title: Ten-year stability of remission in private alcohol and drug outpatient treatment: non-problem users versus abstainers.
abstract: BACKGROUND
  This study examined stability of remission in patients who were abstainers and non-problem users at 1-year after entering private, outpatient alcohol and drug treatment. We examined: (a) How does risk of relapse change over time? (b) What was the risk of relapse for non-problem users versus abstainers? (c) What individual, treatment, and extra-treatment characteristics predicted time to relapse, and did these differ by non-problem use versus abstinence?
  
  
  METHODS
  The sample consisted of 684 adults in remission (i.e., abstainers or non-problem users) 1 year following treatment intake. Participants were interviewed at intake, and 1, 5, 7, 9, and 11 years after intake. We used discrete-time survival analysis to examine when relapse is most likely to occur and predictors of relapse.
  
  
  RESULTS
  Relapse was most likely at 5-year, and least likely at 11-year follow-up. Non-problem users had twice the odds of relapse compared to abstainers. Younger individuals and those with fewer 12-step meetings and shorter index treatment had higher odds of relapse than others. We found no significant interactions between non-problem use and the other covariates suggesting that significant predictors of outcome did not differ for non-problem users.
  
  
  CONCLUSIONS
  Non-problem use is not an optimal 1-year outcome for those in an abstinence-oriented, heterogeneous substance use treatment program. Future research should examine whether these results are found in harm reduction treatment and self-help models, or in those with less severe problems. Results suggest treatment retention and 12-step participation are prognostic markers of long-term positive outcomes for those achieving remission at 1 year.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612-2304, United States. Jennifer.Mertens@kp.org
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Mertens
authors.forename: Andrea H
authors.initials: AH
authors.lastname: Kline-Simon
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.forename: Charles
authors.initials: C
authors.lastname: Moore
authors.forename: Constance M
authors.initials: CM
authors.lastname: Weisner
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000523:psychology*; D000437:Alcoholism / Q000534:rehabilitation*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult