Despite widespread belief to the contrary, people who manage to overcome their addiction to one substance do not become addicted to another substance, results of a large, prospective study show.
The study disproves the widely held view among many clinicians that adults who experience remission from a substance use disorder (SUD) are at increased risk of starting another addiction, Carlos Blanco, MD, PhD, from Columbia University and the New York State Psychiatric Institute, New York City, told Medscape Medical News.
"This view is called the drug substitution or switching addictions hypothesis, and it can create a sense of demoralization or hopelessness, because what is the point of treating someone for their addiction if they are going to just come up with a different addiction?" Dr. Blanco said.
"My clinical experience has not reflected this, and now our study of a large, nationally representative population also shows that people who remit do not go on to become addicted to another substance," he said. Dr. Blanco sought to validate his clinical experience in a systematic way in the current prospective cohort study.
The study was published online September 10 in JAMA Psychiatry.
Remission, Not Substitution
The investigators used data drawn from a nationally representative sample of 34,653 adults aged 18 years and older from the National Epidemiologic Survey on Alcohol and Related Conditions.
The individuals were interviewed twice, 3 years apart. The first interview period was 2001 to 2002, and the second was 2004 to 2005.
The investigators compared new-onset SUDs in 3275 individuals who abused at least 1 substance from 2001 to 2002 and who did not undergo remission from any addiction during the period 2004 to 2005 with 2741 individuals who abused at least 1 substance in the period 2001 to 2002 but who did undergo remission during the period 2004 to 2005.
The results showed that approximately one fifth of the total sample (n = 2741) had developed a new-onset SUD by the second assessment period.
Individuals who experienced remission from 1 addiction during this period were significantly less likely than those who did not do so to develop a new SUD (13.1% vs 27.2%, P < .001).
The highest percentage of remission was from nicotine dependence (51.2%), followed by alcohol use disorder (42.9%) and drug use disorder (16.5%).
After adjusting for the number of SUDs at baseline, remission from nicotine dependence, an alcohol use disorder, or a drug use disorder all decreased the odds of a new-onset SUD, whereas the number of SUDs at baseline increased the odds.
Table. Risk for New Addiction by SUD Remission
|SUD||Odds Ratio||95% Confidence Interval|
|Nicotine dependence||0.38||0.31 - 0.48|
|Alcohol use disorder||0.23||0.17 - 0.32|
|Drug use disorder||0.66||0.46 - 0.95|
|Number of baseline SUDs||1.68||1.43 - 1.98|
After quitting cigarette smoking was excluded from the analysis, those who underwent remission continued to have lower rates of a new-onset addiction than those who did not experience remission (8.7% vs 43.3%, P < .001).
Also, patients in remission who had only 1 addiction during the period 2001 to 2002 were less likely than patients not in remission to have a new addiction during the period 2004 to 2005 (21.4% vs 46.3%, P < .001).
Seeking treatment for the addiction was also associated with a greater likelihood of remission. Of those who sought treatment between the first and second periods, 36.8% experienced remission vs 19.2% of those who did not seek treatment (P < .001).
Those individuals also had lower odds of a new-onset SUD during the period 2004 to 2005 (odds ratio = 0.31; 95% confidence interval, 0.22 - 0.43).
The investigators also found that those who experienced remission were significantly less likely than those who did not to have a new-onset alcohol use disorder, cannabis use disorder, opioid use disorder, cocaine use disorder, and a disorder involving another drug. There was no significant difference in the rate of new onset of nicotine dependence.
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 addiction during the follow-up period. "This is not surprising, as we know these are risk factors for addiction," Dr. Blanco said.
Commenting on this study for Medscape Medical News, Petros Levounis, MD, chair of the Department of Psychiatry at Rutgers New Jersey Medical School, Newark, and vice-chair of the American Psychiatric Association's Council on Addiction Psychiatry, said: "It's a wonderful study, very well designed and very well researched, that points to the heart of the problem that most people have with addiction."
Some people are under the misconception that once an addict, always an addict, Dr. Levounis said.
"They erroneously believe that once you get addicted to any drug, you fry your brain, and from that point on, you're addicted for life, and if you stop using drug X, then you would immediately have to jump to drug Y or Z or even jump to an addictive behavior such as gambling or sex, as if you have an addictive personality to begin with or, by using the drugs, that you have made such changes in your brain that you are doomed, you're a lost cause, and therefore you don't deserve treatment, you don't deserve our empathy, and you don't deserve to be treated like a human being," he said.
"This study is much more than just the very specific finding of people not necessarily falling into another addiction. It addresses the very core prejudice that some have towards people who suffer from substance use disorders and behavioral addictions."
The study was supported by the National Institutes of Health, the Agency for Healthcare Research and Quality, and the New York State Psychiatric Institute. Dr. Blanco and Dr. Levounis report no relevant financial relationships.
JAMA Psychiatry. Published online September 10, 2014. Abstract
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Cite this: Remission of One Addiction Linked to Lower Risk for Another - Medscape - Sep 26, 2014.