Predictors of relapse in alcohol use disorder: Identifying individuals most vulnerable to relapse

linear new multiple Abstract This paper reviews the literature discussing the various biological, psychological, environmental, and social factors contributing to the risk of relapse for individuals with Alcohol Use Disorder (AUD). Identifying these risk factors and understanding their complex interactions in contributing to relapse vulnerability is crucial to improving relapse prevention interventions and outcomes. The impact of chronic alcohol abuse on brain structure and function are discussed. Specifically, altered reward circuitry, modified stress pathways, and compromised frontal white matter integrity in regions associated with decision making, impulse control, and executive functioning are identified as risk factors associated with predicting long- term abstinence. Neural adaptations increased craving, which has been attributed to relapse vulnerability. The literature examined alcohol attentional-bias, coping style, early onset alcohol dependence, duration of treatment, attendance at AA, personality traits, self-efficacy, comorbid depression, deficits in social cognition, interpersonal relationships, and facial emotion recognition ability as risk factors that may be predictive of relapse. Clinicians should encourage AA attendance, treat depressive symptoms, address coping mechanisms, and enhance social support in the first year of abstinence. Future studies that focus on establishing the strength of the predictability of these risk factors, as well as identifying protective factors, could make substantive contributions to improving outcomes for individuals who are most vulnerable to the relapse process. Identifying risk factors at the brain and biological level could establish biomarkers for relapse risk, which would have implications for clinical practice and treatment of AUD by enhancing targeted interventions and individualized care.