- It takes 9 years on average from initial treatment entry to achieve full sustained remission.
For individuals who seek treatment for substance use disorder (SUD), it takes roughly 9 years on average from initial treatment entry to achieve full sustained remission (i.e., no symptoms other than craving for 1 year). This clinical course of the disorder is likely to include 3 to 4 separate treatment episodes. During this long period people are typically accruing longer and longer periods of abstinence before achieving 365 consecutive days (which is often synonymous with full sustained remission). Consequently, for many if not most people, the majority of the days during this 9 year period to full sustained remission are abstinent ones as they move gradually toward achieving one full year of remission.
- Despite severe consequences, substance use disorder is ultimately a “good prognosis” disorder.
Despite the severe, and sometimes life-threatening consequences it can cause, substance use disorder (SUD) is ultimately a “good prognosis” disorder. Remission (i.e., recovery) is the most likely clinical outcome, with 60% eventually achieving full sustained remission. Several factors influence the likelihood of whether, and how soon, remission will be achieved. These factors include, but are not limited to, seeking professional treatment and beginning the treatment process earlier after meeting SUD criteria, as well as modifying one’s social network to support recovery, for example, through mutual-help organizations like Alcoholics Anonymous.
- Precise clinical recommendations are unclear for the appropriate amount of time that individuals with opioid use disorder should take an agonist medication (buphenorphine (Suboxone), methadone)
Precise clinical recommendations are unclear for the appropriate amount of time that individuals with opioid use disorder should take an agonist medication, such as buprenorphine and methadone. Evidence suggests these medications help reduce frequency of opioid use not only during the earliest stages of recovery – during the first 3 to 6 months – but also over the course of the 3-5 years after receiving the medication for the first time.
- The biggest benefit of mutual help organization participation (AA, NA, etc.) appears to be the socially-oriented support.
Mutual-help organizations, like Alcoholics Anonymous, are empirically-supported, community-based resources that facilitate long-term remission and recovery. Overall, when several potential explanations of AA benefit are considered at once, the socially-oriented recovery benefits of mutual help organization participation appear to carry the most weight. However, studies on how AA is helpful (i.e., “mechanisms of behavior change” research) show AA doesn’t work the same way for everyone. For example, it works by increasing confidence to handle difficult emotions without drinking for women, but not men. Men, on the other hand, are likely to benefit more from AA through enhanced self-efficacy to handle risky social situations without using alcohol. It works by providing a place to meet individuals who will support someone’s recovery for older but not younger adults (30+ vs. 18-29 years). For younger individuals, AA helps them most by reducing the heavy drinkers in their social networks. It works by enhancing spirituality/religiosity only for individuals with more severe forms of alcohol use disorder. Put another way, people seeking addiction recovery use different aspects of AA to help them cope with the most pressing and salient or important challenges occurring at that time.
- If the criteria for a substance use disorder is already met, it takes 5 years of full sustained remission to be no more likely than anyone else in the general population of meeting criteria for the disorder.
Even after achieving full sustained remission from substance use disorder (SUD), the risk for meeting criteria for the disorder in the following year remains greater than it is in the general population. It is not until an individual has 4-5 years of full sustained remission from substance use disorder (and 6 or more years of remission for heroin use disorder) before their risk of meeting criteria for the disorder in the next year drops below 15% — the lifetime risk for SUD in the general population. Said another way, if you’ve already met criteria for SUD, it takes about 5 years of remission to be no more likely than anyone else in the general population of meeting SUD criteria in the next year. This suggests that SUD is a chronic illness, somewhat susceptible to reoccurrence for at least several years, even after someone appears relatively stable.
- Not everyone achieves full sustained remission through complete abstinence.
Some individuals can achieve full sustained remission from substance use disorder (SUD) without being completely abstinent. It is very important to note, however, that the abstinence pathway to remission is much more stable – that is, it is a safer route. In a large, representative sample of individuals in remission from alcohol use disorder in the United States, for example, 38% were abstainers, 37% low-risk drinkers (based on the National Institute of Alcohol Abuse and Alcoholism guidelines), and 25% were risky drinkers (in remission but not meeting the low-risk drinking guidelines). Three years later, only 7% of abstainers had any recurrence of alcohol use disorder symptoms, compared to 27% of low-risk drinkers, and 51% of risky drinkers. Adjusting for clinical and demographic characteristics to understand better the unique risk of remission type (e.g., adjusting for age given that younger individuals were both more likely to be in non-abstinence remission groups and to have alcohol use disorder symptoms 3 years later), compared to abstinence, risky drinking is 2.7 times more likely to lead to a recurrence of alcohol use disorder symptoms, and low-risk drinking 1.8 times more likely.
- The benefits provided by medications for alcohol use disorder (naltrexone, acamprosate) – are modest.
The benefits provided by medications for alcohol use disorder – including naltrexone and acamprosate – are modest. Studies show taking this medication gives patients only about a 5-10% better chance at abstinence or only non-heavy drinking (less than 4 drinks per day for women & 5 for men) than if they take a placebo medication. That said, these medications are convenient to access (e.g., they can obtained via primary care) and naltrexone that is prescribed and monitored regularly by a non-addiction clinician (e.g., internist), in particular, may have similar short-term positive effects on alcohol abstinence as that of specialized psychosocial treatment. Taken together, they are helpful and accessible, but not a panacea. Taking the medication consistently and meeting regularly with the prescriber (e.g., weekly or biweekly) are key to maximizing positive outcomes.
- Some achieve full sustained remission without formal help from professional treatment or mutual-help organizations.
Some individuals can achieve substance use disorder remission without formal help from professional treatment or mutual-help organization participation. That said, when previously untreated individuals with alcohol use disorder who are interested in making a change in their drinking are followed over time, individuals who obtain formal help are 2 to 3 times more likely to achieve remission.
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