Probability and predictors of remission from life‐time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Abstract

Aim To estimate the general and racial-ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. Design Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version. Setting The 2001–2002 NESARC surveyed a nationally representative sample from USA adults (n=43,093) selected in a three-stage sampling design. Participants The subsamples of individuals with lifetime DSM-IV diagnosis of dependence on nicotine (n=6,937), alcohol (n=4,781), cannabis (n=530) and cocaine (n=408). Measurements Cumulative probability estimates of dependence remission for the general population and across racial-ethnic groups. Hazard ratios for remission from dependence. Findings Lifetime cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis, and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. Conclusions A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their lifetime, although the probability and time to remission varies by substance and racial-ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need of providing coordinated psychiatric and substance abuse interventions.

Three-Year Course of Cannabis Dependence and Prediction of Persistence

“…Other studies have used different definitions (e.g. presence of any CUD symptoms [20,21] or continued cannabis use [7]) and different follow-up period and therefore direct comparison between studies is hardly possible. However, significant differences in the course of cannabis use and cannabis-related problems and functioning between persisters and stable remitters (DNN) seem to indicate that our definition of persistence is appropriate.…”

“…However, findings regarding externalizing disorders were somewhat inconsistent: CD increased the probability of remission, whereas antisocial personality was one of the personality disorders that reduced the probability of remission [21]. These studies are, however, constrained by the absence of cannabis exposure measures [20,21] or imprecise estimates such as number of days using cannabis and number of cones per day [17]. Especially among frequent or dependent cannabis users, more detailed measures of exposure, including cannabis dose per joint and THC-concentration, may be better predictors of the course of cannabis dependence [18,22].…”

“…The predictive power of individual cannabis abuse and dependence symptoms was not considered, while certain abuse/dependence symptoms (especially ‘impaired control over use') have been shown to be more predictive than others for persistent cannabis use [7], onset of cannabis dependence in frequent users [18] and persistence of alcohol use disorders [19]. Two retrospective studies showed higher remission rates in younger, female, highly educated and employed subjects, in subjects with a later onset of cannabis dependence, a shorter duration of cannabis dependence and in subjects without other mental disorders (conduct disorder (CD), personality disorder, alcohol dependence, cocaine dependence) [20,21]. However, findings regarding externalizing disorders were somewhat inconsistent: CD increased the probability of remission, whereas antisocial personality was one of the personality disorders that reduced the probability of remission [21].…”

“…Two retrospective studies showed higher remission rates in younger, female, highly educated and employed subjects, in subjects with a later onset of cannabis dependence, a shorter duration of cannabis dependence and in subjects without other mental disorders (conduct disorder (CD), personality disorder, alcohol dependence, cocaine dependence) [20,21]. However, findings regarding externalizing disorders were somewhat inconsistent: CD increased the probability of remission, whereas antisocial personality was one of the personality disorders that reduced the probability of remission [21]. These studies are, however, constrained by the absence of cannabis exposure measures [20,21] or imprecise estimates such as number of days using cannabis and number of cones per day [17].…”

Gender Differences in Prevalence of Substance Use Disorders among Individuals with Lifetime Exposure to Substances: Results from a Large Representative Sample

“…5 Research in the recent decades has brought to attention numerous gender differences in substance use and SUDs suggesting that females and males differ in their behavioral, physiological, neurological, and pharmacological responses to substances, as well as in patterns of use and prevalence of substance use and SUDs. [6][7][8][9][10][11][12] Various biological, social, and cultural factors have been proposed to explain these gender differences. 13 Specifically, though it has been shown that males have more opportunities for initial exposure to substances 14 and overall higher lifetime prevalence of exposure to substances, [15][16][17] there is little research to date focusing on gender differences in the prevalence of SUDs among those who have been previously exposed to particular categories of substances.…”