The Recovery from Alcohol Consumption: Analysis of the Construct of Relapse

Hugo E. Reyes-Huerta, Ángeles Vacio, Francisco Pedroza, Martha Salazar, Kalina Martínez


Objective: A systematic review was conducted to identify definitions that facilitated the study of relapse as both behavioral pattern and process. Methods: The review was conducted following the PRISMA-P guidelines. Articles that met the following inclusion criteria were considered: (a) published in peerreviewed journals, (b) provided an explicit operational definition of relapse, (c) assessed relapse during or after a specific psychological or self-care group intervention, (d) focused on alcohol consumption, and (e) were published between 2000 and September 2016. Results: “Any drinking” was the most frequent outcome used to identify relapse, although other discrete outcomes were also considered. Nevertheless, none of the definitions operationalize the notion of the return to a problematic drinking pattern and/or the process of relapse. Conclusion: Problems related to any drinking definition are discussed and we propose the use of a composed index to study relapse.


alcohol consumption, relapse, treatment outcomes, pattern, process

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Allsop, S., Saunders, B., & Phillips, M. (2000). The process of relapse in severely dependent male problem drinkers. Addiction, 95(1), 95–106. doi: 10.1046/j.1360-0443.2000.9519510.x

Anderson, K. G., Ramo, D. E., Schulte, M. T., Cummins, K., & Brown, S. A. (2008). The impact of relapse predictors on psychosocial functioning of SUD youth one year after treatment. Substance Abuse, 29(2), 97–106. doi: 10.1080/08897070802093411

Baer, J. S. (2002). Student factors: Understanding individual variation in college drinking. Journal of Studies on Alcohol, Supplement(s14), 40-53. doi: 10.15288/jsas.2002.s14.40

Bennett, G. A., Withers, J., Thomas, P. W., Higgins, D. S., Bailey, J., Parry, L., & Davies, E. (2005). A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence. Addictive Behaviors, 30(6), 1111–1124. doi: 10.1016/j.addbeh.2004.10.008

Bottlender, M., & Soyka, M. (2004). Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment. Alcohol and Alcoholism, 39(4), 357–361. doi: 10.1093/alcalc/agh073

Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. (2002). Process and outcome changes with relapse prevention versus 12-Step aftercare programs for substance abusers. Addiction, 97(6), 677–689. doi: 10.1046/j.1360-0443.2002.00101.x

Card, N. A. (2012). Applied meta-analysis for social science research. New York: Guilford Publications. doi: 10.1111/insr.12011_17

Chung, T., & Maisto, S. (2006). Relapse to alcohol and other drug use in treated adolescents: Review and reconsideration of relapse as a change point in clinical course. Clinical Psychology Review, 26(2), 149–161. doi: 10.1016/j.cpr.2005.11.004

Chung, T., Maisto, S. A., Cornelius, J. R., & Martin, C. S. (2004). Adolescents’ alcohol and drug use trajectories in the year following treatment. Journal of Studies on Alcohol, 65(1), 105–114. doi: 10.15288/jsa.2004.65.105

Cisler, R. A., & Zweben, A. (1999). Development of a composite measure for assessing alcohol treatment outcome: Operationalization and validation. Alcoholism: Clinical and Experimental Research, 23(2), 263–271. doi: 10.1111/j.1530-0277.1999.tb04109.x

Demirbas, H., Ilhan, I. O., & Dogan, Y. B. (2012). Ways of problem solving as predictors of relapse in alcohol dependent male inpatients. Addictive Behaviors, 37(1), 131–134. doi: 10.1016/j.addbeh.2011.08.007

DiClemente, C. C., & Prochaska, J. O. (1998). Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In W. R. Miller & N. Heather (Eds.), Applied clinical psychology. Treating addictive behaviors (pp. 3-24). doi: 10.1007/978-1-4899-1934-2_1

Donovan, D. M., & Marlatt, G. A. (2005). Assessment of addictive behaviors (2nd Ed.). New York: Guilford Press.

Engel, K., Schaefer, M., Stickel, A., Binder, H., Heinz, A., & Richter, C. (2016). The role of psychological distress in relapse prevention of alcohol addiction. Can high scores on the SCL-90-R predict alcohol relapse?. Alcohol and Alcoholism, 51(1), 27-31. doi: 10.1093/alcalc/agv062

Estopiñán, P. C., Poza, A. P., Martín, P. S., & García, C. P. (2009). Terapia grupal en prevención de recaídas del alcoholismo frente a seguimiento ambulatorio habitual. Adicciones, 21(1), 15–20. doi: 10.20882/adicciones.247

Feeney, G. F., Young, R. M. D., Connor, J. P., Tucker, J., & McPherson, A. (2002). Cognitive behavioural therapy combined with the relapse-prevention medication acamprosate: are short-term treatment outcomes for alcohol dependence improved? Australian and New Zealand Journal of Psychiatry, 36(5), 622–628. doi: 10.1046/j.1440-1614.2002.01019.x

Gossop, M., Stewart, D., Browne, N., & Marsden, J. (2002). Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses. Addiction, 97(10), 1259–1267. doi: 10.1046/j.1360-0443.2002.00227.x

Greenwood, G. L., Woods, W. J., Guydish, J., & Bein, E. (2001). Relapse outcomes in a randomized trial of residential and day drug abuse treatment. Journal of Substance Abuse Treatment, 20(1), 15–23. doi: 10.1016/S0740-5472(00)00147-1

Ham, L. S., & Hope, D. A. (2003). College students and problematic drinking: A review of the literature. Clinical Psychology Review, 23(5), 719–759. doi: 10.1016/S0272-7358(03)00071-0

Hayes, A. M., Laurenceau, J. P., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715–723. doi: 10.1016/j.cpr.2007.01.008

Holt, L. J., Litt, M. D., & Cooney, N. L. (2012). Prospective analysis of early lapse to drinking and smoking among individuals in concurrent alcohol and tobacco treatment. Psychology of Addictive Behaviors, 26(3), 561–572. doi: 10.1037/a0026039

Kirchner, T. R., Shiffman, S., & Wileyto, E. P. (2012). Relapse dynamics during smoking cessation: recurrent abstinence violation effects and lapse-relapse progression. Journal of Abnormal Psychology, 121(1), 187–197. doi: 10.1037/a0024451

Koob, G. F., & Volkow, N. D. (2009). Neurocircuitry of addiction. Neuropsychopharmacology, 35, 217–238. doi: 10.1038/npp.2009.110

Maisto, S. A., Pollock, N. K., Cornelius, J. R., Lynch, K. G., & Martin, C. S. (2003). Alcohol relapse as a function of relapse definition in a clinical sample of adolescents. Addictive Behaviors, 28(3), 449-459. doi: 10.1016/S0306-4603(01)00267-2

Maisto, S. A., & Connors, G. J. (2006). Relapse in the addictive behaviors: Integration and future directions. Clinical Psychology Review, 26(2), 229-231. doi: 10.1016/j.cpr.2005.11.009

Maisto, S. A., Witkiewitz, K., Moskal, D., & Wilson, A. D. (2016). Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice? Journal of Studies on Alcohol and Drugs, 77(6), 849-858. doi: 10.15288/jsad.2016.77.849

Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press. Marlatt, G. A., & George, W. H. (1984). Relapse prevention: Introduction and overview of the model. British Journal of Addiction, 79(3), 261–273. doi: 10.1111/j.1360-0443.1984.tb00274.x

Marlatt, G. A., & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors, 27(6), 867-886. doi: 10.1016/S0306-4603(02)00294-0

Martínez, K. I., Pedroza, F. J., Salazar, M.L., & Vacio, M. (2014). Estrategias de enfrentamiento y número de recaídas en el proceso de cambio de adolescentes que abusan del alcohol. Revista Mexicana de Análisis de la Conducta, 40(3), 11–31.

McKay, J. R., Franklin, T. R., Patapis, N., & Lynch, K. G. (2006). Conceptual, methodological, and analytical issues in the study of relapse. Clinical Psychology Review, 26(2), 109-127. doi: 10.1016/j.cpr.2005.11.002

McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284(13), 1689–1695. doi: 10.1001/jama.284.13.1689

Mertens, J. R., Kline-Simon, A. H., Delucchi, K. L., Moore, C., & Weisner, C. M. (2012). Ten-year stability of remission in private alcohol and drug outpatient treatment: Non-problem users versus

abstainers. Drug & Alcohol Dependence, 125(1), 67-74. doi: 10.1016/j.drugalcdep.2012.03.020

Miller, W. R. (1996). What is a relapse? Fifty ways to leave the wagon. Addiction, 91(12s1), 15-28. doi: 10.1046/j.1360-0443.91.12s1.6.x

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1. doi: 10.1186/2046-4053-4-1

Moore, T. M., Seavey, A., Ritter, K., Mcnulty, J. K., Gordon, K. C., & Stuart, G. L. (2014). Ecological momentary assessment of the effects of craving and affect on risk for relapse during substance abuse treatment. Psychology of Addictive Behaviors, 28(2), 619–

doi: 10.1037/a0034127

Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 101(2), 212–222. doi: 10.1111/j.1360-443.2006.01310.x

Moyer, A., Finney, J. W., & Swearingen, C. E. (2002). Methodological characteristics and quality of alcohol treatment outcome studies, 1970–98: An expanded evaluation. Addiction, 97(3), 253–263. doi: 10.1046/j.1360-0443.2002.00017.x

Mueller, S. E., Petitjean, S., Boening, J., & Wiesbeck, G. A. (2007). The impact of self-help group attendance on relapse rates after alcohol detoxification in a controlled study. Alcohol and Alcoholism, 42(2), 108–112. doi: 10.1093/alcalc/agl122

Mundt, J. C., Moore, H. K., & Bean, P. (2006). An interactive voice response program to reduce drinking relapse: A feasibility study. Journal of Substance Abuse Treatment, 30(1), 21–29. doi: 10.1016/j.jsat.2005.08.010

Muraven, M. (2010). Practicing self-control lowers the risk of smoking lapse. Psychology of Addictive Behaviors, 24(3), 446–452. doi: 10.1037/a0018545

Neto, D., Lambaz, R., Aguiar, P., & Chick, J. (2008). Effectiveness of sequential combined treatment in comparison with treatment as usual in preventing relapse in alcohol dependence. Alcohol and Alcoholism, 43(6), 661–668. doi: 10.1093/alcalc/agn075

Papachristou, H., Nederkoorn, C., Giesen, J. C., & Jansen, A. (2014). Cue reactivity during treatment, and not impulsivity, predicts an initial lapse after treatment in alcohol use disorders. Addictive Behaviors, 39(3), 737–739. doi: 10.1016/j.addbeh.2013.11.027

Potgieter, A. S., Deckers, F., & Geerlings, P. (1999). Craving and relapse measurement in alcoholism. Alcohol and Alcoholism, 34(2), 254–260. doi: 10.1093/alcalc/34.2.254

Rahill, G. J., Pinto Lopez, E., Vanderbiest, A., & Rice, C. (2009). What is relapse? A contemporary exploration of treatment of alcoholism. Journal of Social Work Practice in the Addictions, 9(3), 245–262. doi: 10.1080/15332560902841816

Ramo, D. E., Prince, M. A., Roesch, S. C., & Brown, S. A. (2012). Variation in substance use relapse episodes among adolescents: A longitudinal investigation. Journal of Substance Abuse Ttreatment, 43(1), 44–52. doi: 10.1016/j.jsat.2011.10.003

Schmidt, L. G., & Smolka, M. (2001). Relapse prevention in alcoholics by cigarette smoking? Involvement of nicotinic–dopaminergic mechanisms. Alcohol, 24(2), 111–115. doi: 10.1016/S0741-8329(01)00129-X

Scott, C. K., Dennis, M. L., & Foss, M. A. (2005). Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence, 78(3), 325–338. doi: 10.1016/j.drugalcdep.2004.12.005

Sheffer, C. E., Christensen, D. R., Landes, R., Carter, L. P., Jackson, L., & Bickel, W. K. (2014). Delay discounting rates: A strong prognostic indicator of smoking relapse. Addictive Behaviors, 39(11), 1682–1689 doi: 10.1016/j.addbeh.2014.04.019

Sobell, L. C., Sobell, M. B., Connors, G. J., & Agrawal, S. (2003). Assessing drinking outcomes in alcohol treatment efficacy studies: selecting a yardstick of success. Alcoholism: Clinical and Experimental Research, 27(10), 1661–1666. doi: 10.1097/01.ALC.0000091227.26627.75

Stockwell, T. (1999). Should a few hours of therapy change behavior 3 years later? Addiction, 94(1), 50–52. Stout, R. L. (2000). What is a drinking episode? Journal of Studies on Alcohol, 61(3), 455–461. doi: 10.15288/jsa.2000.61.455

Strowig, A. B. (2000). Relapse determinants reported by men treated for alcohol addiction: the prominence of depressed mood. Journal of Substance Abuse Treatment, 19(4), 469–474.

Takeda, Y., Roper, L., Duff, S., & Booth, P. G. (2013). Decision-making throughout the whole process of relapse: A qualitative analysis of problem drinkers’ accounts of recent episodes. Journal of Substance Use, 18(5), 417–428. doi: 10.3109/14659891.2012.721446

Tate, S. R., Brown, S. A., Glasner, S. V., Unrod, M., & McQuaid, J. R. (2006). Chronic life stress, acute stress events, and substance availability in relapse. Addiction Research & Theory, 14(3), 303–322. doi: 10.1080/16066350500262817

Toneatto, A., Sobell, L. C., Sobell, M. B., & Kozlowski, L. T. (1995). Effect of cigarette smoking on alcohol treatment outcome. Journal of Substance Abuse, 7, 245–252. doi: 10.1016/0899-3289(95)90008-X

Tuithof, M., ten Have, M., van den Brink, W., Vollebergh, W., & de Graaf, R. (2014). The Relationship between excessive alcohol consumption and alcohol use disorders according to DSM-IV and DSM-5. Alcoholism: Clinical and Experimental Research, 38(1), 249–256. doi: 10.1111/acer.12248

Van Zundert, R. M., Kuntsche, E., & Engels, R. C. (2012). In the heat of the moment: Alcohol consumption and smoking lapse and relapse among adolescents who have quit smoking. Drug and Alcohol Dependence, 126(1), 200–205. doi: 10.1016/j.drugalcdep.2012.05.016

Vielva, I., & Iraurgi, I. (2001). Cognitive and behavioural factors as predictors of abstinence following treatment for alcohol dependence. Addiction, 96(2), 297–303. doi: 10.1046/j.1360-0443.2001.96229713.x

Walton, M. A., Castro, F. G., & Barrington, E. H. (1994). The role of attributions in abstinence, lapse, and relapse following substance abuse treatment. Addictive Behaviors, 19(3), 319-331. doi: 10.1016/0306-4603(94)90033-7

Wetzel, H., Szegedi, A., Scheurich, A., Lorch, B., Singer, P., Schlafke, D., ... & Hautzinger, M. (2004). Combination treatment with nefazodone and cognitive-behavioral therapy for relapse prevention in alcohol-dependent men: a randomized controlled study. Journal of Clinical Psychiatry, 65(10), 1406–1413. doi: 10.4088/JCP.v65n1017

Winters, K. C., Stinchfield, R. D., Opland, E., Weller, C., & Latimer, W. W. (2000). The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers. Addiction, 95(4), 601–612. doi: 10.1046/j.1360-0443.2000.95460111.x

Witkiewitz, K. A., & Marlatt, G. A. (Eds.). (2011). Therapist’s guide to evidence-based relapse prevention. USA: Academic Press. Witkiewitz, K., & Masyn, K. E. (2008). Drinking trajectories following an initial lapse. Psychology of Addictive Behaviors, 22(2), 157–167. doi: 10.1037/0893-164X.22.2.157

Witteman, J., Post, H., Tarvainen, M., de Bruijn, A., Perna, E. D. S., Ramaekers, J. G., & Wiers, R. W. (2015). Cue reactivity and its relation to craving and relapse in alcohol dependence: a combined laboratory and field study. Psychopharmacology, 232(20), 3685-3696. doi: 10.1007/s00213-015-4027-6

Zweben, A., & Cisler, R. A. (2003). Clinical and methodological utility of a composite outcome measure for alcohol treatment research. Alcoholism: Clinical and Experimental Research, 27(10), 1680–1685. doi: 10.1097/01.ALC.0000091237.34225.D7

Zywiak, W. H., Stout, R. L., Trefry, W. B., Glasser, I., Connors, G. J., Maisto, S. A., & Westerberg, V. S. (2006). Alcohol relapse repetition, gender, and predictive validity. Journal of Substance Abuse Treatment, 30(4), 349–353. doi: 10.1016/j.jsat.2006.03.004


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