Prognosis and duration
For people with drug dependence problems, there is no quick solution and no ’cure‘ for drug abuse. The eventual outcome of drug abuse is, like its initiation, dependent on the unique interaction between drug, individual and society in addition to the treatment intervention. Once dependence has developed, it is generally a chronic condition of relapse and remission lasting for years rather than months and one that is difficult but not impossible to overcome.
Studies have shown that it is the less chronic addicts who are likely to become abstinent in the short term, and that short-term or early improvement is more likely to lead to long-term improvement.
Most of the studies looking at deaths of people with addiction problems report that 2-3% of addicts are dead within one year of making contact with a clinic or helping agency.
Several factors determine the prognosis for any individual. These include:
- The substance of abuse. Substances that have high rates of dependence and severe or prolonged withdrawal symptoms are associated with a worse prognosis.
- The reasons for the substance abuse. Teenage experimentation or drug abuse during reversible life crises is associated with a good prognosis.
- Personal vulnerability. Poor family background, poor school record and truancy, thrill seeking, impulsivity and personality disorders are associated with a worse prognosis.
- Associated psychiatric disorders. People with associated psychiatric disorders, for example people with depression, schizophrenia and personality disorders tend to have a worse prognosis
- Multiple substance or alcohol abuse is associated with a worse prognosis
- Poor social environment, for example homelessness and unemployment is associated with a poor prognosis.
- The duration of the substance abuse. A worse prognosis is associated with longer duration of substance abuse.
- Motivation of the person to change. Lack of motivation is associated with a worse prognosis.
- Support available to the person. Lack of availability of support services are associated with a worse prognosis.
The prognosis for certain specific individual substances is briefly described below.
Amphetamines
Amphetamine use is more likely to be recreational than opioid use. It is thought that the vast majority of young adults give them up in due course. A very small proportion of amphetamine injector’s progress to high dose daily usage. Complications and contact with psychiatric services is more likely in dependent users and in episodes of psychosis. The prognosis is good provided the person abstains from drug use after any related psychiatric disorder occurs. The prognosis is worse in people with associated personal or social difficulties or psychiatric disorder including personality disorder.
Anabolic steroids
The prognosis is not known because no long-term follow up or large treatment trials are available.
Barbiturates
The prognosis is not known because no trials or long term follow up studies are available.
Benzodiazepines
Success rates for supervised withdrawal are high. Of those people who participate in supervised withdrawal programmes, about half complete a programme and of these, half to two thirds remain benzodiazepine free after 1 to 3 years. A few people continue to experience withdrawal like symptoms for months or even years after cessation of benzodiazepines (prolonged withdrawal syndrome). A considerable proportion of people may temporarily take benzodiazepines again and some may need other psychotropic medication.
Cannabis
The vast majority of users do not abuse the drug or become dependent on it. The 12 month prevalence rate of cannabis abuse in general population is 0.7% and 6% of those who used cannabis in the past year are dependent. Only a minority of people seek treatment from a health professional. Post treatment abstinence rates are low.
Cocaine
Cocaine use is more likely to be recreational than opioid use. It is thought that the vast majority of young adults give them up in due course. Heavy use of cocaine is difficult to sustain and its use tends to be periodic in nature. Success rates for treatment of cocaine abuse are high with up to 75% abstinence at 5 years post treatment. The prognosis is worse in people with associated personal or social difficulties or psychiatric disorder including personality disorder. Good prognosis is associated with longer treatment programmes and in women.
Due to the recent increased availability of crack cocaine, there are increasing numbers of cases of very severe dependence with a corresponding very distressing abstinence syndrome. Crack cocaine use seems to be associated with a high mortality rate and criminal involvement and treatment does not appear to be effective in reducing drug use.
Ecstasy
The prognosis is good provided the person abstains from drug use. The prognosis is worse in people with associated personality disorders.
Gamma hydroxybutyric acid (GHB)
There is insufficient evidence available to comment on the prognosis following treatment.
Heroin and other opioids
There is a significant mortality (10 to 15%) over 10 years in opioid abusers. Common causes of death include accidental overdose, suicide, HIV and hepatitis.
Abstinence rates following treatment vary but between 10 to 40% are abstinent 6 months following treatment and the majority of people who relapse do so 3 to 4 months after discharge.
Good prognosis is associated with a greater range of treatment services (health care, family therapy, cognitive behavioural therapy etc) and substantial periods of employment and marriage. Worse prognosis is associated with more severe pre-treatment psychopathology and dependence. Abstinence is often related to change in life circumstance, for example in opiate addicted returning Vietnam veterans.
Approximately 50% abstinence has been reported at 10 year follow up.
It has been demonstrated that eventual cessation of opiate use is a very slow process and becomes increasingly unlikely the longer the person has taken the drug.
Ketamine
The vast majority of people stop using ketamine without treatment as the psychedelic effects diminish as tolerance develops.
Khat
There is insufficient evidence available to comment on the prognosis following treatment.
Lysergic acid diathylemide (LSD)
The long term prognosis for LSD abuse is good provided that the person discontinues use of the drug. Hallucinogen persisting perception disorder may resolve over a period of months or years after last drug use but persists in about 50%. Prolonged psychotic episodes have a relatively poor prognosis and there is a high risk of suicide.
Nitrites (Poppers)
The prognosis is not known because there are no available treatment trials or long-term follow up studies.
Phencyclidine (angel dust)
The majority of people stop taking phencyclidine once they pass young adulthood. The prognosis for chronic phencyclidine psychosis is poor.
Psilocybe mushrooms
Users do not usually regard themselves as having a problem and almost never present to drug services for help with cutting down or stopping.
Solvents
For many users, experimentation is a temporary phase which does not result in persistent abuse or dependence. However, treatment is difficult for the dependent subgroup with associated personality disorder and chaotic social circumstances.
All substances
Therefore the following awards should be considered -:
First award period – award for 2 years.
Second award period – award for 5 years.
Thereafter an indefinite award may be appropriate. However, in some cases there is potential for improvement in the condition in the longer term.
All information must be taken into account when considering the duration of disabling effects and the duration of disabling effects must be based on the particular circumstances of the individual claimant.
Amended June 2008
