Relapse is common, the risk falls the longer a quit lasts, and most people recover in the end

How often addiction comes back

Most people who try to quit something slip at least once. The useful question is what the slip means. In 2000, McLellan, Lewis, O'Brien and Kleber set outcome studies of drug and alcohol treatment beside studies of long-term illnesses, and compared how often each one came back within a year¹.

For addiction, 40 to 60% of people treated for alcohol or drug dependence were using again within a year of leaving treatment¹. For high blood pressure and for asthma, the share whose symptoms came back badly enough to need more medical care within a year was 50 to 70%¹. Addiction came back about as often as asthma did, and no more often.

Nobody calls an asthma treatment a failure because the symptoms returned¹. The plan gets adjusted and the care goes on. The US National Institute on Drug Abuse puts addiction treatment and recovery in the same frame, as care for a long-term illness². We think that is the right way to read a relapse. It is a sign the plan needs work. It is not a verdict on the person.

The ranges deserve some caution. They come from a literature review, so they are the authors' reading of other studies, with no pooled sample behind them¹. Relapse also means something different for each illness, which makes the bars a loose comparison. And there is a bigger gap that runs through this whole article. Every study here is about smoking, alcohol or drugs. We have not found the same comparisons for pornography.

If relapse is this common, the next question is when it happens. Is the risk the same on day 400 as on day 4?

The first days carry the most risk

The clearest answers come from smoking. In 1992, Hughes and colleagues followed 630 people who quit smoking on their own³. Only 33% were still abstinent after 2 days. After 3 months, 11% were³. Most quits that end, end early.

Herd, Borland and Hyland came at the same question from the other side. They asked how likely a quit was to end given how long it had already lasted⁴. The International Tobacco Control survey followed smokers in Australia, Canada, the UK and the US from 2003 to 2006, asking them again about once a year. The 1,296 people who had quit gave 1,800 sets of answers, since some took part in several rounds⁴.

Of those who had been quit for a week or less, 78% had relapsed by the next survey, 114 of 146⁴. Relapse counted anyone back smoking, and anyone quit again who had smoked since the last survey⁴. At 8 to 30 days it was 64%, and at one to six months, 42%⁴. Between six months and a year it fell to 22%, and between one and two years to 17%⁴. Of the 143 answers from people quit for more than two years, 7 had relapsed, which is 5%⁴.

Each stretch survived made the next one safer, and the fall was steepest early. That matches what Hughes saw, where two thirds of self-quitters had slipped within 2 days³. A quit that ended last week says very little about how a quit of two years will go.

Two things limit how far this reaches. A relapse could have come days after one survey or close to a year later, a gap the authors name as a limit of their study⁴. And on our own reading, the people still quit after two years include those who were always going to make it, so the chart cannot separate the effect of time from who they were.

Over a lifetime, most people get there

A year is a short window, though. If the early weeks are where most quits end, what happens over twenty years? Lopez-Quintero, Hasin, de los Cobos and others used a US national survey of 43,093 adults, run in 2001 and 2002, to look at the whole span⁵. People who had ever been dependent on nicotine, alcohol, cannabis or cocaine were asked how old they were when it started. Then they were asked how old they were when they finally stopped having any of its symptoms⁵. From those ages the authors projected how many would recover in the end.

Most of them would. Over a lifetime, the projected share was 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine⁵.

The catch is time. Within 10 years of dependence starting, only 18.4% had recovered from nicotine and 37.4% from alcohol⁵. Half had recovered after about 26 years for nicotine and about 14 for alcohol⁵. Cannabis and cocaine were faster, at about 6 and 5 years⁵. In the first year, 3.0% had recovered from nicotine or alcohol dependence⁵.

Set that beside the smoking survey and the two fit. Quits fail most often in the first weeks, and recovery in the first year is rare. Yet over decades the share who recover from alcohol dependence climbs past nine in ten⁴⁵. A relapse ends one attempt. On these numbers it rarely ends the story.

The definitions matter here. Recovery in this survey, which the authors call remission, means no longer having any symptom of dependence. The question asked about symptoms, not about use⁵. The lifetime figures are projections, not the share seen to recover by the time of the survey. People living in institutions, and people who had died or come to severe harm from their use, may not have been sampled, which pushes the figures up, the authors note⁵. Ages were recalled years later, self-report may overstate remission, and the survey did not count relapses between episodes⁵.

The routes people took

If most people get out in the end, how did they do it? Kelly, Bergman, Hoeppner, Vilsaint and White ran the National Recovery Survey in July and August 2016⁶. A national panel screened 25,229 US adults, asking whether they used to have a problem with drugs or alcohol and no longer do. 2,047 said yes and took the survey, and 2,002 of them gave valid answers⁶. That is 9.1% of adults, about 22 million people⁶.

The most used route was a mutual-help group. 45.1% had used one, with Alcoholics Anonymous at 34.6% and Narcotics Anonymous at 17.5%⁶. Formal treatment came next at 27.6%, split between outpatient care at 16.8% and inpatient or residential care at 15.0%⁶. Recovery support services such as sober living homes and recovery community centres came to 21.8%⁶. Faith-based recovery services, counted inside that group, came to 9.2%⁶. Medication against relapse or craving was the least used, at 8.6%⁶.

The number we find most striking is the one under all the bars. Only 53.9% had used any of these kinds of help⁶. Many used more than one, so the bars add up to more than that. By our subtraction, about 46% resolved their problem with none of them⁶. Groups were the most common route, and still more people found their own way out than went through a clinic.

That fits the lifetime survey. Recovery mostly came slowly, over years, and close to half of the people who resolved a problem did it outside any program⁵⁶. Peers came up more often than professionals.

This survey has its own limits. A problem was self-defined, so resolving one does not necessarily mean a diagnosed remission⁶. People recalled their whole lives, and 29% had resolved their problem 15 or more years before⁶. Using a kind of help also does not show it caused the recovery. Someone who went to AA and got better may have got better for other reasons.

How they found it

• A 2000 review set outcome studies of drug and alcohol treatment beside studies of high blood pressure and asthma. For addiction, relapse meant using again within a year of leaving treatment. For the other two, it meant symptoms coming back within a year and needing more care.
• In a 1992 study of 630 people who quit smoking on their own, 33% were still abstinent after 2 days and 11% after 3 months.
• The International Tobacco Control survey followed smokers in Australia, Canada, the UK and the US, asking them again about once a year. The 1,296 people who had quit gave 1,800 sets of answers, since some took part in several rounds. The chart counts sets of answers.
• In the 2001 to 2002 US survey, people who had ever been dependent were asked how old they were when it started, and how old they were when they finally stopped having any of its symptoms. The lifetime figures are projections from those ages.
• For the 2016 National Recovery Survey, a national panel screened 25,229 US adults, asking whether they used to have a problem with drugs or alcohol and no longer do. 2,047 said yes and took the survey, and 2,002 gave valid answers.
• Many used more than one kind of help, so the bars add to more than the 53.9% who used any. The rest, about 46% by our subtraction, used none of these.

What it cannot tell you

• Smoking, alcohol and drugs, not pornography. We have not found the same comparisons for it.
• The relapse ranges come from a literature review, the authors' reading of other studies with no pooled sample size. Relapse means something different for each illness, so compare the bars loosely.
• People still quit after two years include those who were always going to make it. The chart cannot separate the effect of time from who they were. Surveys were about a year apart, so a relapse could have come days or months after the last answers.
• In the lifetime survey, recovery means no longer having any symptom of dependence, and the question asked about symptoms, not use. People living in institutions, and people who had died or come to severe harm from their use, may not have been sampled, which pushes the figures up, the authors note.
• Ages were self-reported and recalled years later, self-report may overstate remission, and the lifetime survey did not count relapses between episodes.
• In the recovery survey a problem was self-defined, and 29% had resolved it 15 or more years before. Using a kind of help does not show it caused the recovery.

In P-Minus

P-Minus has no day counter. It tracks constancy, and a slip never sets anything back to zero. You renew the intention, log what led there, and carry on with the step you were on.

Sources

1. McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-95.
2. National Institute on Drug Abuse. Drugs, brains, and behavior: the science of addiction. Treatment and recovery. 2020.
3. Hughes JR, Gulliver SB, Fenwick JW, et al. Smoking cessation among self-quitters. Health Psychol. 1992;11(5):331-4.
4. Herd N, Borland R, Hyland A. Predictors of smoking relapse by duration of abstinence: findings from the International Tobacco Control (ITC) Four Country Survey. Addiction. 2009;104(12):2088-99.
5. Lopez-Quintero C, Hasin DS, de los Cobos JP, Pines A, Wang S, Grant BF, et al. Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction. 2011;106(3):657-69.
6. Kelly JF, Bergman B, Hoeppner BB, Vilsaint C, White WL. Prevalence and pathways of recovery from drug and alcohol problems in the United States population: implications for practice, research, and policy. Drug Alcohol Depend. 2017;181:162-9.

Sources checked October 2026.