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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

Authors

  • Catalina Lopez-Quintero,

    1. New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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  • Deborah S. Hasin,

    1. New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA,
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  • José Pérez de los Cobos,

    1. Addictive Behaviors Unit of Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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  • Abigail Pines,

    1. New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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  • Shuai Wang,

    1. New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
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  • Bridget F. Grant,

    1. Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
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  • Carlos Blanco

    Corresponding author
    1. New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,
      Carlos Blanco, New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, unit 69, New York, NY 10032, USA. E-mail: cb255@columbia.edu
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Carlos Blanco, New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, unit 69, New York, NY 10032, USA. E-mail: cb255@columbia.edu

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 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (= 43 093) selected in a three-stage sampling design.

Participants  The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (= 6937), alcohol (= 4781), cannabis (= 530) and cocaine (= 408).

Measurements  Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence.

Findings  Life-time 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 life-time, 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 for providing coordinated psychiatric and substance abuse interventions.

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