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Signs an Alcoholic Is Drinking Again

By Manjari Bansal, Neha Kashyap
Certain personality and behavior changes could indicate an alcohol use disorder relapse.

Recovering from alcohol use disorder is rarely a linear journey, and many addiction experts regard relapse as a normal part of healing from addiction. However, relapse should still be avoided, and learning the warning signs of it could help you support the recovery process of someone in your life. If you’re a loved one of an alcoholic, it’s important to know the signs of a relapse. Read on to learn more.

What Are the Warning Signs of an Alcohol Relapse?

“Relapse generally does not occur out of the blue; rather relapses are often a slow process that occur over time beginning with emotional or mental cues alongside behavioral changes that gradually lead up to the physical act of ingesting alcohol,” Aaron Sternlicht, LMHC, CASAC, a therapist and co-founder of Family Addiction Specialist in New York, tells WebMD Connect to Care.

According to the US Department of Veterans Affairs, relapse can be considered both an event as well as a process. Initial use of substance, after a period of recovery, is called a lapse. However,e of the substance is termed a relapse. You may experience the warning signs of a relapse long before you actually use the substance.

Sternlicht tells WebMD Connect to Care, that warning signs vary from person to person but may include:

  • Increased cravings or thoughts of using alcohol, especially as a means of coping with emotional, mental or physical discomfort.
  • Becoming increasingly or commonly angry, agitated, overwhelmed or stressed.
  • Stopping recovery related activities such as attending mutual-help groups or speaking with a support network, or stopping healthy routines such as a regular sleep schedule or exercise.
  • Onset of depression, anxiety or other mental health issues.
  • Engaging in other addictive behaviors or unhealthy coping skills such as overeating or binge eating.
  • Putting oneself in high risk situations or environments such as places where alcohol is being served.
  • Erratic eating and sleeping habits.
  • Social isolation or boredom.

What Are the Symptoms of an Alcohol Relapse?

“When someone relapses with alcohol, symptoms are more exaggerated because they’ve lost their tolerance,” Daniel Hochman, MD, a Psychiatrist and Founder of SelfRecovery.org, tells WebMD Connect to Care. “For example, four drinks in the middle of addiction may cause a buzz, but four drinks during a relapse can cause heavier intoxication.” 

Some signs an alcoholic is drinking again include:

  • Symptoms of Intoxication.

“Immediately during a relapse, you’ll see symptoms consistent with intoxication. Those would be things like irritability, dismissiveness, irregular blood pressure, confusion, and less organized thoughts,” Hochman says. 

Bodily symptoms may include “Blackout, dizziness, shakiness, craving, or sweating, physical substance dependence, problems with coordination, slurred speech, or tremor,” Hassaan Tohid MBBS, SUDCC, CCATP, Board Certified Addiction Counselor and Founder of California Institute of Behavioral Neurosciences and Psychology, tells WebMD Connect to Care.

  • Behavioral changes.

 “Individuals who relapse on alcohol may become impulsively, uncontrollably or easily irritated and agitated, or may show increasing signs of depression, anxiety or stress,” Sternlicht says.

“Sometimes, a shift in mood can happen because of an emotional trigger or guilt over wanting to drink again,” Sabrina Spotorno, LCSW, Clinical Operations Manager at Monument in New York City, tells WebMD Connect to Care. “The alcoholic might even try quitting again because of that guilt.”

“If the relapse persists, you can generally notice changes in personality. Common changes are a decrease in connection (but increased time with bad influences), missing obligations, isolation, deceit, and more use of other vices too (food, shopping, gaming, smoking/vaping, porn). And all of this spirals further into depression, shame, and hopelessness that becomes the source of even more avoidance through drinking,” Hochman explains.

  • Social withdrawal.

Someone struggling with sobriety might start isolating themselves from loved ones and not following through on plans, including recovery-related activities. 

“Social withdrawal will include things like ignoring text messages or phone calls, not going to recovery meetings, skipping social events, and more,” Caitlin Garcia, CADC-II, Program Director at Renaissance Recovery, tells WebMD Connect to Care. “Oftentimes, when people relapse on alcohol or other substances they will ignore nearly every other facet of their lives as they feed their addiction.”

  • Neglecting personal tasks.

“Trouble with work, school, or caring for family could also signal an alcohol use disorder relapse,” Parool Desai, a psychiatric nurse practitioner at Clarity Health Solutions Mental Health Center in Southern Florida, tells WebMD Connect to Care. “Also, alcoholics who are drinking again might neglect personal hygiene or change their eating patterns.” 

“Being able to recognize the signs of an impending alcohol relapse allows you to offer your support and encouragement, hopefully fending off the relapse altogether,” Priya Chaudhri, MD, and CEO of Elevation Behavioral Health in Southern California, tells WebMD Connect to Care.

What Can Trigger a Relapse?

“For the most part, the final return to use is triggered by cues associated with alcohol addiction,” Paulo Negro, PhD, MD, Medical and Addiction Advisor at All Sober, tells WebMD Connect to Care. 

“These cues may be embedded in people, places and things. Vulnerable individuals may be exposed to them, and end up drinking not immediately, but a few days after the exposure,” Negro adds.  

Sternlicht notes that triggers for relapse will vary between individuals, but some common triggers may include:

  • Loss of a loved one
  • A traumatic event
  • A divorce, separation or breakup with a significant other
  • Arguments that cause emotional distress
  • Significant life changes such as losing a job, starting a new job or moving
  • Life stressors such as financial stress, unemployment, or relationship troubles
  • Revisiting negative connections such as people you used to drink with or places you used to drink

According to the US Department of Veterans Affairs, there are certain internal and environmental risk factors which may act as a trigger for a relapse. These may include:

  • Untreated physical or mental health conditions
  • Feeling hungry, angry, lonely, or tired
  • Living in a neighborhood with high substance use activity
  • Living close to a liquor store or bar
  • Often being exposed to substance use at work or social gatherings

How Can You Tell if Someone Has Been Drinking?

Addiction professionals widely regard relapse is a part of recovery from alcohol or drug dependence. A relapse happens when you drift from your goal of maintaining sobriety and start consuming alcohol again. While relapses should be avoided, they can also be regarded as a normal part of recovery that you can bounce back from. 

“Alcohol relapse is the outcome of a process that usually happens much before the first drink,” Negro says. 

Sternlicht notes that some signs of drinking may include:

  • Smelling alcohol in their breath
  • Slurred speech
  • Impaired coordination and motor skills
  • Change in appearance
  • Mood swings or exhibiting irritability
  • Personality changes

It's also important to know that behavioral changes and new habits can be implemented as a means for sustained recovery. “Abstinence is maintained by “sober thinking”, which is a way to keep the mind focused on recovery. Although some people may impulsively drink, thoughts justifying possible alcohol use usually precede the actual reinstatement of the use,” Negro adds. Counseling and therapy can help you analyze and avoid these impulses. 

    How Do You Treat a Relapse?

    “Relapse is not a sign of failure, but rather a sign that more support is needed. If relapse is continuous or pervasive this may be a sign that a different approach to treatment should be undertaken. Anytime an individual in recovery relapses it should be taken seriously and addressed immediately; however, relapse can vary greatly in their significance and fall on a spectrum in their severity,” Sternlicht says. 

    According to a 2015 study published in the Yale Journal of Biology and Medicine, the aim of treating relapse is to help you identify the early stages of relapse, when the chances of success are highest. The two main tools of relapse prevention are cognitive therapy and mind-body relaxation, which help in developing healthy coping skills.

    “If the relapse is severe, a person may need to look at accessing detox treatment as withdrawal from alcohol can be deadly,” Kristen M Gingrich, LCSW, CADC, CCS, Program Clinical Supervisor at Tri-County Mental Health Services, tells WebMD Connect to Care. 

    “For some people, they may just need to reevaluate where they are currently and make adjustments to help support their non-use. I think it is important that when a relapse does happen that each person looks at what lead to that relapse and reflect upon it so that they help themselves to build awareness to signs and risk factors so that if it were to happen again, they might be able to implement skills and changes earlier,” Gingrich says. 

    “There are three essential parts of a relapse plan,” Daniel Hochman, MD, a Psychiatrist and Founder of SelfRecovery.org, tells WebMD Connect to Care.

    “You need to plan for triggers well before a relapse, plan for what to do in the middle of a relapse, and plan what to do after a relapse. When you stack all three on top of each other, you create multiple lines of defense and more resilience. As with anything, the more you rehearse and plan ahead, the more successful you will be in preventing cravings, interrupting a relapse, and getting back on track,” Hochman says. 

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