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Quitting Drugs: Quantitative and Qualitative Features

Article · Literature Review (PDF Available) inAnnual Review of Clinical Psychology 9(1) · January 2013with407 Reads
DOI: 10.1146/annurev-clinpsy-032511-143041 · Source: PubMed
Abstract
According to the idea that addiction is a chronic relapsing disease, remission is at most a temporary state. Either addicts never stop using drugs, or if they do stop, remission is short lived. However, research on remission reveals a more complex picture. In national epidemiological surveys that recruited representative drug users, remission rates varied widely and were markedly different for legal and illegal drugs and for different racial/ethnic groups. For instance, the half-life for cocaine dependence was four years, but for alcohol dependence it was 16 years, and although most dependent cocaine users remitted before age 30, about 5% remained heavy cocaine users well into their forties. Although varied, the remission results were orderly. An exponential growth curve closely approximated the cumulative frequency of remitting for different drugs and different ethnic/racial groups. Thus, each year a constant proportion of those still addicted remitted, independent of the number of years since the onset of dependence. Expected final online publication date for the Annual Review of Clinical Psychology Volume 9 is March 26, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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  • ... In another study analyzing remission trends among the California Civil Addict sample, Hser (2007) documented a rising rate of heroin-abstinence over the three decade period, from 37.8%, when men were in their mid-thirties on average, to 41% in mid-forties, and 55.8% in mid-fifties. Explanations for this declining rate of drug use in older age have been variously described as a process of "maturing out" ( Winick, 1962), as a result of heightened mortality among substance users ( Moos, Brennan & Mertens, 1994;Hser, Hoffman, Grella & Anglin 2001), or simply the result of a stable rate of remission over time that subsequently accumulates among older cohorts ( Heyman, 2013). Drawing firm conclusions form this body of research is complicated by differences in findings by the type of substance used, the population of users studied, and differences across cohorts. ...
  • ... However, research has also indicated individual differences in these trends, with some individuals not experiencing such changes in personality or the decline in drug use (Fillmore, 1988;Littlefield et al., 2009;Littlefield and Sher, 2016;Vergés et al., 2012). Research in representative samples suggests that typical drug users quit after six to eight years from the onset of drug use (e.g., NESARC project;LopezQuintero et al., 2011); however, a portion of these drug users continue the pattern of problematic drug use for a significantly longer time, developing SUDs (Heyman, 2013). Further, persistent drug use patterns increase as a function of life transitions in different developmental stages (Vergés et al., 2012). ...
  • ... The dates indicate the period in which the research was conducted.example, if we assume that about 80% of those who ever became addicted were still addicted at about age 45, there would have to be approximately 20 million missing addicts that no one knew about (calculations inHeyman (2013)). This is not plausible. ...
  • ... There would be wide agreement among those involved in treating addiction that the main difficulty lies not in initiating the desired behaviour change but in preventing relapse after the client's change in behaviour has been made (Marlatt & Gordon, 1985). At first sight, the statement that addiction is a relapsing condition might seem to conflict with data summarised above on high rates of natural recovery and 'maturing out' in the common addictions (seeHeyman, 2009Heyman, , 2013Heyman & Mims, 2017). This problem is more apparent than real. ...
  • ... Proponents of the BDMA misleadingly cite epidemiological data on the prevalence of the common forms of addiction in community surveys as if the addiction of individuals described in those surveys was the same as that in the minority of severely addicted individuals whom neuroimaging researchers study [6]. They fail to note that their pessimistic view of addiction chronicity is at odds with the same epidemiological evidence that they cite in showing very high rates of recovery from addiction in adulthood [25] in the absence of treatment, as a result of positive changes in life circumstances [3]. ...
  • ... However, as our model predicts, the extinction of drug craving with repeated drug priming should not be expected to have protective effects against relapse, a conclusion that is generally consistent with other cue extinction procedures (Conklin & Tiffany, 2002). Finally, the notion that drug seeking and taking largely remains goal-directed, even after escalation, may help to explain why after some initial relapses, people with addiction nevertheless remain able, at some later stages of their life, to quit drugs when having the opportunity to engage in other goals or pursuits that are incompatible with continued drug use (Heyman, 2013). ...
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