Surviving Drug Addiction: The Effect of Treatment and Abstinence on Mortality

Lighthouse Institute, Chestnut Health Systems, Chicago, IL, USA.
American Journal of Public Health (Impact Factor: 4.55). 02/2011; 101(4):737-44. DOI: 10.2105/AJPH.2010.197038
Source: PubMed


We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables.
We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality.
Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months was related to a decreased likelihood of abstinence, suggesting that treatment timing is significant.
Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time.

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Available from: Christy K Scott, Oct 28, 2015
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    • "As we observed in our study, patients' vulnerability during the initial years of treatment for AUD is revealed by the high number of deaths, especially due to intentional injuries (suicide ). Therefore, as some authors have shown a short latency period between the onset of addiction and the initiation and adherence to treatment, they both reduce mortality (Scott et al., 2011). Thus, it is essential to explore all opportunities offered by social and health services to detect, assess, and refer or treat individuals with AUD, either through emergency departments, or primary or specialized care (Martineau et al., 2013). "
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    ABSTRACT: Background The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death.Methods We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan–Meier method and Cox regression.ResultsWe recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment.Conclusions This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.
    Alcoholism Clinical and Experimental Research 05/2015; 39(7). DOI:10.1111/acer.12755 · 3.21 Impact Factor
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    • "Furthermore, compared to young adults in drug treatment, older adults exhibit more personal characteristics and treatment engagement experiences that aid favorable outcomes (Satre et al., 2003) and they seem to have better post-treatment outcomes (Satre et al., 2004). The timing of drug treatment appears to be significant (Scott et al., 2011) but its effects are poorly understood. "
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    ABSTRACT: To examine the developmental timing of first drug treatment and its associations with 10-year drug use patterns, pooled data (N=1318) from four longitudinal studies conducted in California was used to compare individuals first treated during young adulthood (26%) to those first treated at an older age. Treatment timing was associated with particular participant characteristics and experiences. Matched data showed that most people in both age groups exhibited a low level of drug use after first treatment, albeit fewer who were first treated during young adulthood maintained a low drug use level over time. Receipt of more drug treatment over 10 years was associated with maintenance of low drug use levels among those first treated as young adults, but not among those first treated as older adults. Developmental timing of first drug treatment interacts with subsequent treatment experiences in ways that impact the course of drug use.
    Journal of substance abuse treatment 09/2012; 44(3). DOI:10.1016/j.jsat.2012.07.012 · 2.90 Impact Factor
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    • "Early readmission to treatment after relapse and multiple episodes of treatment are associated with the increased likelihood of achieving sustained abstinence and the reduced likelihood of mortality (Scott et al., 2011). Historically, however, addiction treatment has been organized around discrete episodes of care in which a person seeks treatment, receives an assessment, is treated and released to the community within a few months – with an implicit assumption by clients, family and society that they will then maintain lifelong abstinence (Scott and Dennis, 2011). The hard facts tell a different story: 50–70% of persons leaving addiction treatment will likely resume substance use in the first year following treatment, most within the first 30–90 days (Scott et al., 2005a; Scott et al., 2005b; Simpson et al., 2002; Hser et al., 1998; Godley et al., 2007). "
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    ABSTRACT: While drug abuse is the 10th leading cause of mortality in the US, the public health care system has been slow to adopt a chronic disease approach with aggressively timed monitoring and interventions. Drug abuse remains isolated from adoption into the "chronic condition" model of care. This paper evaluates the efficacy of quarterly Recovery Management Checkups (RMCs) on treatment reentry and long-term substance use in the context of chronic substance use disorders. 446 adult substance users were randomly assigned to RMC or a control group and assessed quarterly for 4 years (94% completion). The main outcome measures were: time from need of treatment to treatment reentry, frequency of treatment reentry, days of treatment, number of substance use related problems per month, and total days abstinent. Participants in the RMC condition were significantly more likely than participants in the control group to return to treatment sooner, to return at all, to return more times, and to receive more total days of treatment. They subsequently had significantly fewer quarters in need of treatment, fewer substance related problems per month, and more total days of abstinence. Effects were larger for those with earlier onset and higher crime/violence scores. RMC is an effective method of monitoring and re-intervening with chronic substance users and is associated with improved long-term outcomes. A subgroup of people for whom RMC did not appear to be "enough," signals a need to explore more intensive models to address chronicity.
    Drug and alcohol dependence 09/2011; 121(1-2):10-7. DOI:10.1016/j.drugalcdep.2011.07.026 · 3.42 Impact Factor
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