IMPORTANCE: Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management. OBJECTIVE: To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001-2002; wave 2, 2004-2005). MAIN OUTCOMES AND MEASURES: We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741). RESULTS: Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period. CONCLUSIONS AND RELEVANCE: As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.
IMPORTANCE: Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management. OBJECTIVE: To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001-2002; wave 2, 2004-2005). MAIN OUTCOMES AND MEASURES: We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741). RESULTS: Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period. CONCLUSIONS AND RELEVANCE: As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.
Authors: Catalina Lopez-Quintero; Deborah S Hasin; José Pérez de Los Cobos; Abigail Pines; Shuai Wang; Bridget F Grant; Carlos Blanco Journal: Addiction Date: 2010-11-16 Impact factor: 6.526
Authors: W June Ruan; Risë B Goldstein; S Patricia Chou; Sharon M Smith; Tulshi D Saha; Roger P Pickering; Deborah A Dawson; Boji Huang; Frederick S Stinson; Bridget F Grant Journal: Drug Alcohol Depend Date: 2007-08-13 Impact factor: 4.492
Authors: Carlos Blanco; Joan Hanania; Nancy M Petry; Melanie M Wall; Shuai Wang; Chelsea J Jin; Kenneth S Kendler Journal: Addiction Date: 2015-06-06 Impact factor: 6.526
Authors: Justin Knox; Melanie Wall; Katie Witkiewitz; Henry R Kranzler; Daniel E Falk; Raye Litten; Karl Mann; Stephanie S O'Malley; Jennifer Scodes; Raymond Anton; Deborah S Hasin Journal: Drug Alcohol Depend Date: 2019-05-29 Impact factor: 4.492
Authors: Andrea H Weinberger; Misato Gbedemah; Melanie M Wall; Deborah S Hasin; Michael J Zvolensky; Renee D Goodwin Journal: Addiction Date: 2017-12-19 Impact factor: 6.526
Authors: Laura E Kwako; Melanie L Schwandt; Vijay A Ramchandani; Nancy Diazgranados; George F Koob; Nora D Volkow; Carlos Blanco; David Goldman Journal: Am J Psychiatry Date: 2019-01-04 Impact factor: 18.112
Authors: Carlos Blanco; María García-Anaya; Melanie Wall; José Carlos Pérez de Los Cobos; Ewelina Swierad; Shuai Wang; Nancy M Petry Journal: Drug Alcohol Depend Date: 2015-02-25 Impact factor: 4.492