So how did Eminem spend his time off? Drugs, mostly. "I fall in bed with a bottle of meds and a Heath Ledger bobblehead" doesn't even begin to cover it. Relapse, Em's first album in nearly five years, is studded with brand names, but not Lexus or Cristal — more like Lunesta, Ambien, Vicodin, Valium, NyQuil and other brain candy that helped Marshall Mathers turn himself into a zombie, before he got clean last year. It's hard to keep all the drugs on this album straight, but that's probably the point. Relapse is like a hip-hop version of Richard Pryor's Live on the Sunset Strip, the classic 1982 stand-up flick where Pryor makes the audience squirm through jokes about freebase addiction and setting himself on fire. If it's stronger than his last album, Encore, that's because Em's doing what he does best: cleaning out his closet. And there's more psychotic shit piled up in there than ever.

The power of Relapse comes from Em aiming his beat-downs at his truest target, himself. By letting Dr. Dre take over the low-end-funk production, and rhyming about things he actually cares about, he comes up with a more painful, honest and vital record than anyone could have expected at this late date, up there with The Eminem Show or maybe even better. The album it recalls most is his 1999 major-label debut, The Slim Shady LP, from the stripped-down Dre beats to the self-lacerating wordplay. There are no familiar pop samples from Aerosmith or Martika or Heart, no rock choruses, no guest cameos beyond a couple of verses from Dre and 50 Cent. Instead, Em gets down to business, because this guy's got real problems. (None of which he blames on his ex-wife, Kim, who isn't even mentioned — whew.) "What's a beer?" he asks at one point. "That's a devil in my ear/I been sober a fucking year/And that fucker still talks to me, he's all I can fucking hear."

"Déjà Vu" is a brutally funny confessional, unpacking the whole gruesome story of where Em's been lately: addiction, rehab, overdoses, ambulances, hiding his pills from his daughter in video boxes. When he went to the hospital in December 2007, it was reported as pneumonia, but Em admits, "That whole pneumonia thing/That was baloney/Was it the methadone, ya think?" When Hailie finds him passed out in his car with a bag of Three Musketeers bars, he makes excuses and pops more pills: "It's 12 noon, ain't no harm in self-inducing a snooze/What else is new?/Fuck it/What would Elvis do in your shoes?" He's always made a joke out of identifying with Elvis, but the joke stings a little more now that he's passing out cold on the bathroom floor.

Sobriety hasn't brightened his personality, that's for sure. "Insane" begins, "I was born with a dick in my brain/Fucked in the head," and goes on to elaborate a disturbing tale of childhood molestation. "My Mom" takes on a familiar object of scorn, but with the claim that his mom is exactly who he's turned into, drugging himself into a stupor in front of his kid. In the singsong chorus, he chants, "I'm on what I'm on/Because I'm my mom." At the end, he mutters, "Sorry, Mom. I still love you, though." (Good Lord, is he doing Step Nine? Because that will take him at least three or four entire albums!)

Just as Richard Pryor looked miserable taking audience requests for corny old Mudbone routines, there are songs here where Em flogs himself through the motions to rehash same-old shtick. The singles "Crack a Bottle" and "We Made You" are two of the weakest cuts, recycling beyond-stale boasts and celebrity disses. (Who were Amy and Blake, again?) In phony woman-baiting and gay-hating rants like "Stay Wide Awake," he sounds like an old retired hockey coach yelling at the kids on his lawn. In moments like these, he sounds unsure of himself, trying to guess what people expect from him, and that eager-to-please sweat doesn't suit him. It's no coincidence that the one where he raps about killing Lindsay and Britney is called "Same Song and Dance," as if even he realizes how played-out these jokes are — the only shocker is that he left out Nicole Richie.

He sounds more honestly screwed up in "Beautiful," his touching attempt at an inspirational ballad, singing, "Don't let them say you ain't beautiful" in his gawky voice. On the other end of the emotional spectrum, there's "Old Time's Sake," where Dre drops tasteless lines about getting Em stoned again. "Medicine Ball" goes back to cracking mean jokes about poor old Christopher Reeve — but in one of the album's funniest moments, Em turns himself into Reeve so the late, great Superman can get the last word in from beyond the grave: "Eminem, I'm coming to kill you/I always hated you and I still do."

There's a lot of hate on Relapse. Eminem hates himself for getting sober only slightly less than he hates himself for doing drugs in the first place. He hates himself for being famous, for hating his mom, for taking so long to make this album. (In one skit, his old nemesis Steve Berman taunts him, "You hide out in Detroit for almost five years while the music industry melts the fuck down? You know how many people lost their jobs because of your fucking vacation?") All that negative energy helps him fight the temptation to become comfortably numb. If you hate Em, he probably wouldn't blame you. But Relapse is reason to be glad he's still around.