Tuesday, December 22, 2015

After 5 Years of Recovery Are Patients Cured?

by Peter R. Coleman, MD

Recently, we have been hearing more and more about the idea that if people can sustain recovery for 5 years, they are (almost) cured. The concept is, just like a cancer diagnosis, if people can be free of their disease for five years, then the chance of the disease coming back is very unlikely - we can almost say they are cured. It is very unlikely that relapse will occur.

This idea appears to go beyond traditional thinking. We all know the saying - "once an alcoholic, always an alcoholic". We also refer to people in recovery as being "in recovery" and not "recovered", because we don't want to forget the fact that relapse is always possible, and recovering people need to protect their recovery. So, this new thinking is very bold, but maybe it is not so different after all.

I attended the American Society of Addiction Medicine (ASAM) annual conference earlier this year and some preliminary research was published that sheds some light on this situation.

A large study is looking at what happens to people if they are able to maintain 5 years of drug and alcohol free recovery. The results of the study so far indicate that if the patients were able to maintain 5 years of drug free recovery, then the relapse rate over the next five years was an amazingly low rate of only 3%. Fully 97% of people did not fall off the wagon. 

These are amazing results and very encouraging. When you think about it, the results are not as surprising as they first seem. If we think of nicotine dependence, another chemical addiction, then we would probably see very similar results. If people are able to stay off cigarettes for five years, they are very unlikely to pick up smoking again. Of course, they can relapse back to cigarette use if they make silly mistakes, but they are unlikely to do so. After 5 years of abstinence, people see themselves as non-smokers. They are no longer affected by triggers and they have learned how to deal with their emotions rather than just smoking cigarettes when they are bored, lonely, or frustrated. 

So, it makes sense that if people can achieve 5 years of abstinence from drugs and alcohol, they will also be unlikely to return to their former addictions.

Is five years the magic number? We do know that it takes a long time for the brain to heal after the drug use stops. I used to say that 12 months was a reasonable amount of time to assume the brain had returned to normal, but when it comes to opiates like prescription painkillers or heroin, I believe it takes a lot longer for all of the brain to heal. 

There is no other explanation for the fact that relapse is so common, even after very long periods of abstinence. The truth is most people who go to jail and are then released, will relapse virtually as soon as they get out. This seems to be true even when people are incarcerated for long periods of time. Clearly, the memory circuits in the brain and the systems responsible for cravings and impulse control have not fully healed.

We are now recommending treatment and follow up for five years. Using Naltrexone implants and injections for this first part of recovery is crucial. Transitioning to lesser levels of support can then be done when clinically indicated. If we treat this disease just like other medical conditions, we are much more likely to have favorable outcomes.

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