According to the findings of a study reported in Addiction, only 43 percent of those who go through an alcohol addiction treatment program can abstain from drinking over the subsequent weeks and months. The percentage is even lower (a paltry 21 percent) for those who try to quit drinking but do not undergo a formal treatment process. These statistics prove that relapses among treated and untreated alcohol addicts are very common.
But knowledge is power, and the more you know about alcoholism, treatment, and recovery the better your chances of overcoming your drinking problem. You can win the battle against alcohol and remain sober for life if you learn to recognize and avoid the triggers that can provoke a relapse.
What Are Alcohol Use Triggers?
Alcohol use triggers are events, people, places, social interactions, situations and emotions that make a recovering alcoholic feel a strong urge to drink. For many people who try to quit drinking, yielding to alcohol abuse triggers is what ends their sobriety and puts them back where they started.Drinking triggers can range from cues in the external environment—like being around alcohol or seeing other people drink—to negative emotions that feel overwhelming and unmanageable.
To understand how triggers affect a recovering alcoholic, you must realize that his or her brain functions differently from the brain of a person who is not physically and/or psychologically dependent on alcohol:
- Chronic alcohol consumption rewires the brain’s risk-reward circuitry, giving it undue influence over an alcoholic’s cognitive faculties.
- The recovering addict’s brain is literally brainwashed into believing that drinking is the most effective way to deal with problems.
- A person with a history of alcohol abuse will form a whole new set of behavioral responses, based on a deeply ingrained instinct that tells them drinking is always a rewarding experience. As a result, his or her automatic behavioral response to the sight of alcohol is to reach out for that familiar comfort.
- The coping mechanisms of a person addicted to alcohol are severely compromised, and even after going through treatment those old habits remain tenacious. Being in recovery and dealing with the stresses of physical and mental withdrawal symptoms stretches his or her coping mechanisms to the limit, which inevitably creates a high risk for relapse.
The brains of people with substance use disorders perceive and respond to environmental stimuli differently. Consequently, what are merely passing nuisances to others become powerful alcohol abuse triggers for individuals in recovery.
How to Deal with Alcohol Triggers
To avoid succumbing to alcohol abuse triggers, you need a plan of action, and you have to execute it thoroughly. You must learn how to anticipate alcohol triggers, recognize them in their early stages, and develop strategies to reduce their power over your behavior.
Identifying Your Triggers
Triggers differ from person to person, but they are everywhere around you. Often their connection to drinking seems tangential at best, yet your learned behavior with alcohol still makes you vulnerable in a wide variety of circumstances.
Drinking triggers can be classed into three groups:
- Environmental Triggers
- Re-Exposure Triggers
- Stress Triggers
These include people, places, and events that you’ve come to associate with drinking. Your environmental triggers may include:
- Encounters with former drinking companions who have yet to embrace sobriety.
- Places where you once used to drink, like bars, clubs or even certain private areas in your home.
- Social or cultural events where alcohol is served and tends to flow freely, like backyard barbecues, family reunions, holiday celebrations, and concerts or sporting events.
These can occur in any location you visit where others are drinking, or through exposures to alcohol in TV commercials or movie scenes. Re-exposure triggers are impossible to avoid completely since drinking behavior is so open and ubiquitous in our society.
Potential triggers of alcohol abuse include stressful occurrences or developments, such as:
Strong and persistent negative emotions. Emotions like fear, anger, anxiety, guilt, shame, hopelessness and depression are powerful alcohol triggers that tend to overwhelm the fragile coping mechanisms of problem drinkers. If you have a history of dealing with negative feelings by turning to alcohol, you can easily slip back into those habits if your recovery is still in a sensitive stage.
Physical pain or stress. Physical stress can be a chronic illness, a painful condition or unpleasant withdrawal symptoms that sap your moral strength and leave you unable to resist the urge to self-medicate with alcohol.
Sleep deprivation. Lack of sleep is stressful and can leave you feeling fatigued and low on energy. In this state your willpower may be weak, tension and anxiety can build, and you may be strongly tempted to turn to drinking in an attempt to end your insomnia (which won’t work for long).
Sudden or profound life changes. Profound life changes can leave you feeling overwhelmed. The loss of a loved one and unemployment are examples of negative life changes that can set off a relapse, while getting married, having a baby, or moving to a new city to take a new job are examples of positive developments that can still be stress-inducing (and alcoholism triggers often involve stress, regardless of its source).
Avoiding Triggers to Alcohol Abuse
The best way not to yield to triggers is to stay away from them. You can easily avoid some, but you might have to work a little harder to avoid some others. You might also need to make some fundamental alterations in your patterns of thought and behavior to avoid a few.
Here are some ideas on how to avoid the most common drinking triggers:
- Ask your friends and family members not to drink in front of you.
- If there are people in your house who drink, request they stock their supplies where you won’t find them.
- Avoid your old drinking buddies, and ask them respectfully not to visit you.
- Avoid going to the places where you used to drink.
- Find a new route to your workplace or school, if the old one takes you past bars or clubs you used to haunt.
- Avoid going to social events where drinks will be served. Politely explain your reasons for declining invitations, to avoid being misunderstood.
- Examine relationships that might be stressing you or causing anxiety. Talk with the other person to work out solutions to the problems that trigger arguments, misunderstandings, and accusations.
- End any relationships that are toxic and irredeemable.
- Look closely at your job and living arrangements and identify any emotional and/or physical stressors they invoke. Be prepared to make some significant changes, if it becomes clear those stressors are unavoidable or too difficult to resolve.
Asking for Help in Recovery
Battling alcoholism is not a solo venture, or at least it shouldn’t be. Since most relapses occur during the initial months of recovery, during that time, you’ll need a network of compassionate, supportive people to help you resist temptation.
Your social support network may include:
- Close family members: partners, parents, siblings, children (if they’re adults)
- Loyal, close friends
- Trusted co-workers, teachers and/or classmates
- Pastors, priests, mentors or other advisors
- Members of support groups you can look to for guidance and understanding
- Professionals therapists and addiction specialists involved in your aftercare/outpatient treatment program
- Yourself (during your recovery, you should remain optimistic and resolute in your determination to overcome your substance abuse issues)
How to Prevent Relapse During Recovery
Relapse prevention means continuing treatment during aftercare when your recovery is still new and your vulnerability to triggers still high.
Outpatient treatment during the first 6-12 months of recovery will consist primarily of individual, group and family psychotherapy, and medication therapy to relieve the intensity of physical and psychological cravings for alcohol.
Depending on the needs of the individual patient, aftercare treatment programs may be extended for as long as necessary, and identifying triggers and avoiding relapse will remain a point of emphasis.
Psychotherapy for Alcohol Addiction
Among their many contributions to healing, experienced addiction counselors can help patients identify, anticipate and defuse alcohol abuse triggers.During psychotherapy, patients can learn behavioral responses that will help them deal with triggers honestly, proactively and effectively.
Therapists who work with alcoholics are flexible and versatile, and to some extent, counseling programs are always tailored to meet the unique needs of each patient. Nevertheless, addiction counselors do prefer certain evidence-based approaches to recovery and relapse prevention, including cognitive-behavioral therapy (CBT) and contingency management (CM):
Cognitive Behavioral Therapy (CBT)
During CBT sessions, patients are taught to be mindful of their emotions and to pay close attention to what’s happening in the surrounding environment, so they can learn to identify triggers before they magnify in strength. The individual is also taught coping strategies to deal with triggers (i.e., distracting the mind by reading, going out for a walk, listening to music, meditating, watching a movie, talking with close friends, etc.).
Over time, CBT helps modify behavioral responses in people whose inner resources have been neglected because of their dependence on alcohol.
Contingency Management (CM)
Contingency management is used as both a stand-alone therapy and as a supplement to other therapeutic approaches, including CBT. Under CM protocols, people receive rewards of various types of staying away from alcohol. Typical rewards include vouchers redeemable at retail stores, or tickets to a movie or concert.
This relapse prevention technique strives to rewire the brain until it is conditioned to reject alcohol and seek happiness and fulfillment only in healthy, sobriety-enhancing activities.
Medicines are often prescribed as part of an alcohol addiction treatment program. Certain drugs can help counteract the intensity of withdrawal symptoms and cravings, lessening the urge to drink and negating the effects of triggers.
Medications commonly prescribed for alcohol treatment include:
- Disulfiram (Antabuse). This drug produces strong nausea when it mixes with alcohol in the stomach. Eventually, the person using disulfiram learns to associate alcohol with highly unpleasant experiences.
- Naltrexone (ReVia, Vivitrol). By blocking opioid receptors in the brain, naltrexone reduces the intoxicating effects of drinking. In the process, it also reduces the intensity and frequency of cravings.
- Acamprosate (Campral). This medication works by repairing chemical imbalances in the brain associated with alcohol withdrawal symptoms. It thereby negates much of the severity of withdrawal and makes detox go more smoothly, ultimately reducing the urge to drink.
Disulfiram, naltrexone, and acamprosate are the only drugs approved by the FDA for the treatment of alcohol use disorders.
Spotting the Warning Signs of Relapse
A relapse is not a momentary slip of minor significance. It is a dangerous retreat into self-destructive habits that can have severe negative consequences.
Some of the telltale warning signs of an impending relapse include:
- Finding excuses to reconnect with old drinking buddies
- Staying away from people who support and encourage sobriety
- Romanticizing alcohol use or waxing nostalgic about “the good old days.”
- Deliberately tempting fate by attending events where alcohol is being consumed
- Missing appointments with addiction counselors or therapists
- Skipping doses of medications that were prescribed by an addiction specialist
- Not attending support group meetings
- Exhibiting overconfidence or minimizing the depth of the addiction
- Drastic changes in mood, like being overcome by feelings of depression or hopelessness
- Sudden struggles to cope with the common work, family or home life stressors that were supposedly addressed in rehab
- Neglecting personal hygiene
- Abandoning hobbies and activities that were once enjoyable
- Exhibiting strong cravings and talking about them or obsessing over them constantly
When the warning signs of relapse are present, it is vital that recovering alcoholics speak to their therapists and/or support group sponsors about what has been happening—before it is too late.
Myths About Alcohol Relapse
Relapses are frightening, disappointing and frustrating. Alcohol triggers seem to come out of nowhere and catch you unaware. It difficult to fathom how seemingly innocuous people, places, and events can be triggers, and yet that is exactly what they so often are.
Given the complexity and unpredictability of relapse and its multitude of potential alcohol abuse triggers, it is no wonder myths surround the issue of alcohol relapse. Separating truth from falsehoods in this instance is essential, since understanding the true nature of the challenges you face as an alcoholic will improve your chances of maintaining your sobriety.
Myth 1: Being treated for alcoholism guarantees lifelong recovery
Sobriety is a lifelong journey. It is not a fixed goal or a final destination, but an ongoing, unfolding process that requires commitment, patience, and focus.
Recovery, in essence, is like a second full-time job. It will test your mettle and reward you only if your effort remains consistent from your initial time in inpatient rehab through your aftercare program and beyond.
Myth 2: Relapse is inevitable after abstinence because the triggers are everywhere
More than four-in-ten recovering alcoholics avoid relapse after leaving treatment, and it is this group that has the greatest chance of remaining sober for life.The trick to stretching the abstinence period is to dodge the triggers or to resist their seductive pull when they are unavoidable. To stay sober, you must take your recovery one day, one hour, one minute at a time.
To stay on the path to permanent sobriety, you must alter your attitudes and beliefs, learn new coping mechanisms, identify and disengage from self-sabotaging behavioral responses, work on methods for handling stress, and overcome negative thoughts that may have held you back in the past. Relapse triggers are an obstacle on your road to recovery, but they are obstacles you can avoid once you know what to look for.
Myth 3: It takes only a moment of weakness to relapse
This is one of the most damaging myths about relapse because it causes people to let their guard down once they resist the initial temptation to drink during a particularly vulnerable moment.
In fact, the existence of those vulnerable moments is not a test of your courage or strength but a warning sign, and one you cannot afford to overlook. If you find yourself thinking about drinking it means you’re responding to a trigger, and when that happens you should consult with your addiction therapist about it before it becomes a trend.
Relapse is more of a slippery slope than an impulse, and the fact that you have such impulses in the first place is what can set you up for trouble.
Myth 4: Relapse is a sign of weak will
On the contrary, relapse is an indicator of how chronic alcohol abuse alters mental and neurological functioning in ways that require time and enormous, sustained effort to overcome.
The brain’s reward circuitry can be re-trained to resist the pull of alcohol, and unhealthy and unproductive beliefs, attitudes and behavioral responses can be unlearned. But you cannot expect the brain to return to normal simply because you’ve been clean and sober for a few weeks, and if the worse happens and you do relapse it is important to get back on the wagon as quickly as you can—and if that proves too difficult, it could be a sign that you need more time in rehab.
Myth 5: You are alone in this journey
The path to sobriety should never be traveled alone. To avoid relapse, you need the emotional and logistical support of your family and friends. They should be your champions and your cheerleaders, helping keep your spirits up when life’s stresses are putting your recovery at risk.
They should also be careful not to expose you to triggers by drinking in your presence, taking you to bars, clubs, or social events where alcohol is prominent, or adding to your stress and anxiety by creating conflicts. Their companionship can make a vital impact as you move forward in the recovery process.You also need the support of therapists and counselors. They will teach you constructive behaviors and help you eliminate self-sabotaging ways of thinking and functioning.