Looking for stats re: %success in herion recovery

In My Humble Opinion
1

I’m trying to find % success rates for recovery in heroin addicts, specifically, after so-and-so many attempts, the % chance of remaining sober for X amount of time is blah%. Or, after so many years of using, the chances of rehab working increases/decreases by whatever percent.

The back story: I have a friend whose estranged wife just reached 20 years of addiction, with about 40 - 50 stints in rehab or methadone or another type of treatment. (13 in one year.) She’s still using. The longest period of not using she’s had is just under one year, and that was after her first rehab. Her average is about two weeks clean. I have no idea how she’s managed to stay alive.

While discussing this with another friend the other day, she told me that statistically, she has no chance of ever recovering for any appreciaple length of time. She said that there’s about a 20% chance of a program working, no matter what it is, from methadone to cold turkey, so after 5 attempts, you’ve used up your chances. I’d think if the 20% rate of success is true, then it wouldn’t matter how many times you’ve been, you’re still looking at about a 20% chance of it working. (This time.) So, since obviously neither of us “gets” the math, I figured I’d turn to the wisest bunch of people I know of, and ask for real numbers. Or anectdotes, or anything. I’m just eternally curious about how this works. I can envision it getting easier to stay clean after repeated attempts, but I can also see how after a bunch of attempts it just isn’t going to work. And she’s been through everything, and I mean every single program. Inpatient, outpatient, aversion Rx, fancy, expensive programs to the free program for the homeless. So, I think she’s probably hopeless, myself, but it’s really (A) not my business and (B) impossible to accurately predict. I think I just want something to wrap my head around. I’m also curious to other numbers surrounding it, pretty much anything. All the numbers I’m finding are the number of people per 100,000 who use per state, and individual facilities success rate after 2 months. (Which seems to be 75% on average.)

Bonus question - if anyone would care to share stories with me, good, bad, or indifferent, about their personal experience dealing with another person’s addiction to herion, I would really like to hear about them. I think they may help my friend understand that he’s not alone in struggling with watching her kill herself without any chance of him actually being able to help her. He’s really messed up, doesn’t go to Narc or Al-anon because he’s just too embarrassed and practically ruined by the whole thing. (Yes, I know I’m just an extension of co-dependency if I’m trying to help him and he’s trying to help her, etc. I don’t let it affect my life, honestly. My husband and I both care about him a lot and hope to help him deal with this part of his life.)

Thanks in advance! I have to go to work, so I can’t check back in until late tonight, but I’m really looking forward to anything you all could tell me.

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That’s an excellent question, and given that I am about to start a fellowship in addiction psychiatry, probably the sort of thing I should know. I will see what statistics I can dig up, but I would point out that “success” in this sort of endeavor has more than one potential definition…this link from the National Institute on Drug Abuse reports (although in a less detailed fashion than I would like) that “treatment” (unclearly defined) produces dramatic reductions in drug use, criminal behavior, unemployment and HIV transmission. If you define “success” only as “acheiving complete long-term abstinence”, I would say that the chances of someone as severely addicted as your friend’s wife obviously is acheiving this is quite small. However, I suspect that without all those treatments, she would probably be even worse off than she is (probably dead, in fact), so they should probably be thought of as “limited successes” rather than “failures”.

I have no idea where your friend’s “20%” figure comes from.

I am hoping that this woman has some sort of long-term relationship with a psychiatrist or counselor and is involved in ongoing 12-Step or other support groups; if she is just alternating periods of intense treatment with periods of no treatment at all, this is not likely to work. I also hope that your friend can overcome his embarrassment and get into Narc-Anon for his own sake and hers; if he finds this too difficult, perhaps he could consider individual psychotherapy to help him deal with these issues.

Good luck…I will see what else I can find.

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Sorry, this link should actually work!

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I know alcoholism and in rehab they treated us and the opiate addicts about the same. I am sad to say that I had to go to a few of them myself before things got better. Anyway, I went to some pretty reputable outpatient programs taught by addiction specialists who were often former addicts themselves. They basically all said that the chances for relapse after any one detox/rehab were pretty high. The numbers several of them used were an 85% relapse rate during the first year and a few more percent after that making the total failure rate over 90% for a given detox. That sounds bleak but they also said that given enough repeat tries, about 2/3rds will gain lasting sobriety. Of course, there are that 1/3 that never do and that is pretty bad.

I met many people including some of the addiction specialists who got it together and went back to school who had 50 - 100 inpatient treatments so she isn’t all that unusual. This thread is kind of timely because my wife’s nephew just showed up a little while ago. He got out of his ## heroin detox/rehab last night and is going out to dinner with us. We were talking about his long-term chances earlier and they don’t seem that good. He is only 21.

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I’ll chime in with an anecdote. Last year, my parents and I found out that my younger sister (19 at the time) was a heroin addict. Needless to say, it hit all of us pretty hard, especially my folks. They were used to getting upset about things like me getting a speeding ticket or my sister getting caught smoking cigarettes. This was just way too real for them, you know?

Anyway, I was away at school for the whole thing, and for the first 6-8 months following us finding out, my sister went through a really tough time in various out-of-state rehab clinics. There were relapses, an escape attempt, lies, therapy, and lots and lots of crying. I felt pretty helpless myself, just hearing weekly updates from my folks on the phone and talking to my sister once in a while.

Since then, things have gotten better. My sister completed one of the programs and returned home. She was a lot more cooperative with my folks and worked really hard to regain some of their trust. She got a job and her own apartment. As far as I know she’s been going to NA meetings and therapy regularly. The best thing is that she seems so much more lucid and confident and just plain happy than she has in years.

A week ago she moved to the west coast with a friend of hers to go back to art school, and she still seems to be doing great. My folks are somewhat freaked out at the prospect of her being so far away, but they’re also glad she’s happy and getting back into school. My parents and I are really proud of her recovery and how well she’s doing, but we’re also really scared. There’s always the chance of a relapse, and especially when she’s so far from home, it’s very hard to keep an eye on her.

So I guess this is an example of a “good” heroin abuse story, in that at this point things seem to be looking up. It’s still the worst thing that has every happened to our family though, and our lives will probably never be the same.

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Sorta related.
This month’s issue of Alternative Medicine ( Go to the current issue tab on top) does a really good cover story of different approaches to sobriety other than AA. Not really sure if it touched on recovering from heroine. Mostly alcohol, I beleive.
There was a very good part in the article about accupuncture and something with the ear and how severe addicts who normally needed ummm methadone? to help them off addiction felt no need for methadone at all. YMMV, naturally, but I have a neighbor who went to an accupuncturist as attempt to quick a 25+ year addiction to smoking. He stuck needles in her ear and she never had a problem after that. No problems with withdrawl either. Make of that what you will.

As a non-drug user it made sense in my mind. The story is not available on the site, but it might be worth it to take a looksy at the bookstore. Worth the cover price to pass it along, IMHO.

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OK, I just did a search on PsycInfo for peer reviewed studies. I found many studies supporting the general principle I mentioned that long term follow-up is key, but not a lot addressing your specific question. Most studies actually seem not to identify long-term abstinence as a primary outcome variable, instead looking at various quality of life measurements like employment, criminal convictions, drug-related health problems, and the like. This fits with the idea I brought up, that this is more like diabetes than like a broken leg; it’s a chronic illness whose natural outcome is premature death, and the goal of treatment is not “cure” but amelioration of the consequences of the disease.

The Journal of Drug and Alcohol Dependence just this month published the results of a large trial (Teessen and Ross) in Australia of 745 heroin users entering a variety of forms of treatment, plus a control group of 80 users with no treatment. Depending on the kind of treatment, between 52% and 65% were abstinent a year later, compared to 25% of the treatment group. This seems high to me; I have ordered the article through interlibrary loan and will review it.

Another recent study (Darke & Williamson, Addictive Disorders and Their Treatment , v. 5 #1) looked at 100 addicts two years after enrolling in residential treatment; 72% had at least a month of abstinence at the time of followup, but only 18% had been continuously abstinent for the full two years. Again: chronic disease. Relapses common. Successful completion of the residential treatment, not surprisingly, was highly correlated with abstinence.

Jones and Wong (Drug and Alcohol Dependence v. 79 #2) tested something called Reinforcement-Based Therapy vs. usual treatment control in addicts who had just completed a short-term residential treatment. They reported generally depressing abstinence rates in the low teens for the control group at 1, 3, 6, and 12 month followups; their treatment was better, but only for the first few months.

So, it appears that the odds overall are not great, but your friend’s wife certainly seems to be having significantly worse luck than average. But as Shagnasty points out, sometimes people do get clean after multiple treatments. Let’s hope she gets it together at some point.

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Statistically, this is wrong. Given the statement “20% chance of a treatment working”, ie that every treatment has that chance irrelevant of what’s gone before, you don’t “use up your chances”. That’s like saying you have a 1/6 chance of rolling a 6 on a dice, so if you don’t roll one in your first 6 rolls you’ve used up your chances of ever doing so.

Back to the real world, of course a treatment failing may well influence the chances of the next one working, conceivably in either direction. Without doing any research I’m going to bet that if there was a treatment that worked vastly better than the others we’d all know about it by now.

I assume this should be “… 25% of the no-treatment group”?

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Thanks for the replies, and especially thanks for the research, Thing Fish. I really do want to learn more about this all, as it’s a foreign topic to me and I’m simply stunned by what I have learned about it so far. I hadn’t thought at all about the “increased quality of life” as opposed to just the problems associated with using. I kind of saw it as using=bad, not using less=not as bad.

More backstory, now that I have more time to write about it. My friend’s ex is somewhat functional. She can hold a job for about a month at a time, rarely longer than that. She doesn’t support herself, and the situation is basically that my friend can’t seem to make himself move on and take full care of himself, as a majority of his income is spent keeping her rent paid so she doesn’t end up on the street. He personifies “codependence”, but he’s a close, close friend of mine and my husband, and it really has started to get to me to see someone’s life going so badly as his. He’s written off the marriage, absolutely. The lies and affairs and everything that went with her addiction ruined that part, but he can’t seem to make himself give up giving her “just one more month” to get her act together. They have no contact except she leaves a message each month to say what the exact rent is. And my husband and I have kind of taken him on to help - we end up helping him financially, which in turn makes it possible for him to do more for her financially, and I feel kind of crummy and responsible somehow for keeping a bad cycle going. Then I feel guilty for thinking I should stop, as it’s not hurting us any to help him, and taking it away would hurt him badly.

So, several of our friends want to confront him about it all. He’s starting to fall in too deep, part with finances, part with how he’s starting to neglect himself, badly. He has two jobs, one pays better and takes up more time, and he hates. The second is moreso his calling, he loves it and wants to dedicate himself to it, but he can’t quite afford to give up job “A” for “B”, as he’s got an extra $1500/month he’s paying for what I see as an ivory tower for his ex to shoot up in. Additionally, since his life is just not at all what he wants, he’s angry a lot, and he’s becoming someone I don’t much care to be around at times. (insert how this isn’t really my problem, but I do care.) So, giving him facts, and stories, and whatever else I can garner may or may not help, but it is already making me feel a little better about it all. Of course, I want her to be OK. I did know her and she is a good person, but I care much more that HE is ok as he’s the one that’s my friend. So I need to remind myself - a lot - that I can’t fix his life any more than he could fix hers, and that I need to take care of my own self, etc. I just wish there was something I could do.

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Check out The Stanton Peele Addiction Web Site for a different view of overcoming addiction. He states:

But this fatalistic thinking about addiction doesn’t jibe with the facts. More people overcome addictions than do not. And the vast majority do so without therapy. Quitting may take several tries, and people may not stop smoking, drinking or using drugs altogether. But eventually they succeed in shaking dependence.

and

Every year, the National Survey on Drug Use and Health interviews Americans about their drug and alcohol habits. Ages 18 to 25 constitute the peak period of drug and alcohol use. In 2002, the latest year for which data are available, 22 percent of Americans between ages 18 and 25 were abusing or were dependent on a substance, versus only 3 percent of those aged 55 to 59. These data show that most people overcome their substance abuse, even though most of them do not enter treatment.

He is a very rational and pragmatic thinker in the field of addiction.

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I assume this should be “… 25% of the no-treatment group”?
[/QUOTE]

:smack: Yes, of course.

don’t ask , I agree that the statistics you cite are highly relevant to some sort of political discussion about whether the sky is going to fall due to the drug “epidemic”, but the particular person we are discussing here is clearly way over on the unfortunate side of the bell curve, and I don’t think “she’ll eventually get over it by herself” is a realistic way of looking at the situation. Also, keep in mind that although most of the decline in drug dependence between youthful and middle-aged cohorts is due to people cleaning up, a large part of it is also due to people dying!

Based on your backstory, SIC , this is a very complicated problem and I would not presume to offer any detailed advice over the Net. But clearly, your friend needs to do some individual or group work on his codependent behavior to enable him to take the steps that would clearly be in everyone’s best interest. Must go for now. Best of luck.

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Post snipped.

There is something you can do. Get your friend information on Nar-Anon meetings in your area. He really should go to those meetings. Nar-anon, and Al-anon, help families and friends of addicts deal with the addiction. They provide guidence and support and they know what it is like.

Your friend, by paying his ex-wifes rent, is enabling his ex-wifes addiction. It isn’t helping her at all. All he is doing by paying her rent is allowing her to continue with her addiction with a free place to live. It is making it easier for her to use.

When I was an active alcoholic, my family supported me by paying rent for a while. This was the worst thing they could have done. They did not know any better at the time, they were trying to help. Their help just made it easier for me to drink. They finally cut me off. They said that they would help me find a halfway house but they would not do anything else. It was the right thing to do. I had a choice, either be homeless with all that entails or going into a halfway house. I chose to do the halfway house (rather reluctantly). The halfway house and AA worked for me.

Some people will choose the addiction over everything else. There is nothing anyone can do about that. It is the addicts choice. All that friends and family can do is to offer the person help in getting into some sort of recovery program. Note, this does not mean to pay for everything. If the addict cannot afford a treatment program, then the addict needs to find a halfway house. Providing any thing more than that is jst enabling the addict to continue using.

Slee