Remission from substance use disorders: A systematic review and meta-analysis

- Twenty-one of 8855 studies published in the past 15 years were selected for this meta-analysis.
- Remission occurred after 17 years for up to 50% of persons with substance use disorders (SUDs).
- Aggregate SUD remission rates were 10-15% for any given year.
- Higher SUD remission rates correlated with lower sample retention and longer follow-up period.
- Results support the contention that SUDs are “chronic” or long term disorders.

ObjectiveThis paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies.MethodsA comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables.ResultsOf 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates.ConclusionsResults support the contention that SUDs are more likely to be “chronic” or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.