Remission from drug dependence symptoms and drug use cessation among women drug users in Puerto Rico

BACKGROUND: Studies of remission from drug dependence have most often been based on treatment samples, with limited generalizability to persons who may benefit from but never seek substance abuse treatment. Little is known about remission patterns among drug users in the community. OBJECTIVE: To identify patterns and predictors of remission in a community sample of drug users followed up prospectively. DESIGN: Three waves of data on a range of individual and interpersonal correlates of drug abuse and health care service use were collected between April 1997 and October 2000. SETTING: Areas of metropolitan San Juan where drug sales were known to occur. PARTICIPANTS: Two hundred seventy-five women aged 18 to 35 who were crack cocaine or injecting drug users. MAIN OUTCOME MEASURES: Self-reported drug use validated with urine screens and drug use dependence criteria based on the DSM-IV. RESULTS: Most (86.9%) of the women were drug dependent at baseline. By wave 3, fewer than half (42.6%) of the women were dependent, 13.8% had subthreshold disorder, and 17.8% used substances but did not endorse any dependence criteria. Cessation of use and decreases in the number of dependence criteria endorsed were significantly less likely for women with depressive symptoms (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.88-0.96; and OR, 0.88; 95% CI, 0.86-0.90; respectively), with a partner who engaged in criminal activities (OR, 0.30; 95% CI, 0.16-0.58; and OR, 0.63; 95% CI, 0.46-0.85; respectively), and who traded sex for money or drugs (OR, 0.12; 95% CI, 0.05-0.29; and OR, 0.26; 95% CI, 0.19-0.35; respectively). CONCLUSIONS: Drug use patterns and rates of dependence fluctuated substantially over time among drug users recruited from the community. Findings regarding the characteristics that impede remission suggest that mental health practitioners have an important role to play in community-based outreach and interventions designed to support women's efforts to stop using drugs.