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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    • "After decades of emphasizing acute care and brief intervention models for treating persons with alcohol and drug disorders, researchers, policymakers and providers are increasingly focusing on services that can help individuals sustain long-term recovery in the community (McLellan, 2002; Scott, Dennis, Laudet, Funk, & Simeone, 2011). A major problem with acute care interventions is that the improvements made during treatment are often shortlived , particularly if the individual does not have access to an alcohol and drug free-living environment that supports recovery. "
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    ABSTRACT: Although research shows treatment for alcohol and drug problems can be effective, persons without stable housing that supports recovery are at risk for relapse. Recovery residences (RRs) for drug and alcohol problems are a growing response to the need for alcohol- and drug-free living environments that support sustained recovery. Research on RRs offers an opportunity to examine how integration of these individuals into a supportive, empowering environment has beneficial impacts on substance use, housing, and other outcomes, as well as benefits for the surrounding community. Research can also lead to the identification of operations and practices within houses that maximize favorable outcomes for residents. However, research on RRs also presents significant obstacles and challenges. Based on our experiences conducting recovery home research for decades, we present suggestions for addressing some of the unique challenges encountered in this type of research.
    Full-text · Article · Nov 2015 · Journal of drug issues
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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.
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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.
    Full-text · Article · Sep 2012 · Journal of substance abuse treatment
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