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February 8, 2019

What Drug Has the Highest Relapse Rate?

Alcoholics Anonymous tradition is that whoever stands up to speak introduces him- or herself with, “I am an alcoholic,” present tense. And that applies even to members who are celebrating 30 years of sobriety.

Is this simple honesty, or a detriment to self-esteem and perhaps to sobriety motivation? Is the cynical saying, “Once an addict, always an addict,” really true?

Most experts agree there’s some truth to it. First, some people are biologically more susceptible to becoming addicted (cases of addiction running in families are influenced by environment and heredity). Second, addiction isn’t called a “habit” for nothing: as with learned skills like bicycling and swimming, it creates lasting neuron patterns in the brain that can trigger “respond this way” actions in certain situations, sometimes decades later.

Still, many people give up drugs and never use again. Most of them agree that one secret of success is not to emphasize the “never again” too heavily, lest anyone get the idea “one slip and you’re through.” In fact, many recovering addicts (more accurately, people in recovery from addiction disorders) “relapse” into drug use multiple times before getting permanently clean.

Relapse is in fact a much misunderstood phenomenon, generating such questions as: Will I have to go through the whole detox procedure again if I use again just once? Is relapse inevitable? What factors affect my relapse risk: work situation, time of year, type of drug I was addicted to? What drug has the highest relapse rate?

The bulk of this article will focus on the addictive drugs with the highest relapse rates: but first, a quick look at relapse in general.


By dictionary definition, “relapse” means “to suffer deterioration after a period of improvement” or “a deterioration in someone’s state of health after a temporary improvement.” Since “deterioration” covers a wide spectrum of possibilities, some people count it as “relapse” if drugs are used just once after a period of sobriety (even in the absence of subsequent withdrawal symptoms or additional using). Others say it doesn’t become a relapse until someone is obviously back on the way to using drugs on an everyday basis.

What the experts agree on is that:

  • The risk of returning to addiction is highest in the first year after detox.
  • People who receive professional treatment for their addiction are less likely to use again.
  • Those who participate regularly in follow-up support programs also reduce their risk of relapse.
  • People who stop using drugs but make few other changes in their lives are at higher risk because they’re more likely to encounter “trigger” situations.
  • Addiction relapse rates are similar—roughly 50 percent—to recurrence-of-symptoms rates for chronic diseases such as asthma. Hence, addiction is classified as a chronic disease.

“Fifty percent chance of relapse” does not, of course, mean that everyone who detoxes from addiction has a fifty-fifty chance of staying sober. The odds for any individual are affected (as already noted) by follow-up behavior, and also by temperament, home/work atmosphere and the duration of the original addiction. And, often, by the type of drug involved.


Partly because of the inherent difficulties defining “relapse,” and partly because many people with addiction disorders use several substances together, precise statistics for specific drugs are hard to come by. It’s generally agreed, though, that the drugs with the highest relapse rates (over 60 percent) are:

  • Opiates
  • Alcohol
  • Cocaine/crack


Although those who grew up in the 1960s and 1970s may associate opiates with heroin as an illegal recreational drug, most societies before and since have known opium and its derivatives primarily as painkilling medications. Doctors knew of opium’s medical properties as early as 4,000 years ago: it was as familiar to the ancient Greeks as to the twenty-first-century Americans who witnessed the rise of the contemporary “prescription opiate” epidemic.

Opiates are addictive and hard to quit because:

  • They are highly effective at reducing pain and inducing euphoria, making “normal” physical and mental states seem undesirable by comparison.
  • The human body develops opiate tolerance and dependence quickly.
  • Withdrawal symptoms are highly unpleasant (though rarely fatal): vomiting, cramps, heavy perspiration.
  • Most medication-assisted treatments for opiate addiction rely on alternate opiates that are frequently addictive

Until recently, indiscriminate painkiller prescriptions and refills also made it easy to obtain opiates with few questions asked. Now that opiates are harder to obtain legally and longstanding addictions are leading to higher tolerance levels, many people who first became addicted to prescription painkillers are “relapsing” (or graduating) to stronger, more dangerous opiates such as heroin and fentanyl.

Suggestions for avoiding opiate relapse:

  • Learn yoga, relaxation exercises and other nondrug methods for reducing physical pain.
  • Take short hourly breaks from work (get up from the desk, sit down from the assembly line) to avoid overstressing any muscles.
  • Take at least one full day a week off from work, and take quarterly or semi-annual vacations.
  • Get 8 to 9 hours of sleep every night.
  • Get tested—and treated if necessary—for medical depression, which can follow in the wake of opiate addiction and make relapse look more attractive.
  • Avoid taking on too many responsibilities. Plan in advance rather than trying to work under pressure.
  • Practice regular “I can cope” and “I am capable” affirmations.


Alcohol (technically, ethyl alcohol) is unquestionably the oldest known common drug. Besides accompanying all manner of recreational activities throughout history, it was mixed with water to kill germs in the days before public sanitation, and was used as a surgical anesthetic before alternate medicines became available. Even today, doctors acknowledge that people who consume alcohol in moderation (no more than 1–2 drinks a day) have slightly lowered risk of heart disease. (But slightly increased risk of cancer.)

Medical questions aside, alcohol is bought, served and consumed recreationally every day throughout most of the world. Which is the number one reason alcoholism relapse rates are high: it’s seriously hard to remove oneself from temptation, even in the most respectable of social or work settings. Add to that the plethora of media images showing happy people consuming alcohol without evident harm, plus the many opportunities to encounter a sweet-wine aroma or fancy alcohol display, and a person recovering from alcoholism hardly needs “forget my troubles” thoughts to be tempted.

Suggestions for avoiding alcohol relapse:

  • Don’t go to venues where alcohol is served without a solid plan for avoiding “drink” temptations. In the early stages of recovery, avoid such settings altogether or bring along a trusty support partner.
  • Take public transportation rather than driving, so it won’t be as easy to stop at the bar. Or carpool with non-drinking friends.
  • If you completed detox in summer, check (better yet, have a sober friend check) your regular routes before the days get shorter, and see if there are any “beer” or “bar” signs that might light up to increase temptation on an after-dark commute.
  • If faced with a drink-pusher who won’t take a simple “No, thank you” for an answer, have a backup statement to convey “not tonight” more clearly. (“I’m a designated driver” is one of the best.) Or just leave the party.


The mildly intoxicating effects of coca leaves have been known in their native South American Andes for millennia: traditionally, the leaves were chewed to increase energy for physical labor or as part of religious ceremonies. Europeans discovered coca in the sixteenth century, but it wasn’t until 1859 that pure, potent cocaine was extracted from the leaves. By the last quarter of the nineteenth century, cocaine was widely used as a medical remedy for depression and impotence, among other ailments. Doctors still occasionally use it as an anesthetic.

Recreational cocaine was largely considered a rich person’s drug until the mid-1980s, when cheap, smokable cocaine, or “crack,” became popular in poorer neighborhoods.

Cocaine is not particularly addictive in the physical sense, but it creates powerful psychological dependence. People who have detoxed from cocaine may be tempted to relapse by:

  • The desire to experience an intense feeling of euphoria and empowerment
  • The desire to get a burst of energy or stay awake longer
  • The hope of losing weight (cocaine suppresses appetite, and also reduces the body’s ability to store fat)

Suggestions for avoiding cocaine/crack relapse:

  • Develop your talents and self-esteem to reduce the allure of artificial “empowerment.”
  • Get adequate sleep.
  • Don’t overload your to-do list: be willing to let some things wait in the interest of getting adequate breaks and going to bed on schedule. (Just make sure to give your best time slots to truly important tasks, which will also help your self-esteem and sense of accomplishment.)
  • Know your ideal weight for your age, gender, height and build (better yet, check with a doctor to get an informed opinion on your unique needs), then focus on achieving and maintaining that weight through exercise and healthy eating. (And if you need to gain weight, look to rich proteins and starches rather than empty-calorie junk foods.)


  • Avoid using any potentially addictive drug, including tobacco. One dependence often tempts to another.
  • Stay active in a support group.
  • See your therapist regularly.
  • Know your true passions and purpose, and focus on living for them.
  • Take time every day to help others.
  • Take time every day to count your blessings. Never let yourself forget you have hundreds of reasons to be happy without drugs!


Cohut, Maria (2018, February 11). “What Happens in the Brain When Habits Form?” Retrieved from

Diep, Francie (2013, August 12). “How Cocaine Makes Users Skinny.” Popular Science. Retrieved from

Genetic Science Learning Center. “Genes and Addiction: Susceptibility Does Not Mean Inevitability.” The University of Utah. Retrieved from

Jaffe, Adi (2012, September 13). “5 Damaging Myths About Addiction.” Retrieved from

Massachusetts Institute of Technology (2018, February 8). “Distinctive Brain Pattern Helps Habits Form.” Retrieved from

Mayo Clinic (2018, November 6). “Alcohol: Weighing Risks and Potential Benefits.” Retrieved from

National Institute on Drug Abuse (2018, July). “Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery.” Retrieved from

National Institute on Drug Abuse (2018, July). “The Science of Drug Use and Addiction: The Basics.” Retrieved from

Norn, S., PR Kruse, and E. Kruse (2005). “History of Opium Poppy and Morphine.” Dan Medicinhist Arbog, Vol. 33, pp. 171–184. Retrieved from (2012, March 5). “Habits: How They Form and How to Break Them.” Retrieved from

Substance Abuse and Mental Health Services Administration (2019, January 2). “New Year’s Resolution 2019: Tobacco-Free Recovery.” Retrieved from

For related information on relapse concerns, see the following articles:

Addiction Relapse Rates Compared to Those For Other Chronic Illnesses

How to Make a Relapse Prevention Plan With Your Loved One in Recovery

Life After Relapse: How to Bounce Back and Start Over

Relapse Prevention 101

Tax Day: How to Handle This Common Trigger for Addiction Relapse

What You Can Learn From a Relapse