This post was originally published on May 13, 2016.
People vanish from my AA meetings all the time and I never notice until several weeks have passed. Of course, no one takes attendance and no one really ever announces their presence, but if you attend a meeting regularly enough, you’ll eventually scratch your head and wonder where someone went. Occasionally I’ll ask around and get the answer I dread: “Oh, you didn’t hear? They went back out.” I can’t fully explain what kind of a gut-punch that is. It’s sort of like hearing about a high school friend who’s died—a queasy reminder of my own mortality.
In the same way, it’s also a reminder of how fragile my sobriety is and all the good people I’d leave behind if I relapsed. My fellow addicts and alcoholics have no idea how much they’ve come to mean to me. Relapses just don’t compute in my brain. Correction—I completely understand them, but I don’t understand the science or ugly logic of how or why they happen. A brand-new study, however, suggests that researchers may have cracked the code behind relapse trends among certain people. This is a potential game-changer for the future of addiction treatment.
What Researchers Have Found
A recent study conducted by Ontario’s McMaster University discovered specific factors that can help predict the chances of relapse. Researchers at the university “looked at 250 adults who had been on a methadone treatment for an average of four years at 13 clinical sites in Ontario.” They found that addicts who injected drugs or ramped up their use of downers prior to drug treatment are the most likely candidates for a relapse. The study also reveals a direct (and somewhat confusing) link between age and treatment. The older an addict is when they start using, the more likely they are to relapse from treatment. Conversely, the older a person is when they begin treatment, the less likely they are to relapse. Basically, this means the risk of relapse decreases the longer an addict manages to stay alive and off drugs.
The study itself cites the US and Canada as the world’s highest consumers of prescription painkillers. In fact, in Canada alone, there was “a 203% increase in the prescription-use of opioids between 2000 and 2010.” Methadone is the most common therapy used to treat those suffering from opiate addiction, though data indicates that roughly half of those same people return to opiates after treatment ends. Those aren’t encouraging figures. If anything, it paints a pretty bleak picture of what lies ahead for most people addicted to Vicodin, Oxycontin and Percocet.
What Does This Mean?
The key to effective treatment might rest in knowing relapse risk factors ahead of time, then customizing treatments to specific patients. In a press release, the study’s principal author Dr. Zena Samaan said, “We can improve our tailoring of treatment to each patient if we know who among patients taking methadone treatment is at high risk for opioid relapse.” Because opioid addiction is both chronic and remitting, researchers zeroed in on the things that actually worked on patients rather than all the things that didn’t. “There has been little research on this issue of how long a patient can go without the illicit opioid use,” one of the paper’s authors said.
The study found that patients who still used illicit drugs during methadone treatment were three times likelier to relapse afterward, suggesting that the window for effective treatment is a narrow one. Researchers believe that the only time to make a genuine impact on opiate addicts is during treatment when specialists can actually tweak and tailor their approaches. “Many studies have shown that methadone and other substitution therapies are used most of the time as a harm reduction strategy,” Samaan said. “Many people with addiction may not completely abstain from using drugs, but they will have better stability on social and health level by reducing the drug use (albeit not stopping completely) and reduce injection behavior.”
Among the study’s critical findings was that the people who injected drugs were “more than twice as likely to relapse” while being treated for opiate addiction. Also, the older someone was when they started using opiates, the more likely they were to using them again. There is a 10% higher risk of relapse for every year later in life that a person started abusing opioids. Every day of benzodiazepine use in the previous month carries with it a 7% increase in relapse, too. Honestly, the only hopeful result was that the older a benzo addict was, the less likely they were to relapse which (to me) is cold comfort at best.
The Vicious Cycle
What’s particularly telling about the study is how the problem of relapse is rooted in the treatment of addiction itself. It almost goes without saying that pain medications are, by and large, incredibly addictive. According to the CDC, more people died in the US in 2014 because of drug overdose than any year before. Of those deaths, over 60% involved painkillers like methadone and hydrocodone. The CDC also estimated that between 2000 and 2014, nearly half a million people died from overdoses, which equals 78 addicts every single day. What’s also remarkable is that since 1999, the amount of prescription painkillers sold in the US has quadrupled, despite the fact that the amount of pain Americans report hasn’t changed whatsoever.
By knowing relapse risk factors ahead of time, treatment specialists can actively work to bring these figures down. Still, they’re going up against some incredibly strong headwinds—both socially and medically. Over-prescription and opioid addiction continue to conspire against the people who try to help, not to mention the very people who need the help. It’s a vicious cycle that only personalized treatment will break, researchers believe. Not every addiction story needs to have an inevitably sad third act. Armed with data from studies like McMaster University’s, physicians and specialists can—for once—outsmart addiction and remain one step ahead.