Adults in Recovery from Substance Use Disorders Have Greater Burden of Physical Diseases than General Population
Key findings
- This nationally representative cross-sectional study involved 2,002 adults who responded affirmatively to the screening question, "Did you used to have a problem with drugs or alcohol, but no longer do?''
- In this survey the self-reported lifetime prevalence of diabetes was 13.62%; heart disease, 5.29%; hepatitis C, 5.49%; and chronic obstructive pulmonary disease (COPD) was 4.99%
- These four chronic diseases were significantly more prevalent in the surveyed sample than in the general U.S. adult population
- Participants who reported diagnoses of diabetes, COPD, alcohol-related liver disease or tuberculosis reported significantly poorer quality of life and/or significantly more psychological distress than those not reporting physical disease
- Primary care physicians should stay alert to the potential need to manage chronic health conditions for patients in recovery from substance use problems
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It's well established that excessive and chronic use of alcohol and other drugs (AOD) can lead to an array of medical conditions that reduce life expectancy and increase the number of years lived with disease and disability. Less well understood, however, is the burden of physical disease among people who are in recovery from AOD issues.
Clinical psychologist David Eddie, PhD, and John F. Kelly, PhD, director of the Recovery Research Institute and associate director of the Center for Addiction Medicine at Massachusetts General Hospital, have conducted the first nationwide U.S. study that estimates the prevalence of common physical diseases among individuals in recovery from significant AOD problems. They published their report in the Journal of Addiction Medicine.
Study Design
The researchers made use of the National Recovery Survey, which screened 38,909 adults with a single question, ''Did you used to have a problem with drugs or alcohol, but no longer do?''
Of the participants who responded affirmatively, the researchers randomly selected a nationally representative sample of 2,002 individuals. The sample matched the Census Bureau's March 2015 Current Population Survey in terms of sex, age, race/Hispanic ethnicity, education, geographic region, household income, homeownership status and metropolitan area. When necessary, the researchers provided participants with a web-enabled computer and free internet service.
Participants were categorized according to the drug they had used most often:
- Alcohol
- Cannabis
- An opioid
- A stimulant
- Other drugs
Prevalence of Nine Diseases
Participants indicated whether they had ever been told by a health care provider that they had:
- Diabetes — 13.62%
- Cancer — 5.50%
- Heart disease — 5.29%
- Hepatitis C — 5.49%
- Chronic obstructive pulmonary disease (COPD) — 4.99%
- Alcohol-related liver disease — 4.84%
- HIV or AIDS — 2.61%
- Another sexually transmitted disease — 8.69%
- Tuberculosis — 1.42%
The prevalences of diabetes, heart disease, hepatitis C and COPD were significantly greater than those reported for the general adult population in the National Health and Nutrition Examination Survey (NHANES) dataset accessed in 2018.
Prevalence of Disease by Primary Drug
There were notable differences in the prevalence of disease according to the primary drug used:
- Diabetes was least common in the cannabis group and was significantly less common in that group than in the alcohol group
- Heart disease was most common in the alcohol group and least common in the opioids group; the difference was statistically significant
- Hepatitis C was significantly more prevalent in the injection drug groups (opioids and stimulants) than in the alcohol group
- Alcohol-related liver disease was, unsurprisingly, most prevalent in the alcohol group; the prevalence was significantly greater than that in the opioids and stimulants groups
- HIV/AIDS and other sexually transmitted diseases were significantly more prevalent in the stimulants group than in the alcohol group
- There were no significant differences between primary drug groups in the prevalence of cancer, COPD or tuberculosis.
Disease and Quality of Life
The researchers assessed the participants' quality of life using the 8-item EUROHIS-QOL questionnaire. The key results were:
- Diabetes, COPD and alcohol-related liver disease were each associated with significantly lower levels of quality of life compared with general population norms
- Alcohol-related liver disease and tuberculosis were significantly associated with greater psychological distress
Recommendations
A survey at one point in time can't prove a causal relationship between AOD problems and an increased prevalence of physical diseases. However, the results of multiple previous studies suggest a high probability that the increased prevalence of certain diseases in the National Recovery Survey participants, relative to the general population, is either directly or indirectly related to AOD problems.
In addition to performing ongoing recovery check-ups, primary care physicians should stay alert to the potential need to manage chronic health conditions for patients in recovery from AOD problems. Smoking cessation might be an intervention of particular benefit, as it's possible that tobacco use itself contributes substantially to the disease burden of AOD problems. In this study, the number of years of smoking was significantly associated with the risk of having one chronic disease versus none and the risk of having two or more chronic diseases versus one.
This study also emphasizes the public health need for early AOD treatment and more aggressive medical care for individuals being treated for AOD problems. As a prominent example, there's high-level evidence that integrating smoking cessation into addiction treatment improves recovery outcomes for other drug dependencies.
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