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The Course of Substance Use Disorders

Trajectories, Endpoints, and Predictors CHRISTINE TIMKO, RUDOLF H. MOOS, AND JOHN W. FINNEY


Worldwide, 76.3 million people have alcohol use disorders (AUDs), and 15.3 million have other drug use disorders (WHO, 2009). These substance use disorders (SUDs) have harmful effects on individuals’ health and safety and are a significant drain on the global economy. For example, excessive drinking in the United States alone costs $223 billion annually,1 and illicit drug use costs $193 billion2 in lost productivity, health care expenses, law enforcement, and criminal costs. Understanding the course of substance use problems is critical to promoting early intervention and treatment and reducing the devastating impact of SUDs and their high costs.

Patterns of lifetime substance use and related problems are heterogeneous.3 Many people experiment with substances and then quit, but some become frequent users, and a subset of those become problematic or dependent users. The research reviewed here provides a perspective on the varied courses of SUDs. We address the course and long-term outcomes for individuals with SUDs and examine whether people who are stably remitted function as well as individuals who never had a SUD. Next, we examine the connection between SUDs and mortality and the extent to which treatment and remission reduce the risk of premature mortality. Finally, we describe the effects of personal and environmental factors on course transitions of remission, resolution, and relapse.

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