Recovery Durability: The 5-Year Set Point
For years I have been asked when recovery from alcohol or drug dependence reaches a point of durability, or put another way, “When does recovery today predict recovery for life?” After investigating all of the scientific evidence I could locate on this question, I have regularly responded that this point of durability seems to be reached at 4-5 years of continuous recovery, meaning that less than 15% of those who reach that point will re-experience active addiction within their lifetime (with opioid addiction potentially being closer to the 25% mark). This means that if you reach the 5-year recovery benchmark, your risk of again meeting diagnostic criteria for a substance use disorder is similar to the risk for such a diagnosis within the general population. (Ironically, this 5-year benchmark is strikingly similar to the durability point for cancer remission.) Reaching this benchmark is not assurance of invulnerability, but it does mark a point at which a much greater force is needed to destabilize recovery. I have used this finding to argue that all persons treated for addiction should be afforded five years of post-treatment recovery checkups (e.g., monitoring and support) on par with that afforded most cancer patients in the U.S.
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For those of you wishing to investigate this conclusion more thoroughly, the following is the list of the studies upon which I based my conclusion about the 5-year recovery set point.
De Soto, C.B., O’Donnel, W.E., & De Soto, J.L. (1989). Long-term recovery in alcoholics. Alcoholism: Clinical and Experimental Research, 13, 693-697.
Dawson, D. A. (1996). Correlates of past-year status among treated and untreated persons with former alcohol dependence: United States, 1992. Alcoholism: Clinical and Experimental Research, 20(4), 771-779.
Dennis, M.L., Foss, M.A., & Scott, C.K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.
Dennis, M.L., Scott, C.K., Funk, R., & Foss, M.A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, S51-S62.
Hser, Y.I., Hoffman, V., Grella, C., & Anglin, D. (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry, 58, 503-508.
Jin, H., Rourke, S.B., Patterson, T.L., Taylor, M.J., & Grant, I. (1998). Predictors of relapse in long-term abstinent alcoholics. Journal of Studies on Alcohol, 59, 640-646.
Langendam, M.W., Van Brussell, G., Coutinho, R.A., Van Ameijden, E.J. (2000). Methadone maintenance and cessation of injecting drug use: Results from the Amsterdam Cohort Study, Addiction, 94, 591-600.
Nathan, P., & Skinstad, A. (1987). Outcomes of treatment for alcohol problems: Current methods, problems and results. Journal of Consulting and Clinical Psychology. 55, 332-340.
Schutte, K., Byrne, F., Brennan, P., & Moos, R. (2001). Successful remission of late-life drinking problems: A 10-year follow-up. Journal of Studies on Alcohol 62, 322-34.
Shah, N.G., Galai, N., Celentano, D.D., Vlahov, & Strathdee, S.A. (2000). Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000. Drug and Alcohol Dependence, 83, 147-156.
Vaillant, G. E. (1996). A long-term follow-up of male alcohol abuse. Archives of General Psychiatry, 53(3), 243-249.
For a discussion of my concern about the lack of research on people who re-experience addiction after reaching this 5-year recovery benchmark, see http://www.williamwhitepapers.com/pr/2009Relapse%20after%20Prolonged%20Addiction%20Recovery.pdf