Identifying Early Predictors of Long term Substance Use Disorders

In this post we will be discussing the peer-reviewed article “Predictors of problematic substance use 18 years after treatment: a longitudinal cohort study of persons with substance use disorders.” This article was published by Hjemsæter, Bramness, Drake, Skeie, Monsbakken, Thoresen, & Landheim in Cogent Psychology’s Clinical Psychology and Neuropsychology subsection in July 2019. The article aimed to examine substance use severity and comorbidity, and most importantly sought to identify early predictors of problematic substance use 18 years following initial treatment.

What did they do?

The authors of this study used a longitudinal study design to examine predictors of problematic substance use 18 years following an initial evaluation.

Why did they do it?

Substance use disorders are prevalent in roughly 20 million adults in the United States. Beyond financial cost, substance abuse plays a devastating role on an individual’s personal, familial, occupational, and social well-being. The authors of this study set forth to try and address an incredibly important question: what factor(s) can actually predict the presence of substance abuse among individuals who have been previously diagnosed with substance use disorders? With high relapse rates and the damaging outcomes associated with substance use, it’s a critical question. The better we can predict, the better we can prevent...it’s as simple as that.

How did they do it?

Patients entering treatment for substance use disorders in two Norwegian counties between the years of 1997 and 1998 were administered a battery of clinical measures, including the Composite International Diagnostic Interview, a structured personal psychiatric interview based on DSM-IV criteria; The Millon Clinical Multiaxial Inventory II, a self-report psychiatric diagnostic inventory used to measure current personality disorders; and The Hopkins Symptom Checklist-25 (HSLC-25), a self-report instrument used to assess mental distress (primarily panic, anxiety, and depression).

18 years following the initial evaluation, researchers followed up with participants who they could reach and had them complete the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT), which are both self-report questionnaires used to identify the problematic use of substances during the past 12 months.

What did they find?

Of the 91 participants who responded at the 18 year follow up, approximately half reported having current substance use problems. The authors compared baseline variables of the current substance abuse group with no substance abuse group. The following baseline variables were identified as significantly different between the current substance abuse group and no substance abuse group: number of personality disorders, score on the HSCL-25, age of onset of substance use disorder, and lifetime prevalence of agoraphobia. Lastly, participants with elevated HSCL-25 scores at baseline were more than 3 times as likely to be categorized as abusing substances 18 years later.

What does it all mean (our take)?

From our perspective, the take-home message from this article is as clear as it gets - evaluation of comorbid mental health problems and subsequent treatment of these problems appears to be absolutely critical to decrease the likelihood of future substance use problems. While the HSCL-25 is not an all-encompassing diagnostic tool, per se (i.e., its results only tell a piece of the psychological puzzle), it is a strong indicator of internalizing distress, and the results identify elevations on the HSCL-25 as the only predictor (in this study) of ongoing substance use problems.

Let’s keep in mind that the sample size of this study is quite small and we should therefore not go overboard with over-interpreting the findings. But, it paints a picture of how we may be able to better treat the millions of individuals who suffer from substance abuse disorders.

While the relationship between substance abuse and mental illness is incredibly complex and intertwined, one thing is certain: we need to continue developing strong research studies to learn how we can best intervene. This work will certainly help us streamline care and drive down costs, but much more importantly it will help us save lives and reduce the devastating impact of substance abuse on individuals and their associated communities.