Past three year continuous abstinence: Full sample, remission stages and gender subgroups

1. Background • Addiction conceptualized as chronic but research typically adopts a short term approach. • We lack knowledge on long-term patterns of remission and their determinants. • This is necessary to identify resources that promote sustained remission. • Remission makes changing demands on the individual as it unfolds. • Different resources may promote remission at different stages of the process. Study Objectives Multivariate Analyses: Key Findings • Describe patterns of continuous abstinence over 3 years among former polysubstance users • Quantify the role of intra- and interpersonal resources in sustaining remission • Examine whether predictors of sustained remission differ as a function of baseline remission ‘stage’ and between men and women. • For the full sample (not shown) andacross remission and gender subgroups, baseline remission duration and continuous 12-step attendance were the only significant predictors of sustained remission over 3 years (see Table). C-STAR Overview of Methods and Procedures • New York City-based longitudinal investigation of factors predicting with stable recovery. • Voluntary participation based on informed consent. • Semi-structured interviews. • Media-recruited cohort in remission from one month to 10+ years at intake. • Yearly interviews up to three-year follow-up (F3). • Study sample: 285 individuals who provided full dataset (83% of surviving BL cohort of 342). Summary of Findings and Implications Center for the Study of Addictions and Recovery • Likelihood of sustained remission from chronic drug dependence increases significantly over time. • However risk of return to drug use remains - even after 3+ years of remission at intake, 25% returned to drug use during the 3 year study. • Women more likely to sustain remission although not differing significantly from men in history or protective resources at baseline. • Continuous 12-step attendance was the only consistent psychosocial predictor of sustained remission for any of the subgroups, increasing likelihood of sustained remission by two to five folds across subgroups. • 12-step fellowships are underutilized: Across subgroups, fewer than one half attended 12-step continuously over the 3 year study period. Measures • PREDICTOR DOMAINS identified from the extant literature, assessed at intake (BL): • Remission duration at intake: months since last used any drug. • Previous remission attempts: Ever had an abstinent period >1 month and went back to using? • INTRA-PERSONAL RESOURCES • Commitment to abstinence: subscale of Addiction Treatment Questionnaire (range 1 to 4) [1] • Self-efficacy scale (range 1 to 4 ) [2] • Spirituality: Spiritual Well-Being Scale (range 1 to 4) [3] • Life meaning and purpose: Existential subscale of Spiritual Well-Being Scale (range 1 to 4)[3] • Religious beliefs and practices: Religious Background & Behavior (RBB) (range 0 to 8) [4] • Addiction as chronic: Addiction Belief Inventory subscale (range 0 to 4) [5] • INTERPERSONAL RESOURCES • General social support: Summary score of the Social Support Appraisal Scale (range 0 to 4) [6] • 12-step involvement (range 0-9) [7] • 12-step attendance (continuous over three years): AA, NA or CA (yes/no - computed) • OUTCOME: Continuous abstinence since intake at F3: No self-reported drug use since previous interview at one-, two- or three-year follow up (yes/no). Biological corroboration of self report (hair or saliva): 84.4% concordance at F3. • REMISSION STAGES at baseline: One to under 6 months abstinent from illicit drugs (27%), 6 to 18 months (26%), 18 to 36-months (20%) and 3+ years abstinent (27%). Limitations and Future Directors • Resources were assessed at baseline: We are repeating the analyses examining the role of change in psychosocial resources over time on sustained remission. • Additional research needed to elucidate determinants of gender differences in sustained remission from severe drug dependence. • Need to identify strategies to foster continued 12-step participation, to identify continuously available recovery resources other than 12-step for those who choose not to participate in 12-step fellowships. Past three year continuous abstinence: Full sample, remission stages and gender subgroups References [1] Morgenstern & McCrady (1993) In: McCrady and Miller (Eds) Research on Alcoholics Anonymous, Opportunities and Alternatives, pp.153-166. [2] Sherer et al., (1982). Psychological Reports, 51: 663-671. [3] Paloutzian & Ellison (1982) In: Peplau and Perlman (Eds) Loneliness: A Sourcebook of Current Theory Research and Therapy.[4] Connors et al., (1996) Psychology of Addictive Behaviors, 10: 90-96.[5] Luke et al. (2002). Substance Use Misuse, 37(1): 89-120.[6] Vaux, A. (1988). Social support: Theory, research, and intervention. NY: Praeger. [7] Laudet et al., (2006) Alcoholism Treatment Quarterly, 24: ½, 33-74. Analyses • Chi squares, one-way ANOVAS and bivariate regressions to examine the role of each predictor domain on outcome across remission stages and gender subgroups. • Separate logistic regressions to quantify the role of predictor domains on sustained remission for each of the four remission stages and by gender. Predicting Sustained Remission from Polysubstance Use: A three-year follow-up studyAlexandre Laudet, Ph.D.1, and William White, M.A.21National Development and Research Institutes, Inc.; 2Chestnut Health Systems; Summary of Bivariate Findings • All predictor domains significantly correlated with outcome (p<.05) except self-efficacy. • When baseline remission duration was held constant, social support, spirituality and life meaning lost statistical significance. • The remaining domains were entered as predictors in logistic regressions. • Funded by National Institutes on Drug Abuse Grant # R01 DA14409 and by the Peter McManus Charitable Trust • The authors have no financial relationships that related to the topic of this presentation. • Correspondence: laudet@ndri.org