Earlier this year, Frontiers in Public Health published an important study by John F. Kelly, Morgan Klein, Katherine Zeng, Sydney Manske, and Alexandra Abry.
I say it’s important because research that captures information about relapse tends to focus on the days, weeks, and maybe months following the initiation of recovery. We have very little professional and empirical knowledge about recovery and relapse across the lifespan—for example, how do life events such as marriage, divorce, having children, geographic moves, job loss, career changes, family losses, retirement, health problems, and other life transitions influence the course of recovery and the risk of relapse?
This study examines relapse after one year of continuous remission and its precursors. To be eligible, subjects had to be adults, have previously met diagnostic DSM 5 criteria for Alcohol Use Disorder, achieved at least 1 year of uninterrupted remission, then experienced a relapse, and be abstinent or in early remission for at least 90 days at the time of the study.
The study interviewed subjects to identify the most common and the most potent changes precipitating the relapse. (Potent = identified as “definitely contributing” to relapse.)
Most Common Changes Preceding Relapse
The graphic below ranks changes that precipitated relapse by how common they were among the subjects. (Most common at the top, least common at the bottom. The shading indicates whether the subject believed the change was definitely, probably, possibly, or not a contributor to the relapse.
For example, note that the two most common changes were a Focus on Recovery and Energy. However, the shading indicates that Focus on Recovery was frequently identified as “definitely” contributing to the relapse, while Energy was frequently identified as not contributing.
Most Potent Contributors to Relapse
The graphic below ranks the most potent identified changes, with the most potent at the top and the least potent at the bottom. Potency was determined by whether the subject believed the change was definitely, probably, possibly, or not a contributor to the relapse.
What is the Single Most Important Contributor to Your Relapse?
Researchers also asked subjects, “As you reflect on your relapse, what do you think was the major reason why you relapsed?” The responses to that question are ranked below, with 50% of all responses falling into 3 changes — mental health symptoms, focus on recovery, and isolation. It’s also noteworthy that 90% of all responses fell into the social and psychological domains.
So What?
This study represents an important step in understanding what the authors refer to as “remission-based warning signs” of relapse. It gives recovering people, addiction professionals, and researchers direction for understanding, preventing, and responding to relapse after a year of recovery.
The authors note that some of their findings align with experiential knowledge in communities of recovery:
…the top factor in terms of frequency of occurrence and potency in the year prior to the relapse was the change in focus on recovery—this aspect of continued cognitive vigilance is a central feature in self-regulation theory [e.g., 12] specifically in maintaining adequate healthy and functional self-regulation individuals must continually be aware of, and appraise, address, and successfully cope with, dynamic elements that might disrupt or distract the equilibrium. Further, underlying such a shift may be elements integral to social identity and behavioral economic theories of addiction recovery as the salience of being a “recovering person” may lose centrality in favor of more novel identities and competing rewards and reinforcers that, paradoxically, have emerged due to individuals’ successful liberation from addiction and the accrual of recovery-related benefits [also referred to as “recovery capital” (27)] (32).
It is sometimes said that the word “slip” often used to describe a return to alcohol use following a period of cessation (e.g., “Jim had a slip”) among individuals with AUD attempting to achieve stable recovery, stands for “Sobriety Losing Its Priority”. What stands out in our set of findings here, is that a reduction in cognitive recovery vigilance may be a potent marker to continually assess for and address among individuals in long-term AUD remission.
Kelly JF, Klein M, Zeng K, Manske S and Abry A (2026) Long-term relapse: markers, mechanisms, and implications for disease management in alcohol use disorder. Front. Public Health 13:1706192. doi: 10.3389/fpubh.2025.1706192
This study represents an important step in better understanding recovery and relapse over the lifespan.
