Our current failure or poor success in treating drug use disorder is partially due to our poor understanding of the complex natural history and its development and change over time. If we consider three potential transitions from non-use to asymptomatic use and to problem use and abandon the older designations of abuse and addiction, then we may more meaningfully arrive at fruitful conclusions.
Crompton et al. published recently in the American Journal of Psychiatry the findings of a study they carried out in which they made two assessments of individuals done at three year intervals. Less than 5% started using during the three year interval but of those over 50% had trouble at the three year follow-up. Of those asymptomatic users at the first assessment, 66% had stopped at follow-up while 20% progressed to problem usage. Of the problem users at baseline, 49% had stopped at the three year follow-up, 40% returned to problem usage, and 11% became asymptomatic users.
A variety of factors appear to influence transitions. Drug initiation appears to be linked to younger age, alcohol and nicotine usage and major depressive disorder. Drug initiation progression to problem usage seems related to lack of health insurance, poor physical and psychological health, and a family history of substance abuse. Higher persistent drug abuse is associated with child abuse and schizotypal and narcissistic personality disorders.
The study demonstrates that the course of drug use and problem use is influenced by factors at many levels including sociodemographic, family history of substance use, history of child abuse, current physical/psychological health and psychopathology.