Variety in alcohol use disorder relapse definitions: Should the term "relapse" be abandoned? (2022)

OBJECTIVE: The definition of relapse has been the subject of debate for decades, and a semantic ambiguity highlighted in a 2016 article in the Journal of Studies on Alcohol and Drugs remains. The current article replicates and extends the 2016 findings on alcohol use disorder (AUD) relapse definitions.
METHOD: We conducted a systematic review of 321 articles that examined relapse in patients with AUD, published from 2000 to 2019. Relapse definitions were extracted and a narrative review of definitions was conducted.
RESULTS: One hundred and one different definitions of relapse were used in 251 (78%) of the reviewed articles. In 70 (22%) of articles, no definition of AUD relapse was provided. Fifty-three articles used diagnostic criteria (i.e., alcohol use after remission of AUD), whereas 99 articles defined relapse as "any alcohol use" or "any use of alcohol/drugs." Additional articles defined relapse by alcohol outcomes (e.g., percent drinking days), alcohol-related problems, or hospitalizations (n = 97). Only 12 articles described the time window of abstinence preceding a relapse. We observed relatively no meaningful intercontinental or time-related differences in relapse definitions, although the outcome "percent heavy drinking days" was used more frequently in recent studies.
CONCLUSIONS: A wide variety of relapse definitions were identified. Despite decades of research and discussion, there is still no widely accepted consensus definition of AUD relapse. We propose to shift the focus toward clinical continuous outcomes, course specifiers based on the number of AUD symptoms present, and quality-of-life-related criteria instead of using current dichotomous AUD relapse terminology.