Understanding Medications and Pharmacology: What Is the Most Common Relapse?

October 10, 2025 •

5 min read

According to the National Institute on Drug Abuse, 40-60% of individuals in substance use disorder treatment will experience relapse, a statistic comparable to other chronic illnesses like hypertension or asthma. Understanding what is the most common relapse involves recognizing the substances with the highest rates and the complex factors, including pharmacology, that influence a return to use.

Quick Summary

Opioid and alcohol use disorders have some of the highest relapse rates, and effective prevention combines medication-assisted treatment (MAT) with psychosocial therapies. Medications help stabilize brain chemistry and reduce cravings, while therapy addresses psychological triggers to aid long-term recovery efforts.

Key Points

Opioids and Alcohol Have the Highest Relapse Rates: Studies consistently show that opioid and alcohol use disorders are associated with the highest rates of relapse during the first year of recovery.
Relapse is a Process, Not an Event: It occurs in stages, starting emotionally and mentally before becoming physical, highlighting the importance of early intervention and recognition of warning signs.
Medication-Assisted Treatment (MAT) Significantly Reduces Relapse: For opioid use disorder, MAT with medications like buprenorphine and naltrexone can dramatically reduce relapse rates, with similar benefits for alcohol use disorder.
Integrated Treatment is Most Effective: The most successful outcomes for addiction recovery combine pharmacological treatments with behavioral therapies like CBT, mindfulness, and strong social support.
Triggers and Comorbidities Increase Relapse Risk: Factors like stress, negative emotions (HALT), environmental cues, and co-occurring mental health disorders are significant triggers that must be addressed in treatment.
Stopping Medication Increases Relapse Risk: For MAT patients, discontinuing medication sharply increases the likelihood of relapse, with rates sometimes returning to pre-treatment levels.
Tolerance Decreases During Abstinence: A relapse is particularly dangerous because a person's tolerance for a substance is lower, increasing the risk of a fatal overdose if they resume using at previous levels.

The Chronic Nature of Substance Use Disorders

Addiction is a chronic disease, not a moral failing. This perspective is vital for understanding relapse, which is often part of the recovery process, not a sign of failure. Just as a person with diabetes might experience a spike in blood sugar, a person in recovery might have a temporary setback. The underlying neurobiological changes caused by prolonged substance use can persist long after abstinence is achieved, making cravings and triggers a persistent challenge. The goal of treatment, therefore, is to manage the condition long-term and equip individuals with the tools to handle setbacks and prevent a full-blown return to use.

What is the most common relapse? An examination of substance use

While relapse is a risk across all substance use disorders, certain substances are associated with particularly high rates. Studies consistently show that alcohol and opioids have the highest rates of relapse during the initial phase of recovery.

Opioid Use Disorder (OUD): Relapse rates for opioids, including heroin and prescription painkillers, are notoriously high. Some studies suggest rates can be as high as 80-95% in the first year without medication, a figure that drops significantly with medication-assisted treatment (MAT). Opioids produce intense euphoria by flooding the brain's reward pathways, and withdrawal symptoms can be severe, driving the high relapse rate.
Alcohol Use Disorder (AUD): Alcohol also has one of the highest relapse rates. Some research indicates that up to 80% of individuals with AUD will relapse within the first year following treatment. Like opioids, alcohol significantly alters brain chemistry, affecting neurotransmitters like dopamine and GABA.
Other Substances: Other substances with high relapse rates include stimulants (cocaine, methamphetamine) and benzodiazepines. The psychological and physical dependencies created by these drugs contribute to the high risk of relapse.

The Relapse Process and its Triggers

Relapse is a process, not a singular event. It often unfolds in three stages: emotional, mental, and physical. Recognizing the early warning signs can help intervene before a full physical relapse occurs.

Emotional Relapse: The first stage, where the individual is not yet thinking about using but is engaging in poor self-care. This can include bottling up emotions, isolating from loved ones, or neglecting self-care.
Mental Relapse: The individual starts thinking about using again. Cravings, bargaining with oneself, and glamorizing past use become common. A person in this stage may actively look for opportunities to use or spend time with people associated with past use.
Physical Relapse: The final stage, where the individual uses the substance again. For many, a single instance can quickly lead back to uncontrolled use.

Common triggers that can initiate this process include:

Stress: High levels of stress, whether from work, relationships, or life events, are a primary trigger.
Negative Emotions: The acronym HALT (Hungry, Angry, Lonely, Tired) is a common reminder of physical and emotional states that increase relapse risk.
Social and Environmental Cues: Being around people, places, or objects associated with past use can trigger powerful cravings.
Co-occurring Disorders: Untreated mental health conditions like depression, anxiety, or PTSD can significantly increase the risk of relapse.

How Pharmacology Prevents Relapse

Medication-Assisted Treatment (MAT) is a cornerstone of relapse prevention for many substance use disorders. It is not a substitute for therapy but works in tandem to address the physiological drivers of addiction. For opioid use disorder, MAT has been shown to reduce relapse rates from 90% to 40-50% in the first year.

For Opioid Use Disorder (OUD):

Methadone: A full opioid agonist that prevents withdrawal symptoms and reduces cravings. It is administered daily in federally certified opioid treatment programs.
Buprenorphine: A partial opioid agonist that also curbs cravings and withdrawal symptoms but with a lower potential for abuse than full agonists. It is available in various forms and can be prescribed by qualified physicians.
Naltrexone (Vivitrol): An opioid antagonist that blocks opioid receptors, preventing any euphoric effects. It requires the individual to be fully detoxified before starting and is available in oral and long-acting injectable forms.

For Alcohol Use Disorder (AUD):

Naltrexone: Reduces cravings for alcohol and blocks its rewarding effects. It is effective in both oral and injectable forms.
Acamprosate (Campral): Stabilizes brain chemistry that has been altered by chronic alcohol use. It helps reduce the emotional distress that can trigger drinking.
Disulfiram (Antabuse): Acts as a deterrent by causing a highly unpleasant physical reaction (e.g., flushing, nausea) if alcohol is consumed.

Comparison of Relapse Prevention Medications


Feature	Methadone (OUD)	Buprenorphine (OUD)	Naltrexone (OUD/AUD)	Acamprosate (AUD)	Disulfiram (AUD)
Mechanism	Full opioid agonist	Partial opioid agonist	Opioid antagonist	Modulates glutamate/GABA	Blocks enzyme (aldehyde dehydrogenase)
Key Action	Reduces cravings/withdrawal	Curbs cravings/withdrawal	Blocks euphoric effects	Reduces emotional distress/cravings	Aversion therapy
Initiation	No withdrawal required	Mild withdrawal required	Full withdrawal required	Post-detoxification	Abstinence required
Administration	Daily dose in certified clinic	Daily sublingual, weekly/monthly injection	Daily oral, monthly injection	Three times daily oral	Daily oral
Adherence	Strictly monitored	Can be inconsistent (oral)	Can be inconsistent (oral)	Consistency can be challenging	Adherence is a major challenge
OUD Relapse Risk	Reduced	Reduced	Reduced (if inducted)	Not for OUD	Not for OUD
AUD Relapse Risk	Not for AUD	Not for AUD	Reduced	Reduced	Potential deterrent
Potential Overdose	Possible (full agonist)	Low (partial agonist)	Increased risk if use resumes after stopping	Not applicable	Not applicable

The Critical Role of Comprehensive Treatment

For long-term recovery, medication must be combined with robust psychosocial support. Standalone medication or therapy is less effective than an integrated approach.

Cognitive Behavioral Therapy (CBT): Helps individuals identify and modify the thought patterns and behaviors that lead to substance use.
Mindfulness-Based Relapse Prevention (MBRP): Teaches mindfulness and meditation techniques to help individuals observe cravings without reacting to them.
Building a Support Network: Engaging with support groups (like AA or NA), family, and friends is essential for reducing isolation and building healthy relationships.
Developing Coping Skills: Learning healthy ways to manage stress and negative emotions is a core component of preventing relapse.

A Path to Lasting Recovery

Relapse is a real and common risk in recovery from substance use disorder, particularly with opioids and alcohol, but it is not a sign of failure. The most effective strategy for combating relapse is a comprehensive approach that integrates pharmacological interventions with behavioral therapy and strong support systems. Medications like methadone, buprenorphine, and naltrexone help manage the biological and neurological aspects of addiction, while therapies provide the skills to navigate triggers and manage the psychological challenges of sobriety. It is also crucial to remember that tolerance decreases during abstinence, making a relapse particularly dangerous and increasing the risk of fatal overdose. By treating addiction as a chronic illness and providing integrated, long-term support, individuals can increase their chances of lasting recovery.

For more information on the effectiveness of medication-assisted treatment and other recovery strategies, the National Institute on Drug Abuse is an excellent resource. https://www.nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

Frequently Asked Questions

While relapse is common for many substances, opioid use disorder (OUD) and alcohol use disorder (AUD) are frequently cited as having the highest relapse rates, often exceeding 80% during the first year for individuals not on medication.

A lapse is a single instance of substance use after a period of abstinence, while a relapse involves a return to continued, uncontrolled substance use. A lapse, if addressed quickly, does not necessarily lead to a full relapse.

Relapse prevention medications, like naltrexone and buprenorphine, work in different ways to help normalize brain chemistry, reduce cravings, and, in some cases, block the euphoric effects of a substance. They address the biological underpinnings of addiction, making it easier for individuals to focus on therapy.

Yes, research shows MAT, particularly for opioid use disorder, is significantly more effective than treatment without medication. For OUD, MAT has been shown to reduce relapse rates from 90% to 40-50% in the first year.

Common triggers include stress, negative emotions (HALT: Hungry, Angry, Lonely, Tired), social situations involving substance use, and exposure to people, places, or things associated with past use. Co-occurring mental health issues like depression also significantly increase the risk.

Yes, a relapse, especially involving opioids, carries a high risk of overdose, including death. After a period of abstinence, a person’s tolerance decreases, meaning that a dose they previously used could be fatal.

No, addiction is a chronic disease, and relapse is a common part of the recovery process, not a sign of failure. It indicates that the treatment plan may need to be adjusted or reinforced. The key is to resume treatment and learn from the experience.