Holidays and Relapse Risk

The invitation is on the counter, and you already know which room will have the drinks. SAMHSA's 2023 post on mental health during the season says the holidays can be a time of celebration and joy, and also a period of stress, sadness, and loneliness. The post says that mix can be particularly difficult for people living with mental health and substance use conditions. Added stress is common, and that stress can worsen symptoms of depression, anxiety, or a substance use disorder. For people in recovery, SAMHSA is specific: the season presents challenges that can trigger the use of alcohol and drugs. Having a plan for social events and for loneliness can reduce the risk of substance use. Reduce is the verb. A plan is not a promise that the month will be easy.

If you might harm yourself, call or text 988. If the moment is an emergency, including an overdose, call 911. A holiday dinner is not the place to wait that out.

One survey, and what it measures

SAMHSA cites a National Alliance on Mental Illness survey: 64 percent of people living with a mental illness reported that their conditions worsened around the holidays. The reasons SAMHSA lists from that discussion are separation from loved ones, personal grief, the pressure of gift-giving, economic hardship, hard interactions with family, and shorter days. SAMHSA's own footnote says the survey was featured because it was the only known survey on that topic among people with a mental health condition. Keep the boundary. The 64 percent figure is about mental illness symptoms in that survey. It is not a percentage of people in recovery who return to use, and it should not be quoted as one.

Grief gets louder for some people in this season. SAMHSA says feelings of grief and loss can amplify, and it suggests checking on loved ones who may be alone. Loss is the longer subject on the grief guide. Low mood together with substance use is on the depression guide. Seasonal affective disorder is a separate condition in the holiday post: depression symptoms triggered as the days get shorter, often improving in spring and summer. SAMHSA says to talk with a health care provider if you think that is happening. It says treatment is effective and may include light therapy, antidepressant medication, talk therapy, or a combination. Do not start, stop, or swap a medicine because a calendar changed.

The plan SAMHSA actually describes

The post says it is okay to feel unhappy during the holidays, and that recognizing the feeling is the first step. The plan it describes, for moments of stress, sadness, or loneliness, may include calling a friend or family member, going for a walk, doing an activity that brings joy, or watching a favorite movie. Making the plan ahead of time, it says, can help the difficult moments stay more manageable.

Self-care, in the same list, means scheduling time and activities that recharge you. Examples given are reading, working out, time in nature, and stress skills such as deep breathing, meditation, and mindfulness. The post also says to prioritize necessities: a balanced diet, plenty of sleep, and time for exercise. Those are examples of taking care of a body during a loud month. They are not a training plan. Ordinary activities as part of a week, without a made-up schedule, are on the hobbies guide.

If you cannot be near loved ones, SAMHSA suggests a supportive community through clubs, support groups, community centers, local meetups, and faith communities, and a regular phone call with family or friends. That circle beyond a single holiday is on the support-network guide. Helping someone else is on the list too. SAMHSA says checking on a friend or neighbor can matter for them and for your own well-being. It is an option, not an assignment to host.

The line about alcohol and drugs is short, and it is the one people came for. Avoid them. Have a plan for events and for loneliness. Family and friends are asked to check on people who may be struggling with substance use. The post does not teach a sentence to say when someone offers a drink, and it does not rank parties. Cues and cravings, without a wait-it-out protocol, are on the triggers guide. Skills inside treatment are on the relapse-prevention guide.

When the plan is not enough

SAMHSA says to seek help if mental health struggles become overwhelming, and that treatment is available. It lists its National Helpline, 1-800-662-HELP (4357), as a free, confidential, 24-hour information service in English and Spanish for people and families facing mental or substance use disorders, with referrals to local treatment, support groups, and community organizations. It also lists FindSupport.gov and FindTreatment.gov. Veterans can use that same crisis number, then press 1, to reach the Veterans Crisis Line.

A return to use has its own page, first steps after relapse. SAMHSA's recovery page says the process includes managing setbacks, because setbacks are a natural part of life, and that resilience is part of recovery. That is a description of the process. It is not permission to shrug off a medical emergency, and a holiday is not proof that treatment failed.

What to line up before the week arrives

1. Who will you call when the room feels wrong, and is that person's number already in the phone?
2. Which of SAMHSA's plan pieces fits your actual day: a walk, a call, food, sleep, or leaving earlier than the invitation assumes?
3. If a gathering is built around alcohol, what is your plan for that event, since the post says a plan can reduce risk and does not say attendance is required?
4. If mood has dropped with the daylight, who is the health care provider you will tell, rather than deciding alone that it is only the calendar?
5. If you use, which page and which number come next, so the night does not end in hiding?

Call or text (800) 653-9376 if you want help finding treatment before the season, or after a rough night.

You are allowed to dislike a holiday, to skip parts of it, and to ask for company that is not a drink. SAMHSA's list is short on purpose. The rest of the month is still yours to plan with people who know you.

Additional Resources

Sources cited on this page:

• SAMHSA blog: Supporting Your Mental Health During the Holiday Season (November 20, 2023)
• SAMHSA: About recovery, including setbacks as part of life
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions