Our findings on predictors of relapse suggest that risk for relapse in remitted individuals becomes lower over time. Of note, we did not find that predictors of relapse differed for the non-problem users (versus abstainers). Overall, the lack of unique predictors for non-problem users suggests that among those treated in abstinence-oriented treatment, there may be no need to develop different treatment approaches for such individuals’ long term care, and that 12-step and longer initial treatments could be beneficial for them as well. Moreover, even if a subgroup of patients can resume non-problematic use, clinicians are not able to easily identify them in advance. Abstinence as a goal at the very least allows patients to choose something that may be unattainable over the longer term but encourages efforts that would not otherwise be present. Thus, the number of relapsers may have been even higher if abstinence was minimized as a desirable endpoint. The results also suggest that treatment retention and 12-step participation are prognostic markers of long-term positive outcomes for those who achieve remission at 1 year.
