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This study aims to specify the determinants of low‐risk alcohol drinking and relapse at different time points after detoxification in patients with severe alcohol use disorder (AUD). Fifty‐four patients with AUD and 36 healthy controls (HC) were evaluated early in abstinence (T1). They underwent clinical, neuropsychological and neuroimaging (structural MRI and ¹⁸FDG‐PET) investigations. Patients with AUD were subsequently classified as “low‐risk drinkers” (LR) or “relapsers” (R) based on their alcohol drinking at 6 months (T2) and 1 year (T3) after discharge, using their medical record or self‐reported drinking estimation at follow‐up. Based on the alcohol status at T2 and compared with HC, only R had alexithymia, lower grey matter volume in the midbrain and hypermetabolism in the cerebellum and hippocampi. Based on the alcohol status at T3 and compared with HC, only R had more severe nicotinic …