Review articleOutcome predictors in substance use disorders
Section snippets
Dopamine
Evidence exists that central dopaminergic activity has an important role in mediating some effects of ethanol and that indirect assessments of dopamine activity may serve as a predictor of relapse in alcohol dependence. The dopamine system is an integral part of brain reward circuitry, and is altered by both acute and chronic ethanol. Acute administration of ethanol enhances dopamine release in the nucleus accumbens, whereas chronic use of alcohol results in down regulation of D2 receptors.
Severity of dependence
Perhaps the most robust outcome predictor in cocaine dependence is baseline severity of drug use, which is associated with poor treatment response. In particular, severity of withdrawal symptoms and urinary measurement of cocaine metabolites predicts failure to complete treatment [120], [121]. Alterman et al [122] have found that patients with urine indicative of recent cocaine use were less likely to complete treatment or achieve initial abstinence. Mulvaney et al [123] used initial urine
Opioids
Retention of patients in methadone programs is critical to successful treatment outcomes and longer retention is influenced by adequate dose, well-trained staff, clear policies and procedures, low staff turnover, high staff morale, and flexible take-home policies. Effective methadone treatment programs report that 70% to 85% of those entering treatment voluntarily stay in treatment for 1 year or more, and after the first 6 months of stabilization in treatment, the illicit use of opiates falls
Tobacco
As with other substance-use disorders, severity of dependence is associated with poor outcomes in tobacco-use disorders. An average rate of long-term tobacco abstinence in a general population of treatment-seeking tobacco users is about 25% [181]. Even though the smoking cessation rates have continued to increase, most smokers who quit eventually relapse. It has been estimated that 75% to 80% of individuals who quit smoking relapse within the first 6 months [182]. More than one third of all
Summary
Given the heterogeneous nature of substance abuse, it is notable that several predictors of response are independent of the primary drug of abuse or the treatment setting [208]. Although the strength of the relationship of predictor to outcome varies, the following factors have been identified consistently: severity of dependence or withdrawal; psychiatric comorbidity; substance-related problems; motivation (abstinence commitment); length of treatment; negative affective states; cognitive
Acknowledgements
The authors thank Karyn Coveney and Meghan Zysik for their assistance in the preparation of this manuscript.
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