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Roger Watts, Ph.D.Roger P. Watts, Ph.D.
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Alcoholism Relapse Part 1: High Risk Situations

Roger P. Watts, Ph.D. Updated: Oct 1st 2012

Many times people who are addicted to alcohol are confused about the reasons that they drink to excess or wonder about the causes for continual relapse. People who are close to them sometimes wonder as well why it is that an alcoholic will continue to drink despite any threat or consequence. However, more than 50 years ago a researcher discovered that the leading cause of relapse among alcoholics was that there was some high risk situation they encountered while sober that caused them to go back to drinking.

man holding bottleTwo other relapse causes that were also identified - failure to improve unhealthy interpersonal relationships and negative moods that overwhelm a person - but failure to successfully negotiate a risky situation was the number one reason people chose to go back to drinking after making an attempt at sobriety. These high-risk situations come in many forms, but the following ten could be considered deadly for recovery unless they are successfully managed.

1. The most prevalent high-risk situation to overcome is being around people, places, things, and situations that were previously associated with drinking or the use of other drugs. Being able to avoid these situations depends somewhat on a person's age. Younger people have a harder time avoiding old drinking friends than older people who seem better able to dissociate themselves from negative people. But, the old 12-Step adage seems to apply here: If you hang around a barbershop long enough, sooner or later you'll get a haircut. Hanging around old people or places can eventually erode confidence to stay clean and sober to the point where picking up again seems the natural thing to do.

2. The notion that a person can use another drug other than alcohol and get away without relapsing later on alcohol is also prevalent among relapsers. Often this is called the "marijuana maintenance" program where a person avoids drinking but uses marijuana to enhance pleasure or dispel pain in life. Having sleeping pills, tranquilizers, or prescription medicines in their possession also falls into this category of high-risk situations.

3. Feeling "Hungry, Angry, Lonely or Tired" - the famous HALT acronym of Alcoholic Anonymous - is a set of situations that can cause relapse. Sometimes a person can get into these states by being in situations that create them. Being bored is frequently listed as a cause of relapse for young people, but the boredom is often a masquerade for depression that is caused by risky situations.

4. Ironically, having positive feelings can sometimes lead to relapse. Some situations - birthday parties, anniversaries, job promotions, etc. - can cause a person to feel like celebrating because they are associated with drinking alcohol. Sometimes people erroneously reason that if the situation causes them to have pleasure, then perhaps adding alcohol to the situation will cause even greater pleasure, and the allure of that is hard to resist.

5. Stress is all about change, and it can cause a person to be involved in situations that can lead to using alcohol or other drugs to manage it. People often resist change because of the unpredictability of the outcome that can cause worry and concern. Avoiding the buildup of stress can go a long way to reducing the temptation to use alcohol or other drugs to soften the strain that stress causes on the physical body and the mind.

6. One part of the HALT slogan mentioned above is "tired" and the role that fatigue plays in relapse is largely misunderstood. When a person gets physically or mental fatigued there is a tendency to not think clearly and to want to take shortcuts. Sometimes the thinking is that fatigue is good because then a person can sleep off the cravings and urges to use that might arise in difficult situations. But, the fact is a person is rarely at their best when tired and they are more vulnerable to distorted thinking.

7. Eventually, every recovering alcoholic asks themselves the question as to whether they are a "real" alcoholic. The greater the distance they have from their last drink the more likely they will forget that it is only through their daily abstinence that they are able to maintain their attitude of sobriety. There is a natural tendency is to think that, since they have successfully managed risky situations in the past that might have caused relapse, the chances are they are not truly addicted to alcohol and can use it in moderation. Controlled drinking creates even more high-risk situations because an alcoholic who is drinking commonly finds themselves surrounded by people who are using or in places where alcohol is a dominant stimulus. Little do most people know, but it is the situation of successful management that causes this overconfidence, and it is hard for many people to realize that the farther away from their last drink that they are, the closer they may be to their next one.

8. There is also a tendency to romanticize the past when one is at a distance from their last episode of drinking. The "war stories" that some people tell create a situation whereby their brain, upon hearing the story being repeated over and over again, begins to interpret the story as a normal life occurrence that is acceptable. People then usually conjure up all the old euphoric memories of when things were just fine and their drinking did not cause them untold pain. And, the sense of bravado that is felt by telling the story can unfairly signal to the person that they have control over alcohol.

9. Cross addictions create hazardous situations for many people as well. Compulsive gambling, sexual activity, eating, spending or working can all lead to unhealthy situations that can lead a person back to compulsive drinking. "Everything in moderation" proclaimed the Oracle at Delphi in ancient Greece, and this message is very important for recovering alcoholics to hear.

10. The high risk situation that is perhaps most obvious is having a lot of cash on hand that makes it deceptively easy to use alcohol or other drugs. Frequently, because cash is not being spent on drugs or alcohol while in recovery, there is a tendency to have a lot of cash in a pocket or purse and this can lead to the temptation to use it to purchase alcohol or other drugs. Alcoholics are conditioned to believe alcohol can enhance pleasure or reduce pain and when money is no barrier to using it, they will often drink.

High-risk situations continue to be the single most important threat to recovery from alcoholism. They are easily rationalized as being safe and acceptable behaviors, yet they can cause untold hardship when a person engages in them.


Roger P. Watts, Ph.D.

Dr. Roger P. Watts, Ph.D., a psychologist and licensed alcohol and drug counselor, operates and currently provides substance abuse counseling to dozens of alcoholics and addicts. He has 23 years experience delivering health care to hundreds of patients through individual, group, and online counseling services. He has been in recovery himself for 24 years. He lives and works in Saint Paul MN, and can be reached at

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