06 Aug Treatment and Recovery Services Appear Particularly Important For Sustained Recovery in Opioid Addiction

MedicalResearch.com Interview with:

Dr. Hoffman

Lauren A. Hoffman, Ph.D.
Research Fellow
Recovery Research Institute
Center for Addiction Medicine
Massachusetts General Hospital
Harvard Medical School

MedicalResearch.com: What is the background for this study?  

Response: In 2017, an estimated 11.4 million Americans reported past-year opioid misuse¹ and opioid-related overdose accounted for more than 47,000 deaths². Prior research has helped further our understanding of the prevalence and consequences of opioid misuse, but we know substantially less about recovery from opioid use problems. Recovery-focused research conducted to-date has largely focused on alcohol use disorder, the most common type of substance use disorder. Characterizing recovery from opioid use problems and the pathways that individuals take to resolve such problems can ultimately help identify effective ways to address opioid misuse.

Using data from the first national probability-based sample of US adults who have resolved a significant substance use problem (National Recovery Survey³), we provide the first national prevalence estimate of opioid recovery, and characterize treatment/recovery service use and psychological well-being in individuals who resolved a primary problem with opioids, relative to individuals who resolved a primary alcohol problem. We focused our cross-sectional investigation of service use and well-being on 2 time-horizons associated with continued vulnerability: <1 year since problem resolution (early-recovery) and 1 – 5 years since problem resolution (mid-recovery).

MedicalResearch.com: What are the main findings?

Response: Our findings suggests that an estimated 1.18 million American adults have resolved a primary opioid use problem. Among those with mid-recovery durations, individuals who resolved an opioid problem were more likely than individuals who resolved an alcohol problem to have ever used treatment and recovery services: they were 4 times more likely to have ever used pharmacotherapy for addiction treatment (e.g., naltrexone, Suboxone), 2.5 times more likely to have used formal treatment (e.g., inpatient, outpatient), and ~2 times more likely to use recovery support services (e.g., recovery community centers) and mutual help organizations (e.g., Narcotics/Alcoholics Anonymous). They were also more likely to report ongoing pharmacotherapy and use of mutual help services, relative to individuals who had resolved an alcohol problem. In early recovery, service use did not differ between the opioid and alcohol problem resolution groups. With regard to well-being, current self-esteem in early recovery appears to be higher among individuals who resolved an opioid problem than those who resolved an alcohol problem. The opposite was observed for mid recovery, with self-esteem being lower among individuals with opioid resolution.

MedicalResearch.com: What should readers take away from your report? 

Response: Our study offers important national prevalence estimates and a foundation for better understanding the ways in which individuals achieve successful recovery from opioids. Our findings suggest that service use may be particularly important for opioid recovery. Additional use of treatment and recovery services, as well as continued care and support might help individuals achieve longer and more stable recovery from opioid use problems. Given that negative affect often plays a role in relapse⁴, lower self-esteem in mid-recovery suggests a potential vulnerability and a need to boost self-esteem beyond the first year of problem resolution to help individuals further maintain their recovery from opioid use problems.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Additional research is needed to better understand recovery from opioid use problems, in general. With growing emphasis on the opioid epidemic, researchers are beginning to focus more on opioid-related research. Although investigation of misuse and treatment is relatively more common, a comprehensive understanding of recovery, pathways to recovery, and the factors influencing recovery outcomes will be necessary to give individuals the best chance at long term problem resolution. Regarding the current investigation, longitudinal research is needed to inform dynamic changes in service utilization, well-being, and resolution status across opioid recovery trajectories. 

Any disclosures?

This research was supported by the Recovery Research Institute at the Massachusetts General Hospital, Harvard Medical School. Dr. Hoffman was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number F32DA047741. Dr. Vilsaint and Dr Kelly were supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Numbers F32AA025823 and K24AA022136, respectively.

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). Key Substance Use and Mental Health Indicators in the United States: Results From the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2018.
2. CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://wonder.cdc.gov.
3. Kelly JK, Bergman B, Hoeppner BB, et al. Prevalence and pathways of recovery from drug and alcohol problems in the United States population: implications for practice, research, and policy. Drug Alcohol Depend 2017;181:162–169.
4. Larimer ME, Palmer RS, Marlatt GA. Relapse prevention an overview of Marlatt’s cognitive-behavioral model. Alcohol Res Health 1999;23:151–1151.

Citation:

Recovery From Opioid Problems in the US Population Prevalence, Pathways, and Psychological Well-Being Hoffman, Lauren A. PhD; Vilsaint, Corrie PhD; Kelly, John F. PhD
Journal of Addiction Medicine: August 2, 2019 – Volume Publish Ahead of Print – Issue – p

doi: 10.1097/ADM.0000000000000561

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Last Updated on August 7, 2019 by Marie Benz MD FAAD