Prognosis of Addictive Disorders

In general, although there are exceptions, such as spontaneous remissions in which drug use disappears without the intervention of health professionals, addictions tend to have a recurrent or cyclic evolution. In other words, periods of less controlled consumption alternate with more or less prolonged periods in which consumption is abandoned (abstinence), followed by substance use relapse. It is, however, possible to break this cycle.

With repeated intoxication, the environmental stimuli associated with substance use (such as the places or people the patient has taken the drug with, or emotional states associated with its consumption) also end up generating cravings, drug-taking behaviour, or the use of large quantities of drugs. These responses become deeply rooted and may continue to provoke an intense desire for the drug long after the person has stopped taking it.

On the other hand, in addiction, consuming the same substance no longer has the euphoric characteristics that it had at the beginning. Also, everyday stimuli (such as interpersonal relationships or activities) that were previously satisfying, no longer seem as attractive when there is an addiction. The brain’s continuous exposure to drugs also means that when the direct effects of the substance disappear, or the substance is removed, the person may enter a state of intense emotional distress. People who have an addiction may, therefore, not only abandon interpersonal relationships and other daily activities that were previously important to focus all their behaviour on drug use, but go from using drugs for their pleasurable effects to using them to temporarily alleviate discomfort.

Drug-induced intoxication can lead to behavioural alterations (with the possibility of injuring oneself or others) and accidents (traffic, machinery, overdose). Continued consumption can also lead to other medical problems such as:

• damage to cognitive functions (such as memory, attention, planning). This in turn diminishes the person’s abilities to stop taking the substance. In many cases, abstinence from consumption and cognitive rehabilitation therapies can reset brain functions.
• Addictions often coincide with other mental disorders such as depression, schizophrenia, or bipolar disorder. Patients with these comorbidities often have more severe disorders and treatment resistance. In these cases, the disorder must be approached in a comprehensive way.
• Drug users are at risk of acquiring infectious diseases when they share materials with other people or have unprotected sex.
• Substance use in pregnant women can affect the proper development of the baby.

In the social and personal sphere, the situation may become extreme and social bonds can be broken. At work and from a financial perspective, repeated consumption can lead to excessive risk taking and overspending; it may require sick leave and lead to reduced performance and productivity. In addition, unfortunately, there is still stigma surrounding mental illness. This means that at least in some settings the person cannot speak naturally about their illness, and they may even feel it is a topic that should be concealed.

It should be remembered that repeated consumption also affects executive functions, in other words, those that enable self-regulation, decision making, and the planning of possible consequences. This means that when a person is addicted, it is difficult for them to resist the desire to use or maintain their decision to abstain, despite the associated consequences.

While in some cases addiction can have irreversible consequences, the process can often be stopped before this happens. In general, interrupting the cycle, this is, treating the addiction, is usually aimed at achieving abstinence from the substance and maintaining this over time.

This process involves a first stage of detoxification in which drug use is interrupted. When an addicted brain ceases to be exposed to the continuing effects of the substance, a series of unpleasant consequences often occur. These are known as abstinence syndrome, or withdrawal symptoms. Although the specific characteristics of this syndrome vary depending on the substance that has generated the addiction, they generally include distress, intense physical and emotional discomfort, and a desire to use. This stage may require medical treatment (depending on the case this will be either on an outpatient or inpatient basis) both to alleviate the symptoms and to ensure that the person’s life is not at risk.

A second stage, which is usually longer and known as detoxification or cessation of use, consists of implementing strategies that facilitate better functioning in social situations, as well as in family and work environments, without the continued use of the substance.

Any process of change, such as abandoning an addiction, is considered a cyclic process in which the person goes through a series of stages, ranging from the stage where change is planned, through the moment in which the pros and cons of change are considered, to the phases in which the patient takes action to achieve and maintain abstinence.

This process often involves ambivalence (conflicting feelings against something, in this case abandoning addiction, which the patient simultaneously wants to change and does not want to change), which can, for a significant period of time, stop the person from completely abandoning the behaviour and habits related to the consumption.

Indeed, relapse, which is the return to an earlier stage, forms part of this cycle of change. For this reason, in many cases, relapses are part of the process of abandoning an addiction. Prior relapses do not, therefore, mean that abstinence cannot be achieved and clinical stability sustained.