Question: Why do some people recover from substance use disorders after treatment while others struggle and relapse?
Answer: This complicated question has perplexed people for a very long time. Even in this modern era, it is hard to answer the question with precision. While the American Medical Association considers substance use disorders as chronic diseases, and they are leading causes of death in the U.S., there is significantly less research conducted on treatment outcomes of these disorders when compared to other chronic conditions like heart disease and diabetes. Like most chronic conditions, many factors contribute to whether or not a person will experience a good recovery outcome. These factors interact with one another in complex ways. Here are a few factors to consider:
1) Severity of the substance use disorder (SUD) - Some people have more severe symptoms of addiction (i.e., craving, compulsion, mood instability, cognitive difficulties, dysphoria, and irritability). Functional changes in the brain cause these symptoms. Scientists have developed several medications to treat some of the more distressing symptoms, which continue even after substance use ends. Studies suggest that genetics can affect whether a person is likely to develop a SUD and the severity of the of course of the illness, but this is only a piece of the puzzle.
2) Co-occurring mental health conditions - People who have both mental health conditions and SUD experience worse outcomes with both conditions.
3) Lack of access to quality services - Most people with SUD will need an array of services to help support them as they recover from their condition. In addition to treatment, people may need help with finding and keeping housing, health care, employment, counseling, and recovery support.
4) Connection - People with fewer social connections and meaningful roles in the community tend to have more difficulty with recovery. Conversely, evidence shows that having significant connections to family, friends, and colleagues supports recovery.
5) Level of stress - High level of daily stress is correlated with high rates of relapse.
These factors may explain why some people have a more difficulty recovering from substance use disorders. An ideal services system should include elements that address all of these factors; treatment to address distressing symptoms of substance use and mental disorders, opportunities to learn strategies for managing stress, making connections to others, meaningful activities, and interventions that serve to lift people out of poverty.
Author: Dr. Cheryl Gagne, posted in BRSS TACS March Monthly Update, 3/21/16