Remission from substance dependence: differences between individuals in a general population longitudinal survey who do and do not seek help.
Level 3 - non-randomized controlled study
Prospective longitudinal cohort study analyzing two waves of population survey data
PubMed 23791039 · doi:10.1016/j.drugalcdep.2013.05.019
What was done
Data from Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed. The cohort included 1,262 respondents with past-year substance dependence at Wave 1, split into those with prior help-seeking (n=356) and those without prior help-seeking (n=906). Multi-group structural equation modeling was used to compare both groups on subsequent help-seeking, stress, health, and remission at Wave 2.
What was found
Baseline help-seekers had higher rates of subsequent help-seeking during follow-up compared to non-help-seekers (31% vs. 8%) and lower rates of remission at Wave 2 (50% vs. 68%). Baseline help-seekers showed stronger relationships between baseline stress/mental disorders and subsequent help-seeking, age and follow-up stress, stress and follow-up health status, and social support and follow-up mental disorders. Non-help-seekers showed stronger relationships between female sex and follow-up stress, and between subsequent help-seeking and follow-up physical health status.
Why it matters
This study demonstrates that most individuals with substance dependence in the general population do not seek treatment, yet non-help-seekers achieve substantial rates of remission. It shows that help-seeking and non-help-seeking individuals follow distinct clinical pathways with different predictors of outcome.
Limits
The abstract relies on self-reported observational survey data. Because help-seeking is confounded by baseline disorder severity and chronicity, the lower remission rates among help-seekers likely reflect greater underlying illness burden rather than negative effects of help-seeking. Specific treatment types, modalities, and intensities were not detailed in the abstract.
Cited by
- supports Representative population surveys show that only a small minority of individuals who recover from substance use disorders ever received formal addiction psychiatric treatment.