There is an ongoing debate in the addiction field: Can people successfully recover from one drug use disorder if they continue to consume a different drug? In this case, authors reviewed more than a dozen studies in the field investigating specifically how drinking alcohol affects other drug use disorder treatment outcomes.
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Addiction treatment studies often focus on one substance at a time – alcohol, marijuana, cocaine, or opioids for example. This makes sense from a research perspective because focusing on one substance makes it easier to understand the study’s findings. It may not be completely applicable to real-world situations, however.
Also because the alcohol industry is generally commercialized and drinking is so common across North America, Europe, and Australia, even when the focus of a study is on an illicit drug, how drinking alcohol changes over time and affects other drug outcomes is important to understand. This research review helped tackle that issue by outlining findings from 13 studies investigating how people’s drinking changes if they sought treatment for another drug problem.
The study was a systematic review, meaning authors searched databases with a clear predetermined strategy and articles needed to meet certain criteria to be included in the review. In this case, the articles needed to be studies of drug treatment outcomes for adults (18+ years), that also measured drinking before and after treatment, as well as at a later follow-up measurement.
Thirteen studies conducted in several different countries met these criteria, including the Treatment Outcome Prospective Study, Drug Abuse Reporting Program, National Treatment Outcome Research Study, Australian Treatment Outcome Study, and Research Outcome Study.
There are two major theories around how alcohol use might be detrimental:
Drinking-induced Relapse Studies:
Authors found support for the hypothesis that drinking alcohol is associated with greater use of the primary drug and greater likelihood of relapse to the primary drug use disorder, for which they received treatment.
For example, drinking was shown to be related to subsequent cocaine and other drug use both during and after treatment for the drug use disorder. Drinking after cocaine use disorder treatment was associated with worse cocaine outcomes 6 months later. On the other hand, alcohol abstinence during cocaine treatment is found to improve drug use outcomes over time.
Substitution Hypothesis:
The authors did not find support for the hypothesis that participants drink in order to provide an alternative coping strategy in place of their primary drug use disorder. There is little evidence that participants that are doing well in drug use disorder treatment are at higher risk for increasing their drinking as a substitute coping mechanism.
This is similar to a study reviewed in a previous RRI Bulletin. In that study authors used a large, representative sample to show that, for individuals with a substance use disorder, remission from that disorder reduces the risk of developing a new onset substance use disorder by 50% compared to individuals not in remission.
Although the reasons for this relationship are uncertain, it is possible that individuals acquired skills (e.g., via treatment, mutual-help, or personal experience) helping them resolve one problem that they could apply to making sure they did not develop another problem.
It seems based on this review that if someone resolves one drug use disorder – cocaine for example – it is much more likely that drinking alcohol will increase risk for relapse of the individual’s primary drug than being able to serve as a substitute.
Next steps might include understanding the mechanisms through which this drinking-induced relapse occurs and, conversely, why people who have positive drinking outcomes are also more likely to have better other drug outcomes as well. Given that in these studies, authors tended to control for demographic and important clinical factors (e.g., severity of their drug use disorder), it is unlikely simply that they had greater overall resources to help them attain and sustain abstinence (e.g., recovery capital) and, thus, are more likely to have good outcomes across the board. There are likely to be other processes at play.
In addition, given the changing landscape of recreational and medical marijuana legalization , another important area may be the impact of marijuana on other drug outcomes, just as was done in this review with alcohol.
Staiger, P. K., Richardson, B., Long, C. M., Carr, V., & Marlatt, G. A. (2013). Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction, 108(7), 1188-1193.
l
Addiction treatment studies often focus on one substance at a time – alcohol, marijuana, cocaine, or opioids for example. This makes sense from a research perspective because focusing on one substance makes it easier to understand the study’s findings. It may not be completely applicable to real-world situations, however.
Also because the alcohol industry is generally commercialized and drinking is so common across North America, Europe, and Australia, even when the focus of a study is on an illicit drug, how drinking alcohol changes over time and affects other drug outcomes is important to understand. This research review helped tackle that issue by outlining findings from 13 studies investigating how people’s drinking changes if they sought treatment for another drug problem.
The study was a systematic review, meaning authors searched databases with a clear predetermined strategy and articles needed to meet certain criteria to be included in the review. In this case, the articles needed to be studies of drug treatment outcomes for adults (18+ years), that also measured drinking before and after treatment, as well as at a later follow-up measurement.
Thirteen studies conducted in several different countries met these criteria, including the Treatment Outcome Prospective Study, Drug Abuse Reporting Program, National Treatment Outcome Research Study, Australian Treatment Outcome Study, and Research Outcome Study.
There are two major theories around how alcohol use might be detrimental:
Drinking-induced Relapse Studies:
Authors found support for the hypothesis that drinking alcohol is associated with greater use of the primary drug and greater likelihood of relapse to the primary drug use disorder, for which they received treatment.
For example, drinking was shown to be related to subsequent cocaine and other drug use both during and after treatment for the drug use disorder. Drinking after cocaine use disorder treatment was associated with worse cocaine outcomes 6 months later. On the other hand, alcohol abstinence during cocaine treatment is found to improve drug use outcomes over time.
Substitution Hypothesis:
The authors did not find support for the hypothesis that participants drink in order to provide an alternative coping strategy in place of their primary drug use disorder. There is little evidence that participants that are doing well in drug use disorder treatment are at higher risk for increasing their drinking as a substitute coping mechanism.
This is similar to a study reviewed in a previous RRI Bulletin. In that study authors used a large, representative sample to show that, for individuals with a substance use disorder, remission from that disorder reduces the risk of developing a new onset substance use disorder by 50% compared to individuals not in remission.
Although the reasons for this relationship are uncertain, it is possible that individuals acquired skills (e.g., via treatment, mutual-help, or personal experience) helping them resolve one problem that they could apply to making sure they did not develop another problem.
It seems based on this review that if someone resolves one drug use disorder – cocaine for example – it is much more likely that drinking alcohol will increase risk for relapse of the individual’s primary drug than being able to serve as a substitute.
Next steps might include understanding the mechanisms through which this drinking-induced relapse occurs and, conversely, why people who have positive drinking outcomes are also more likely to have better other drug outcomes as well. Given that in these studies, authors tended to control for demographic and important clinical factors (e.g., severity of their drug use disorder), it is unlikely simply that they had greater overall resources to help them attain and sustain abstinence (e.g., recovery capital) and, thus, are more likely to have good outcomes across the board. There are likely to be other processes at play.
In addition, given the changing landscape of recreational and medical marijuana legalization , another important area may be the impact of marijuana on other drug outcomes, just as was done in this review with alcohol.
Staiger, P. K., Richardson, B., Long, C. M., Carr, V., & Marlatt, G. A. (2013). Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction, 108(7), 1188-1193.
l
Addiction treatment studies often focus on one substance at a time – alcohol, marijuana, cocaine, or opioids for example. This makes sense from a research perspective because focusing on one substance makes it easier to understand the study’s findings. It may not be completely applicable to real-world situations, however.
Also because the alcohol industry is generally commercialized and drinking is so common across North America, Europe, and Australia, even when the focus of a study is on an illicit drug, how drinking alcohol changes over time and affects other drug outcomes is important to understand. This research review helped tackle that issue by outlining findings from 13 studies investigating how people’s drinking changes if they sought treatment for another drug problem.
The study was a systematic review, meaning authors searched databases with a clear predetermined strategy and articles needed to meet certain criteria to be included in the review. In this case, the articles needed to be studies of drug treatment outcomes for adults (18+ years), that also measured drinking before and after treatment, as well as at a later follow-up measurement.
Thirteen studies conducted in several different countries met these criteria, including the Treatment Outcome Prospective Study, Drug Abuse Reporting Program, National Treatment Outcome Research Study, Australian Treatment Outcome Study, and Research Outcome Study.
There are two major theories around how alcohol use might be detrimental:
Drinking-induced Relapse Studies:
Authors found support for the hypothesis that drinking alcohol is associated with greater use of the primary drug and greater likelihood of relapse to the primary drug use disorder, for which they received treatment.
For example, drinking was shown to be related to subsequent cocaine and other drug use both during and after treatment for the drug use disorder. Drinking after cocaine use disorder treatment was associated with worse cocaine outcomes 6 months later. On the other hand, alcohol abstinence during cocaine treatment is found to improve drug use outcomes over time.
Substitution Hypothesis:
The authors did not find support for the hypothesis that participants drink in order to provide an alternative coping strategy in place of their primary drug use disorder. There is little evidence that participants that are doing well in drug use disorder treatment are at higher risk for increasing their drinking as a substitute coping mechanism.
This is similar to a study reviewed in a previous RRI Bulletin. In that study authors used a large, representative sample to show that, for individuals with a substance use disorder, remission from that disorder reduces the risk of developing a new onset substance use disorder by 50% compared to individuals not in remission.
Although the reasons for this relationship are uncertain, it is possible that individuals acquired skills (e.g., via treatment, mutual-help, or personal experience) helping them resolve one problem that they could apply to making sure they did not develop another problem.
It seems based on this review that if someone resolves one drug use disorder – cocaine for example – it is much more likely that drinking alcohol will increase risk for relapse of the individual’s primary drug than being able to serve as a substitute.
Next steps might include understanding the mechanisms through which this drinking-induced relapse occurs and, conversely, why people who have positive drinking outcomes are also more likely to have better other drug outcomes as well. Given that in these studies, authors tended to control for demographic and important clinical factors (e.g., severity of their drug use disorder), it is unlikely simply that they had greater overall resources to help them attain and sustain abstinence (e.g., recovery capital) and, thus, are more likely to have good outcomes across the board. There are likely to be other processes at play.
In addition, given the changing landscape of recreational and medical marijuana legalization , another important area may be the impact of marijuana on other drug outcomes, just as was done in this review with alcohol.
Staiger, P. K., Richardson, B., Long, C. M., Carr, V., & Marlatt, G. A. (2013). Overlooked and underestimated? Problematic alcohol use in clients recovering from drug dependence. Addiction, 108(7), 1188-1193.
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