Nearly 50 million people in the United States struggle with substance use disorders, and nearly three in four use more than one substance.
People with polysubstance use disorders are more likely than single drug users to suffer poor health, relapse from treatment, and overdose. They're also three times more likely to die.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fifth Edition does not acknowledge polysubstance use disorder. The predominant recovery paradigm tells people with multiple substance dependencies that they aren't in recovery until they achieve complete abstinence from all of them.
But that sends a discouraging message, said Allison Tegge , a research associate professor at Virginia Tech's Fralin Biomedical Research Institute at VTC .
In a new study published Feb. 28 in Harm Reduction Journal , Tegge and her team propose a new measure, proportion of remission, that aims to give polysubstance users credit for progress when they quit one substance and to bolster confidence as they work to quit others. The idea, supported by a study of more than 2,400 people in recovery from substance use disorders, offers a paradigm shift in how recovery is measured, connecting incremental successes with improved quality of life.
"We want to celebrate every success. The expectation that you are completely abstinent or you aren't successful feels, for many, unattainable," Tegge said. "We really want to change that expectation to consider where an individual is. What are their goals? How can we support individuals in achieving long-term recovery at the pace and the way in which they are comfortable doing it?"
Emerging evidence suggests that successfully recovering from using one substance helps people develop strategies they can use to take on their use of other substances.
Tegge's proposed new metric aligns with the harm-reduction movement — a public health approach that aims to reduce the negative health, social, and legal consequences associated with drug use even while people with substance use disorders continue to work toward recovery.
"We want to reduce the overall risk portfolio for an individual by recognizing that incremental improvements matter," Tegge said.
Tegge, with then- translational biology, medicine, and health graduate Fatima Quddos, developed a formula to calculate Proportion of Remission: the number of substances for which the person is in remission in the past year is divided by the total number of lifetime substance use disorders an individual has under standards defined in the DSM-5. Quddos is now a senior research associate
To test the formula, Tegge and her lab team turned to the International Quit and Recovery Registry , an online pool of people who have a history of substance use disorder and are in recovery. The tool was created at the Fralin Biomedical Research Institute by the late addiction researcher Warren Bickel, professor and director of the institute's Addiction Recover Research Center . Using lifetime history and remission information, the team surveyed 2,406 eligible participants to assess their proportion of remission and its association with quality-of-life measures.
"We found strong associations between proportion of remission and all four domains of quality of life – environmental, psychological, physical and emotional," said Tegge.
While the study confirmed the value of the new measure, Tegge said, it also revealed its limitations. The calculation weighted all substances equally, although some are more difficult to quit than others. Understanding the substance-specific impacts on recovery could support design of more personalized treatment, Tegge said.
While still refining the new measure, she stressed its value and importance.
"I hope the paradigm of how we measure recovery changes," she said. "I hope we can acknowledge that any reduction in risk is a reduction in risk. It doesn't have to be an all-or-nothing space. And let's really meet individuals where they're at so we can better support and facilitate their long-term recovery."
