Nearly 50million Americans are battling an addiction, and relapse is a common struggle in the recovery process.
Substance use disorder often requires multiple attempts to quit before successfully going sober, according to a report by researchers at Virginia Polytechnic Institute and State University.
The authors surveyed nearly 350 people about how many attempts it took to quit a substance before they were finally able to maintain their sobriety – revealing which drugs could be the most addicting.
The researchers looked at 12 substances ranging from alcohol and nicotine to cocaine and marijuana.
Some drugs are harder to put down than others, the team said. In a ranking of the substances with the most quit attempts, prescription pain medication such as OxyContin or Vicodin, took the top spot and was followed closely behind by non-prescription opioids such as fentanyl and heroin.
On average, it took addicts about six attempts to quit these vices before they stayed sober.
Quitting these drugs is extremely difficult because of the hold they have over users. The substances hijack the brain to become the user’s entire life, surpassing food and shelter in order of importance. All the while, the user has to keep increasing their dosages to achieve the high they experienced the first time.
An estimated 2.5 million American adults have an addiction to opioids, which were responsible for more than 107,000 fatal overdoses in 2023.
Prescription painkillers and opioids like fentanyl required the most quit attempts followed by stimulants and alcohol. Surprisingly, nicotine ranked below cannabis. Substances with more quit attempts also tend to cause severe withdrawal symptoms, such as pain and anxiety
In a ranking of the substances with the most quit attempts, prescription pain medication topped the list, followed by non-prescription opioids such as fentanyl and heroin
Next in the study, published in the journal Drug and Alcohol Dependence, were stimulants such as Adderall, Ritalin, and methamphetamine, with an average of 4.4 quit attempts, followed by alcohol, which saw 4.2 quit attempts.
Prescription stimulants used to treat ADHD double as party drugs among people who don’t have the condition, and are particularly popular among young adults.
Around 1.5 million Americans 12 and older have a prescription stimulant use disorder.
Some rankings may prove surprising. Nicotine, which has a grip on 24million Americans, did not rank in the top five and came below cannabis.
Researchers said: ‘The differences in the number of quit attempts between substances likely result from a combination of physiological, psychological, and social factors.’
The substances that were hardest to quit were also the ones with low short-term treatment effectiveness and high relapse rates. Opioids, for instance, have a recurrence rate of about 90 percent.
At the same time, if alcohol, stimulants, and cannabis are fixtures in a person’s social life, they can be harder to quit for good.
Substances with a higher number of quit attempts were also those that can bring on severe physical symptoms of withdrawal, such as pain, nausea, and anxiety.
E-cigarette use has reached record heights in the US with more than 17million adults and 2million children hooked on the devices
Opioid withdrawal can be fatal. Symptoms include flu-like signs such as muscle aches, nausea, vomiting, and diarrhea. If vomiting and diarrhea are severe and untreated, they can lead to dehydration, high sodium levels, and potentially heart failure.
Researchers at Virginia Tech reported that substance use disorder is a chronically relapsing condition that often requires multiple quit attempts before successful abstinence. Relapsing is part of the learning process, and stumbling blocks are part of the recovery process.
They also found people who meet the criteria of having a more severe or more extended history of substance use disorder might need more attempts before achieving abstinence.
The analysis found that both age at first use and length of time misusing a substance were significant factors associated with the number of quit attempts.
The longer someone has been using a substance, the more attempts they tend to have made to quit. Those with longer histories of use may face greater challenges in quitting, which is reflected in the higher number of attempts.
Dr Rafaela Fontes, a research scientist at the institute, said: ‘We treat addiction as an acute disorder, even though we know that it is a chronically relapsing condition.
‘When we’re talking about addiction, we need to understand that it’s not one size fits all. There are some substances that are harder to quit than others and it’s not equally easy or equally hard for everyone. We cannot use the same strategy for everything because it might not work.’
Researchers conducted the study using data from the International Quit and Recovery Registry, an online community of adults in recovery.
A recent survey found two-thirds of Americans reported either they or a family member suffer from addiction to drugs or alcohol, have experienced homelessness due to addiction or have been hospitalized because of a drug overdose
A survey was issued to 344 people in August 2023, asking about their history of use for 12 substances – nicotine, alcohol, cannabis, cocaine, opioids, stimulants, prescription pain relievers, hallucinogens, anesthetics, tranquilizers, inhalants, and a category labeled ‘others.’
It also asked about the severity of their addiction, their primary substance, and number of attempts to quit.
For the study, ‘quitting’ was determined by asking people if they still used a particular substance. If they said no, it meant they had quit. On average, participants had been sober for more than seven years.
The substance with the fifth-most quit attempts was tranquilizers, with 3.8, followed by inhalants, such as nitrous oxide (commonly called laughing gas), amyl nitrite (poppers), and ether, with 3.7 quit attempts.
Anesthetics had the seventh-highest number of attempts to quit, with 3.6. Cocaine came next with 3.5 quit attempts, followed by cannabis with 3.4 quit attempts.
Nicotine users saw an average of 3.4 quit attempts, and hallucinogen users saw an average of 2.7.
Dr Allison Tegge, corresponding author on the study and a research associate professor at the institute, said: ‘What makes this research stand out is that, not only did we consider the substance, but we asked additional questions to look at the individual experience in context.’
The study was published in the journal Drug and Alcohol Dependence.
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Addiction recovery is a lengthy, arduous process that requires constant self-reflection, self-discipline, and readiness to seek support when necessary.
Dr Tegge added: ‘If people in recovery knew the average number of attempts it might take to quit a particular drug, rather than see relapse as a failure, they might view it as a step on the journey. Understanding that relapse is part of recovery can help people stay engaged.
‘Maybe they can see that failure is part of the process and think: “I just need to keep trying, and eventually I’m going to get there.”’
