Relapse Risk Calculator for Alcohol Use Disorder

What Is a Relapse?

In the context of recovery from alcohol misuse, a relapse is a return to drinking after a period of abstinence. While the main trigger for relapse is holding on to the belief that alcohol serves you in some way, there are additional factors — such as stress or lack of support — that amplify the risk.

You said goodbye to alcohol and meant it. But then … you said hello again. As Craig Beck writes in Alcohol Lied to Me Again, “This journey backwards virtually always starts with the same sentence being uttered: ‘Surely just one drink won’t hurt.’”

First things first: you’re not alone. Relapse is a reality for many people on the alcohol journey, and it doesn’t mean you’ve failed. There’s also no such thing as “going back to square one”: once you set off on the path of recovery, you’ve been moving forward, even if that path involves a setback. As Reshma Saujani puts it, “There’s no more powerful lesson than knowing that your setbacks will one day help you succeed.”

That said, relapse is something we want to avoid if we can. And that’s where our handy Relapse Risk Calculator comes in!

What Is a Relapse?

Recovery from alcohol use disorder (AUD) can be a rocky road full of ups and downs. A relapse means we returned to drinking after a period of being booze-free. Here are the main things to understand about the science behind it:

• Slips and relapses are common in recovery. In fact, studies show that as many as 85% of patients who receive treatment for substance use disorder relapse within a year. But don’t be discouraged! With some planning, relapse is avoidable. And even if it happens, it’s completely possible to get back on track.
• Cravings don’t disappear when we stop drinking. When we become dependent on alcohol, our dopamine-driven reward system gets hijacked, leading to cravings and withdrawal symptoms if we suddenly stop. And while acute withdrawal symptoms can get resolved within days of putting down the bottle, dopamine levels take longer to rebalance, so we might still find ourselves stuck in that “I need a drink feeling,” especially in the early weeks.
• Habituated brain pathways make setbacks easy to have. It’s kind of like walking a well-worn path through the woods or sliding down the same skiing trail — our brain likes efficiency and gets used to certain behavioral patterns, making them almost automatic. If we’ve been drinking for a long time or are used to having a drink in certain contexts — happy hour after work, weddings, our friend’s famous Halloween bash, and so forth — we can find ourselves reaching for a drink almost on autopilot. This is where knowing our triggers becomes especially useful. Spotting them in time and changing our response eventually rewires the brain, getting us farther out of the relapse danger zone.
• Holding on to cognitive distortions about alcohol makes relapse more likely. By far the most likely “reason” for a slip or a relapse is the belief that alcohol does something for us. Whether we think it helps us relieve stress or helps us socialize (spoiler alert: both are common cognitive distortions that don’t hold up to science), we might be holding on to the idea that we “need” or “want” booze to be part of our lives. 
• A number of other factors play a contributing role. Especially if we haven’t changed the way we see alcohol (and are still feeling deprived), additional factors in our life might contribute to a relapse. For example, stress or a lack of social support can play a role.

Want to know more? Check out “Defining Relapse: A Rehearsal for Success,” and “How To Stay Sober After Recovering From Alcoholism” to learn about the signs of relapse and more. But now, let’s get practical — ready to calculate your relapse risk and form a plan?

What Is a Relapse Risk Calculator?

Teasing out the factors that might set the stage for relapse can be tricky. Enter the Relapse Risk Calculator! By analyzing responses to questions about your history and current habits, it helps you pinpoint factors that might set the stage for a relapse. Think of these factors as relapse red flags marking the areas of your life where slight shifts can set you on the path to success. 

Ready to “weatherproof” your recovery? Let’s get started!

Factors That Contribute to Relapse

Congrats! You just took an important step to a lasting recovery by filling out the Relapse Risk Calculator and finding the factors that might lead you down the relapse road. Now, let’s look at each one in a bit more detail.

1. Stress Levels

Biologically, stress is the body’s response to danger — the so-called “fight-or-flight” mechanism. The stress response is triggered by the amygdala, which stimulates the release of “stress hormones” such as adrenaline and cortisol. The result? Our body switches into “emergency mode”: our heart rate and breathing rate increases, glucose gets pumped into the blood to provide fuel for our muscles, and functions such as digestion get put on hold.

While the stress response is a (literal) lifesaver when it comes to “fighting” or “fleeing” from actual danger (think raging fire or an angry buffalo), it leads to a host of health problems if it’s triggered unnecessarily, especially on a chronic basis. And yet it’s a modern-day reality for many of us: in 2022, over a third of American adults reported that stress was “completely overwhelming” for them on most days.

High stress is a known trigger for relapse. In fact, studies show that stress is a major factor in relapse because of how it affects the brain. For one thing, chronic stress lowers dopamine levels, making alcohol cravings more powerful. It also interferes with the prefrontal cortex — the decision-making hub of the brain involved in self-regulation and impulse control.

Lower your risk:

• Start a mindfulness practice. When it comes to dealing with stress, mindfulness is where it’s at. Whether it’s traditional sitting meditation or a practice such as mindful walking, mindfulness is all about being in the moment without judging it. Science says it lowers cortisol levels while strengthening our prefrontal cortex and enhancing resilience to stress.
• Learn in-the-moment stress management techniques. Progressive muscle relaxation, diaphragmatic breathing, and even splashing cold water on your face to stimulate the parasympathetic nervous system (which is responsible for relaxation), all work wonders when it comes to lowering stress in the moment. Sometimes that brief pause makes all the difference!

2. Social Support

Recovery is a journey, and having a strong support team to back us up is key. A network of trusted friends, family members, and others who support our booze-free life is an essential part of any relapse prevention plan.

While alcohol often gets credit for making us “more social,” the reality is it does the opposite. We might feel less inhibited, but solid connections are unlikely to take root with alcohol in the picture. And when we leave behind our drinking days — and our weekend barhopping posse — we might feel more isolated than ever.

Science says that social support is crucial in recovery for many reasons. Our peers hold us accountable, share their experience and coping skills, celebrate our milestones, and cheer us on when things get tough. As a result, social support provides a powerful buffer against relapse.

So if your social support system needs a tune-up, it’s time for some changes!

Lower your risk:

• Expand your support system. Start with a few people you trust and keep building. And don’t forget that online support is an option! Communities such as Reframe are a great place to meet like-minded people who’ve been where you are and know what it’s like.

• Check in on a regular basis. Set up a system of daily check-ins with your support team members. They don’t need to be long — a simple text or quick phone call will help you stay accountable while keeping the line of communication open.

3. Craving Intensity

Even if we have a strong support system and keep our stress levels low, alcohol cravings can still creep in and lead to relapse. Remember how we said it takes the brain a while to adjust to being booze-free? The main reason for this is that alcohol disrupts the delicate neurotransmitter balance in the brain by boosting dopamine (the reward neurotransmitter) and GABA (an inhibitory one responsible for the downer effects of booze). It also lowers glutamate, GABA’s excitatory counterpart. And while the brain will rebalance itself in time, the process can take a few weeks or even months. In fact, studies show a strong correlation between dopamine levels and likelihood of relapse. One study found that participants who relapsed at various points after detoxification had less dopamine and less activity in the brain’s reward circuit than those who didn’t relapse.

Lower your risk:

• Reframe your cravings. One of the most powerful ways to coast through cravings is to use cognitive restructuring to reframe our thinking around alcohol. A staple of cognitive behavioral therapy (CBT), this technique involves uncovering your subconscious beliefs about alcohol (for example, “I need booze to be social”) and replacing them with ones that align with reality and goals (“Being disinhibited isn’t the same as being social — authentic relationships thrive when I’m clearheaded and present in the conversation.”)
• Learn urge-surfing techniques. There are many urge-surfing techniques out there, and they all have one thing in common — they’re based on the fact that cravings are temporary and last at most 20 minutes. As a result, it’s all about creating an intentional pause — whether that means practicing mindfulness, going for a walk, playing a game on your phone, or calling a friend to check in. Pick what works for you and start surfing!


4. Past Relapse History

Our alcohol journey is unique, and so is our history. One study compared participants who quit drinking and later relapsed to ones who stayed on track. Out of the “relapsers,” a greater percentage had made more than one attempt to leave booze behind, showing that having a history of relapse might sometimes make us more vulnerable in the future.

That said, having multiple relapses in the past is by no means a sign that another one is inevitably coming. Likewise, it’s not a sign of weakness — if anything, it’s a testament to our strength that we keep trying again in spite of experiencing setbacks. The key is to learn from each one and modify our strategy accordingly. Tracking our triggers is key here: if we know what set the relapse in motion — especially more than once — we can be prepared in the future. 

Lower your risk:

• Track your mood and stress levels. Tracking your emotional patterns — as well as noting cravings when they come up — is key to understanding your state of mind and identifying vulnerable times. Even if you end up having a slip, make sure you note the events leading up to it so you can use this information for the future.

• Start a gratitude practice. Tracking our stress and slips in recovery is important, but so is tracking the good stuff! Gratitude is a science-backed way to boost dopamine, which makes it a powerful recovery tool in itself. Moreover, having a record of things that went well deepens our commitment and keeps us going when things get tough.

Relapse Prevention Plan: More Tips for the Journey

No matter which relapse-related factors loom large for you, there are some steps that every relapse prevention plan should include:

• Reframe your mindset around alcohol. Continue questioning your thoughts about alcohol and reframing any distortions that come up. The more you’re able to shift your mindset around booze, the more relapse resilience you’ll build.
• Learn to coast through cravings. At the same time, continue filling your toolbox with urge-surfing techniques. Check out “Mindfulness Techniques to Manage Alcohol Cravings” for some great tips!
• Nourish your body. Alcohol wreaks havoc on the body, and we need to replenish its resources with nutritious food. Think whole grains, lean proteins, healthy fats, and plenty of fruits and veggies.
• Get an exercise routine going. In addition to nourishing your body with healthy food, adding movement to your routine is key. Exercise naturally boosts dopamine, keeping cravings at bay while making us more resilient to stress.
• Establish a healthy sleep schedule. Getting enough rest is key for the body and mind to function properly. Lack of sleep depletes our dopamine levels and raises cortisol, contributing to stress and cravings.
• Find your people and stick with them. Finally, continue building your support team! Sharing your story and having others to lean on when things get difficult will continue to add meaning to your new life while making you more resilient and motivated to stay on track. Plus, being kind and providing support in return will make you feel good and give you an extra dopamine boost!

With these tips — and with the Relapse Risk Calculator — you’re off to a great start when it comes to lowering your chances of getting off track in the recovery journey.