, compared to nonalcoholics. Expectations Play a Role in Relapse Other researchers have theorized that relapse prevention depends on the alcoholic's expectations about his or her ability to cope with alcohol cues. One theory posited in 1999 suggests whether or not the first drinks leads to an excessive-drinking relapse may depend on the alcoholic's: Skills to cope with high-risk situationsLevel of perceived personal controlThe anticipated positive effects of alcohol High-Risk Situations Investigators who analyzed 48 relapse episodes found that most were prompted by the following high-risk situations: Frustration and angerSocial pressureInterpersonal temptation Assuming an Active Role in Relapse Prevention To overcome these high-risk situations, some ways that alcoholics could take a more active role in changing their behavior include: Modify lifestyle to enhance the ability to cope with stress and high-risk situationsIdentify and respond appropriately to internal and external cues that serve as relapse warning signalsImplement self-control strategies to reduce the risk of relapse in any situation One study found that teaching alcoholics how to identify certain coping skills needed to deal with high-risk situations could help reduce relapse rates. Another approach focuses on cue elimination. Many different strategies have been proposed, but in the end, 50% to 90% of people with an alcohol use disorder experience at least one relapse. Medications That Reduce Craving Relapse prevention made great strides with the advent of medications that would reduce cravings. Naltrexone hydrochloride, sold as the brand name Revia and Depade and in an extended-release form under the trade name Vivitrol, was the first medication approved for the treatment of alcoholism that reduced the craving for alcohol. Naltrexone seems to work by decreasing the reinforcing effects of alcohol in the neural pathways of the brain by blocking opiate receptors which then block the effect of endorphins. According to the Sinclair Method, which stipulates using naltrexone one hour before any drinking occurs, the medication can also block the euphoric effects of alcohol and subsequent excessive consumption once drinking starts. Over time, the effect of naltrexone to block this euphoric effect can result in pharmacological extinction and the elimination of craving for alcohol. Some researchers have found that a combination of pharmaceutical treatment and behavioral therapy, along with participation in mutual support groups, is the most effective effort to prevent drug and alcohol relapse. If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.For more mental health resources, see our National Helpline Database. Was this page helpful? Thanks for your feedback! Learn the best ways to manage stress and negativity in your life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cui C, Noronha A, Warren KR, et al. Brain pathways to recovery from alcohol dependence. Alcohol. 2015;49(5):435-52. doi:10.1016/j.alcohol.2015.04.006 Czapla M, Simon JJ, Richter B, et al. The impact of cognitive impairment and impulsivity on relapse of alcohol-dependent patients: implications for psychotherapeutic treatment. Addict Biol. 2016;21(4):873-84. doi:10.1111/adb.12229 Perry CP, Zbukvic I, Kim, JH, Lawrence, AJ. Role of cues and contexts on drug-seeking behaviour. Br J Pharmacol. 2013. doi:10.1111/bph.12735 Ludwig AM, Wikler A, Stark LH. The first drink: psychobiological aspects of craving. 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The Cost Effectiveness of Naltrexone Added to Cognitive-Behavioral Therapy in the Treatment of Alcohol Dependence. J Addict Dis. 2009;28:2:137144. doi:10.1080/10550880902772456 Additional Reading Ramirez JJ, Monti PM, Colwill RM. Brief and extended alcohol-cue-exposure effects on craving and attentional bias. Exp Clin Psychopharmacol. 2015;23(3):159-67. doi:10.1037/pha0000018 Witteman J, Post H, Tarvainen M, et al. Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study. Psychopharmacology. 2015;232:3685–3696. doi:10.1007/s00213-015-4027-6