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San Diego Sober Living - Recovery

Which Substances Have the Highest Rates of Relapse?

In March 2023, during a guest appearance on The Tonight Show Starring Jimmy Fallon, rapper Macklemore spoke about his struggles with relapse at the height of the COVID-19 pandemic, which kept many people in recovery from attending meetings at Alcoholics Anonymous and other 12-step programs. For the 39-year-old musician, it was the second relapse since he had begun his journey to recovery four years before his song “Thrift Shop” became a chart-busting hit. Since Macklemore entered rehab for opioid and alcohol abuse, he has relapsed twice and lapsed many other times. These bumps on the road to recovery are common among people who have become neurochemically dependent on the substances Macklemore continues to recover from and that are at the center of most relapse episodes.

Understanding Lapse & Relapse in Addiction Recovery

A lapse is colloquially referred to as “falling off the wagon.” It occurs when a person in recovery has a drink or gets high without binging or making it a habit again. In a 2017 collaborative research study conducted by American and Indian psychologists, lapsing was estimated to happen at a rate of about 95 percent for all substances. 


Relapse, on the other hand, involves going on a binge, getting intoxicated more than once, or willfully abandoning recovery, thus putting patients at risk for returning to chemical or psychological dependence. Overall rates of relapse are about 50 percent for all substances.

Opiates & Opioids

Ever since the American pharmaceutical industry increased the availability of prescription medications after World War II, synthetic opioids have been at the center of various public health crises. It has been a slippery slope from the drugstore cowboys of the 1970s to the California pill mills of the 1990s and the current street fentanyl crisis. According to the aforementioned 2017 research study, the global rates of opiate recovery relapse are 86 percent, but they break down as follows:

  • 82 percent among heroin users
  • 86 percent among people who abuse prescription painkillers 
  • 91 percent among street fentanyl users

With street fentanyl, there aren’t many lapse episodes because full relapse is so common. A second relapse like the one Macklemore mentioned happens to 48 percent of opioid addicts.

Relapse in Alcohol Use Disorder (AUD)

In the 20th century, relapse rates among alcoholics were estimated to be as high as 84 percent, but the research methodology was later adjusted to eliminate lapses and situations in which patients aren’t militant about abstinence. Less than three-quarters of people who enter Alcoholics Anonymous fall into relapse, and more than 65 percent do so in the first year. The good news about AUD is that modern treatment options such as Encinitas sober living homes are reducing not only the frequency of relapse instances but also their severity, thus making it easier for patients to resume their recovery journeys.

Stimulant Addiction

The psychoactive mechanisms of stimulants such as cocaine and methamphetamine make them particularly addictive, but their relapse rates are lower than for AUD and opioid use disorder. Approximately half of all methamphetamine addicts relapse, and 68 percent of cocaine users who go through rehab will fall off the wagon in the first three years. A side note about cocaine use disorder is that an AUD comorbidity increases the risk of relapse considerably, thus making AUD treatment a priority.

Addiction impacts every aspect of physical and mental health, and it’s a serious problem that requires professional treatment. If you or someone you love is addicted to drugs or alcohol, seek help from a medical professional or another person you trust to help you explore options for treatment and continuing support, such as recovery coaching. Encinitas men who need help with forming new sober lifestyle habits can reach out to the dedicated team at Casa Pacifica Sober Living for the guidance they need. Give us a call today.

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