Former addicts may be at lower risk of new addictions

(Sergio Bruno)

People who manage to get clean after being addicted to drugs are at lower risk of becoming addicted to something else in the future than people who never overcame the first substance use disorder, according to a new study.

“The results are surprising, they cut against conventional clinical lore which holds that people who stop one addiction are at increased risk of picking up a new one,” said senior author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center in New York. “The results challenge the old stereotype that people switch or substitute addictions but never truly overcome them,” Olfson told Reuters Health by email.

Getting over substance addiction reduces criminal activity, improves health and social functioning, as well as overall quality of life, Olfson’s team writes in JAMA Psychiatry.

But research into the assumption that former addicts are vulnerable to becoming addicted again has produced mixed results, they point out.

Using nationally representative data from surveys in 2001 and 2004, the researchers compared the occurrence of a new substance addiction among adults who started out with at least one substance addiction.

Nearly 35,000 people were asked about their use of sedatives, tranquilizers, painkillers, stimulants, cannabis, cocaine or crack, hallucinogens, inhalants, heroin, alcohol and nicotine dependence.

Participants were interviewed once at the beginning of the study and again three years later, with their responses either qualifying or not qualifying them for a diagnosis of substance use disorder.

At the time of the second survey, 3,275 people who had at least one addiction at the time of the first survey still qualified for a diagnosis of substance use disorder, and 2,741 people had overcome their original addiction and no longer qualified.

About 20 percent of participants developed a new substance addiction by year three. That included 27 percent of those who had not gotten clean from the original addiction and 13 percent of those who had gotten clean.

Based on those results, and after adjusting for other factors, the researchers calculated that people who overcame a substance use disorder had less than half the risk of people who didn’t overcome it of developing a new addiction.

“While it would be foolish to assume that people who quit one drug have no risk of becoming addicted to another drug, the new results should give encouragement to people who succeed in overcoming an addiction,” Olfson said.

Young, unmarried men with psychiatric problems in addition to substance abuse were most likely to develop a new substance use disorder during the study.

Though many people believe that conquering one addiction leaves you vulnerable to substituting another substance, that hypothesis actually has little support to-date, said Olaya García-Rodríguez, of the department of Psychology at the University of Oviedo in Spain.

“The ‘Substitution’ hypothesis is mainly based in clinical lore that may be biased with clinicians’ subjective perceptions of specific patients’ progression,” Garcia-Rodriguez told Reuters Heath by email.

This study is the first to test the concept with a large and representative sample in the general population, she said.

In the new results, only 13 percent of former addicts replaced the first substance with a new one, which is lower than usually thought, said Garcia-Rodriguez, who was not part of the new study.

“To achieve remission, most individuals need to make changes in their lifestyle and learn strategies to avoid substance use that will eventually protect against the onset of new addictions,” she said.

They may learn to avoid substance-related situations and peers, expand their behavioral repertory with coping strategies, and improved family relations, health, financial stability may contribute to maintain abstinence, she said.

The results indicate that remission from addiction is possible, and we should rethink the common perception that substance use disorders are chronic illnesses, she said.

“I hope that these results contribute to lessening the stigma and discrimination that many adults and young people with a history of substance abuse face when they seek employment,” Olfson said.