CHAMPAIGN, Ill. — A new study by researchers at the University of Illinois Urbana-Champaign highlights the importance of considering both psychosocial and genetic factors in patients’ prognoses and intervention planning in their recovery from substance use disorders.
The study is novel in that it integrated multiple forms of data — including genetic data on heritable risk factors and statistics on the various psychosocial resources available to support individuals’ recovery — to analyze 7,200 U.S. adults’ probability of remission and relapse, said first author Janaka V. Kosgolla, a research scientist in the School of Social Work ’s Center for Prevention Research and Development .
Kosgolla, who co-wrote the paper with the center’s director, Douglas C. Smith , used a data set from the National Institutes of Health All of Us Research Program that contained information on adults ages 18 or older who were treated for substance use problems between December 2020 and October 2023. Eligible participants were identified from diagnoses, toxicology measurements, medications and treatment procedures for those with substance use problems other than nicotine, according to the study, published in the journal Addiction .
Addiction is a complex biological process, with individuals’ risk increased by interactions among hereditary genetic variations and environmental factors, according to a news release on the National Institutes of Health website. The current study is one of a few projects that integrated patients’ genetic liability with recovery capital resources to measure an individual’s probability of remission and relapse over time.
“Recovery capital is conceptualized as all the resources that you need to stay sober,” said Smith, who is also a professor of social work at Illinois. “These resources include things such as employment, adequate housing, good mental health and access to transportation, along with adequate numbers of treatment facilities and support groups at the community level.”
Using factors such as these and patient survey data from the All of Us dataset, the researchers constructed a recovery capital index with 21 items that spanned human, physical, social and cultural resources. They also created a genetic liability measure that included nearly 585,000 genetic variants and 10 adjusted ancestry-related traits that they used to evaluate the impact of recovery capital on remission at low, medium and high levels of genetic risk, Smith said.
Remission in a given month was considered to be either a related diagnostic code or negative toxicology result in patients’ electronic health records, and remission episodes were contiguous runs of months in remission. On the other hand, active substance use was based upon either a positive toxicology result or a substance use diagnosis without a remission qualifier, according to the study.
Of 7,257 participants, 2,413 people had at least one documented remission episode during the time period studied. Alcohol (33.6%) and opioid use disorders (38%) accounted for the majority of the remission episodes, while cannabis use disorder represented only 1.9% of remissions, the researchers found.
According to the patient records in the sample, individuals’ documented substance use history was 3.67 years on average, and they had an average of four substance-use-related records during the prior year.
While the researchers found that higher recovery capital was associated with more favorable outcomes for remission projections across most of the sample, the size of the advantage varied according to their level of genetic liability.
“What we found was a nonlinear relationship between patients’ genetic risk factors and their recovery capital,” Smith said. “The lowest probability of remission at 12 months was concentrated among people who were in the low-to-middle range of the recovery capital index and the middle-to-high range of the genetic risk factors index. Whereas patients with the highest probability of remission were those with high recovery capital and low genetic risk scores.”
Higher recovery capital with low genetic risk increased the probability of remission at 12 months by 8-11 percentage points, Kosgolla said.
“The recovery capital conveys meaningful information across most of the genetic range, and by integrating genetic data with psychosocial recovery resources this study provides a more holistic clinical assessment of patients,” Kosgolla said. “The findings suggest that individuals’ remission trajectories are jointly influenced by the recovery resources available to them and their genetic liability. This pattern conveys that there are complex interactions, with an overlap of social and biological factors, highlighting the importance of considering both types of factors in substance use disorder prognosis and planning.”
When individuals in recovery have multiple vulnerabilities, factors such as housing stability, social support, daily structure and coping resources are particularly important, the researchers said.
“People generally think that those with addictions are untreatable because addiction is so stigmatized and often is not viewed as a chronic relapsing health condition like heart disease or diabetes,” Smith said. “But in this study, we’re showing that given the right resources, people at high genetic risk with a family history of addiction can and do go into remission and recover. I think this paper provides a hopeful message.”
Addiction
Data/statistical analysis
People
Joint associations of recovery capital and polygenic risk with electronic health record observed remission and relapse in substance use disorder: Longitudinal evidence from the All of Us research program
16-Aug-2026
The authors declare no conflicts of interest.