Studies of remission from drug dependence have most often been based
on treatment samples, with limited generalizability to persons who may benefit
from but never seek substance abuse treatment. Little is known about remission
patterns among drug users in the community.
To identify patterns and predictors of remission in a community sample
of drug users followed up prospectively.
Three waves of data on a range of individual and interpersonal correlates
of drug abuse and health care service use were collected between April 1997
and October 2000.
Areas of metropolitan San Juan where drug sales were known to occur.
Two hundred seventy-five women aged 18 to 35 who were crack cocaine
or injecting drug users.
Main Outcome Measures
Self-reported drug use validated with urine screens and drug use dependence
criteria based on the DSM-IV.
Most (86.9%) of the women were drug dependent at baseline. By wave 3,
fewer than half (42.6%) of the women were dependent, 13.8% had subthreshold
disorder, and 17.8% used substances but did not endorse any dependence criteria.
Cessation of use and decreases in the number of dependence criteria endorsed
were significantly less likely for women with depressive symptoms (odds ratio
[OR], 0.92; 95% confidence interval [CI], 0.88-0.96; and OR, 0.88; 95% CI,
0.86-0.90; respectively), with a partner who engaged in criminal activities
(OR, 0.30; 95% CI, 0.16-0.58; and OR, 0.63; 95% CI, 0.46-0.85; respectively),
and who traded sex for money or drugs (OR, 0.12; 95% CI, 0.05-0.29; and OR,
0.26; 95% CI, 0.19-0.35; respectively).
Drug use patterns and rates of dependence fluctuated substantially over
time among drug users recruited from the community. Findings regarding the
characteristics that impede remission suggest that mental health practitioners
have an important role to play in community-based outreach and interventions
designed to support women’s efforts to stop using drugs.