Functional impairment during sustained remission from a substance use disorder: A cross-sectional population study

Remission from substance use disorders (SUD) is typically associated with improved quality of life and daily functioning. However, it is unclear whether people in long-term remission continue to experience heightened rates of daily functional impairment compared to people without prior SUD.

1) To test whether functional impairment, measured with the World Health Organization Disability Assessment Schedule (WHODAS), is higher for people in long-term SUD remission than people with no lifetime SUD, and 2) to estimate degree of impairment attributable to remitted SUD per se vs. other causes.

Probability sample of U.S. adults in sustained SUD remission (n = 9,295) or with no lifetime SUD (n = 92,228) drawn from the National Survey of Drug Use and Health (NSDUH).

Total impairment was compared between groups with t-tests of unadjusted WHODAS. Degree of impairment related to long-term remission itself vs. current severe psychological distress, social determinants of health, and recent substance use was evaluated with hierarchical generalized linear models and follow-up sensitivity analyses.

People in the remitted sample had higher average WHODAS impairment scores than those who had never experienced SUD (5.14 vs. 3.32) and were less likely to report experiencing no impairment (33.3% v 52.0%). Prior-year psychological distress and mental health treatment accounted for 40% of variance in functional impairment, compared to 2% variance explained by remission itself. Greater impairment among remitted people was also strongly associated with younger age and female sex.

People in long-term remission are more likely to experience difficulty with daily functioning than people with no lifetime SUD. Impairment is more strongly related to acute psychological distress than residual effects of SUD per se for people with at least one year of recovery. Future work should examine approaches to reducing psychological distress in this large but frequently overlooked population, which may include mental health treatment, informal social support, or interventions to increase recovery capital.