Prevalence and Correlates of Ever Having a Substance Use Problem and Substance Use Recovery Status Among Adults in the United States, 2018
Expanding access to treatment and recovery services is key to reducing substance use-related harms. Fundamental to expanding such services is better understanding the populations identifying themselves as in recovery. This study uses nationally representative data to estimate prevalence and correlates of recovery in the U.S.
Data are from the 43,026 adults (aged 18 or older) participating in the 2018 National Survey on Drug Use and Health. Based on self-reported data, the researchers estimate prevalence of ever having a substance use problem, the percentage in recovery among those with a substance use problem, and a multivariable logistic regression model to explore associations of recovery status with demographic characteristics and lifetime mental health problems. Among adults reporting a substance use problem, this study compares prevalence of substance use by recovery status, followed by a multivariable model examining associations between each substance used and being in recovery.
More than 1 in 10 adults (27.5 million) in the U.S. reported ever having a substance use problem, and, among those with a problem, nearly 75 % (20.5 million) reported being in recovery. Reporting lower prevalence of using substances in the past year and having received treatment for their substance use problem were associated with being in recovery. Ever having a mental health problem was highly prevalent among those reporting a substance use problem.
The provision and expansion of substance use treatment services continues to be important to reduce harms related to substance use, especially for those with both substance use and mental health disorders.
Research in context
There are several implications from this research. This study and previous representative studies show that tens of millions Americans have had and resolved a substance use problem. This goes against the common narrative that substance use problems are chronic conditions that keep relapsing and people never fully recover.
The study found certain characteristics which make recovery likelihood higher or lower.
- Having a resolved mental health problem and receiving substance use treatment increased the likelihood that a person reported recovery from a recognized substance use problem in their lifetime.
- Having an unresolved mental health problem, identifying as non-Hispanic black, and past-year use of a wide range of substances decreased this likelihood.
Tobacco use and nicotine dependence were higher among those who have had a substance use problem. Lifetime injecting drug use was more common among those who were in recovery.
Substance use problems are likely to be on a spectrum, from a severe and chronic SUD with many substance-related consequences to more discrete episodes of binge drinking that may have led to a family or legal consequence.
The data from this study show that while formal treatment may help a person resolve an alcohol or drug problem, the majority of people will recover without using formal treatment. This is through other pathways of recovery (e.g. mutual-help organizations) or without using any formal services whatsoever (i.e. natural recovery).
Recovery Research Institute highlights the importance of the research to different groups. In terms of treatment services there is a need for addressing both mental health and substance use problems of those with co-occuring mental health conditions. Smoking cessation services can also help those in recovery experience more benefits.
For policy makers, funding to support research on individuals who resolved an alcohol or drug problem without formal treatment could inform policies which maximize outcomes and enhance the likelihood of more rapid alcohol/drug problem resolution for those who do not seek services. Addressing concerns of non-Hispanic black people in terms of accessing and using treatment and support services is needed. Integrating SUD treatment with mental health treatment could further improve outcomes.