Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, USA.
Addiction (Impact Factor: 4.74). 11/2010; 106(3):657-69. DOI: 10.1111/j.1360-0443.2010.03194.x
Source: PubMed


To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances.
Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.
The 2001-2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43,093) selected in a three-stage sampling design.
The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408).
Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence.
Life-time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances.
A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life-time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.

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    • "Despite this body of knowledge, important questions remain regarding predictors of progression from cannabis use to use of other drugs (Kandel et al., 2006). For example, several sociodemographic, psychopathologic and substance use related predictors previously reported for other types of drug use transitions (Florez-Salamanca et al., 2013; Lopez-Quintero, Perez de los Cobos, et al., 2011; Ridenour, Maldonado-Molina, Compton, Spitznagel, & Cottler, 2005) have not been examined. With the exception of one study that examined depression, no published study has investigated the effect of psychiatric comorbidity (i.e., anxiety, conduct or personality disorders) on progression from cannabis use to use of other drugs. "
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    • "The series of graphs below summarize some of the major findings. Two similar graphs appeared in an article published in the journal Addiction (Lopez-Quintero et al. 2011) The authors generously made the data available for the analyses presented in this review. Figure 3 describes the relationship between time since the onset of dependence and remission for cocaine, marijuana, alcohol, and cigarettes (the legal drugs are included for comparison). "
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