A November 2021 study published in Clinical Psychology Review has tentatively concluded—after analyzing the results of nearly 100 studies published over the past 46 years—that a concurrent recovery model, when contrasted with “addiction substitution” (a.k.a., addiction replacement), provides the best overall treatment results.
The study’s authors define addiction substitution as “the practice of increasing the use of one addictive substance while recovering from another.”
A range of examples were cited from among the studies reviewed, including replacing alcohol abuse with gambling or increasing one’s use of alcohol when seeking to recover from heroin.
Specifically, the researchers sought to conduct a systematic review to analyze data about addiction substitution during recovery from substance use disorders or behavioral addictions. Due to the current amount of inconsistent terminology and mixed results from existing research, they said such a review was necessary.
Working in conjunction with a systematic review expert and relying upon PsycINFO, the researchers utilized data from Medline, CINAHL and Embase databases. The study’s authors analyzed data from research papers published between 1975 and May 2021. Once they’d applied inclusion and exclusion criteria, their review ultimately included 96 articles.
To provide a clear picture of how addiction substitution has manifested in one of today’s most challenging drug problems in the U.S.—the opioid and opiates epidemic—the researchers cited the results of 29 studies focusing on opioid abuse. Eleven of those studies mentioned concurrent recovery was part of the treatment protocol, and that “alcohol, nicotine, cannabis and other drug use decreased during opioid recovery.”
Their data analysis showed that addiction substitution occurred in 20% of the 20 research papers investigating cannabis abuse. In 30% of the cannabis abuse studies, concurrent recovery was reported
While those studies that looked for predictors of addiction substitution did not find race to be a factor, the tendency towards substitution occurred more frequently in younger males.
The research team concludes the results of their review provide “preliminary support for a concurrent model of recovery. The subgroup of individuals who do engage in substitution is likely to experience worse treatment outcomes. Given that people are more likely to engage in multiple addictions, it would be important to identify and enhance factors that will prevent addiction substitution and facilitate concurrent recovery.”
The primary limitations acknowledged by the study’s authors include:
- Inconsistent terminology may have impacted the effectiveness of the review; and,
- Most of the studies consisted of individuals seeking treatment; therefore, the review may not generalize to the broader population of people recovering from an addiction.
Although the research review pointed overall to a general support for a concurrent model of recovery, they emphasized that the number of people who engaged in harmful addiction substitution was “not inconsequential, given that increasing other addictions during recovery was associated with worse treatment outcomes.”
The study’s authors followed up their findings by indicating more research focused on examining characteristics and processes of addiction substitution, in addition to concurrent recovery, will likely “help in the development of more effective treatments for addictions and decrease the likelihood of engaging in addiction substitution.”
Given the widespread damaging effects drug and alcohol addiction have had in recent years, as well as their increase in many parts of the country, this study may prove to be a timely call to policymakers and professionals in the field of addiction medicine and treatment.
 Hyoun, Kim S., et al. “A Systematic Review of Addiction Substitution in Recovery: Clinical Lore or Empirically Based?” Clinical Psychology Review, Volume 89, Nov. 2021.