Monday, October 7, 2013

Recovery Happens.

An analysis of an impressive and wide-sweeping study arrived in my email box this morning, via the wonderful folks at Drug and Alcohol Findings in the UK. For the study, recovery advocate William L White reviewed 415 scientific studies of recovery outcomes from clinically- and culturally-diverse populations, looking at research performed over the past century. Among the highlights, the author concludes from all of this data that recovery happens - at far greater rates than conventional wisdom would have us believe. In fact,  "Recovery is not an aberration achieved by a small and morally enlightened minority of addicted people. If there is a natural developmental momentum within the course of [these] problems, it is toward remission and recovery."

Some very hopeful words to start your day.

Below are some additional highlights. You can access the article here:  http://findings.org.uk/count/downloads/download.php?file=White_WL_24.txt and find great resources for treatment research and interventions here: http://findings.org.uk/index.php (the drug and alcohol matrices are a treasure trove of important research).

1 How many people are in recovery from substance use disorders in the United States? This was answered by extrapolating national estimates from the major governmental surveys of the course of alcohol and other drug use and related problems and from a 2010 recovery survey conducted by the Public Health Management Corporation in Philadelphia and six surrounding counties. Based on this analysis, the proportion of adults in the general US population in remission from substance use disorders ranges from 5.3% to 15.3%. These rates produce a conservative estimate of more than 25 million adults in remission from significant alcohol or drug problems in the United States and possibly up to 40 million.
2 What percentage of those who develop alcohol or drug problems eventually achieve remission/recovery? Of adults surveyed in the general population who once met lifetime criteria for substance use disorders, an average of 49.9% (53.9% in studies conducted since 2000) no longer meet those criteria. In community studies (ie, not sampling treatment populations only) reporting both remission rates and abstinence rates for substance use disorders, an average of 43.5% of people who have ever had these disorders achieved remission, but only 17.9% did so through complete abstinence.
3 What is the rate of remission/recovery for people whose problems are severe enough to warrant professional treatment? Across 276 substance use treatment follow-up studies of adult clinical samples, the average remission/recovery rate was 47.6% (50.3% in studies published since 2000). In studies with sample sizes of 300 or more and follow-up periods of five or more years – used as proxy for greater methodological sophistication – average remission/recovery rates were 46.4% and 46.3%, respectively. In the 50 adult clinical studies reporting both remission and abstinence rates, the average remission rate was 52.1%, and the average abstinence rate was 30.3%.This 21.8% difference appears to reflect the proportion in post-treatment follow-up studies who are using alcohol and/or other drugs asymptomatically or are experiencing problems not severe enough to meet diagnostic criteria for substance use disorders.
4 Does the rate of remission/recovery for adolescents following specialised treatment differ from that of adults? Yes. This analysis compares 276 adult substance use treatment outcome studies conducted between 1868 and 2011 with 60 adolescent substance use treatment outcome studies between 1979 and 2011. The average recovery/remission rate following specialty treatment for adolescents was 42% (35% for studies since 2000), compared to 47.6% for adults (50.3% for studies since 2000). Interpretation of this finding should be tempered by the greater number of adult studies and their larger sample sizes and much longer follow-up periods. While the high percentage of adolescents who report some alcohol or drug use in the months following treatment is discouraging, longer-term studies confirm post-treatment increases in abstinence, reductions in use, and gains in global health among treated adolescents. There is cause for optimism regarding adolescents' long-term prospects for recovery from substance use disorders.
5 How can local communities establish baseline remission/recovery prevalence data? To evaluate community-wide strategies by tracking changes in recovery prevalence over time, local communities can integrate recovery prevalence questions into regular community health surveys. A model for potential replication is the integration of recovery prevalence questions into the bi-annual community health survey conducted in Philadelphia and surrounding counties. Such baseline data are being used there and could be used in other communities to guide recovery-focused systems-transformation efforts and to evaluate planned interventions in particular geographical areas (eg, evaluating service needs by postcode/planning areas and matching treatment/recovery support resources to areas where problem severity is highest and recovery capital lowest).

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