Conceptual, methodological, and analytical issues in the study of relapse (original) (raw)

Conceptualizations of relapse: a summary of psychological and psychobiological models

Addiction, 1996

While suhstance use disorders have long been recognized as chronic relapsing conditions, it has mainly been in the last two decades that clinical researchers have been systematically attending to the nature and processes of relapse. These efforts have led to the development of a variety of psychological and psychobiological models of relapse. These models are summarized in the present article, with particular attention placed on each model's basic principles and on the predpitants of relapse predicted by the respective models. The delineation of these models may help facilitate subsequent cross-referencing and cross-fertilization of thinking in this important area.

Relapse in the addictive behaviors: Integration and future directions

Clinical Psychology Review, 2006

This paper identifies the major consistencies in substantive and methodological findings across the review papers in this special issue on relapse in the addictive behaviors. The papers were consistent in suggesting that there have been major methodological advances which have helped to move the field forward. Furthermore, the papers show the need for taking a biopsychosocial approach to the study of relapse and the major difficulty across addictive behaviors in creating an acceptable operational definition of relapse. Suggestions for future research directions that follow from the papers include deriving and evaluating relapse definitions, systematically developing and testing models and theories of relapse, and understanding and narrowing the relapse research-clinical practice gap. D

The validity of the reinstatement model of craving and relapse to drug use

Psychopharmacology, 2003

Rationale: The reinstatement procedure has been used increasingly as a laboratory model of craving and relapse to drug abuse. With the number of reports involving this procedure growing, its validity as a model of relapse merits discussion. Objectives: The present commentary addresses the validity of the reinstatement procedure in relation to the following three types of models: 1) formal equivalence models, which are assessed on the basis of how well they resemble some phenomenon outside the laboratory (i.e. face validity); 2) correlational models, which are assessed on the basis of how well they predict outcomes of various interventions (such as drug administration or environmental change) when effected outside the laboratory (i.e. predictive validity); and 3) functional equivalence models, which are assessed on the basis of whether the laboratory phenomenon is mechanistically identical or reasonably similar to the phenomenon outside the laboratory (i.e. content validity). Methods: In order to evaluate the reinstatement model, we briefly examined its various forms and uses, and compared preclinical outcomes to what is known about relapse from the clinical literature. Results: In its most general form, the reinstatement model has reasonable face validity; that is, there is a general agreement in appearance or form of the behavior in the model and the clinical target, relapse. This face validity is generally absent for the procedure when it is used as a model of craving. The predictive validity of the model has not been established. Evidence from studies of treatments for drug relapse have not supported the validity of the model, however from studies of the effects of the presentation of various types of stimuli (e.g. drug "priming") there is mixed evidence supporting predictive validity. With regard to functional equivalence, there is reasonable evidence supporting functional commonalities between drug self-administration in laboratory animals and human drug abusers, which lends support to the validity of the reinstatement model. However, there are several specific areas of departure between the methods and results using the model and clinical practices and observations about relapse, suggesting a lack of functional equivalence. Conclusions: There is reasonable evidence to support the face validity of the model, but at this time, neither its predictive validity nor functional equivalence has been fully established, which underscores the need for caution in generalizing results from the model to the clinical condition.

Relapse Precipitants in Addictions

Journal of Addictive Diseases, 2007

In this paper, a study examining high-risk situations for relapse is presented. The sample consisted of 72 participants (51 male and 21 female) who had relapsed after having received a residential psychological treatment for drug addition in a therapeutic community in Spain. In order to analyze what personal, environmental or social factors were the most immediate triggers of relapse, a personal interview, using the Relapse Interview, was administered to each one of the relapsed patients. Results showed that most of the relapses took place during the first year after completing the treatment program. Likewise, the factors most frequently cited for relapse were the following: to cope with negative emotional states (49.5%), to be unable to resist temptations or impulses to consume (17.5%), to test personal control (10.3%) and to cope with interpersonal conflicts (9.3%). Results indicate that most factors were of an intrapersonal nature. Implications of these results for further research and clinical practice are commented upon.

Psychosocial factors associated with relapse in men with alcohol or opioid dependence

Indian Journal of Medical Research 2009; 130, 702-708.

Background & objectives: Relapse is a common and distressing aspect of substance dependence mediated by several biological and psychosocial factors. This study examined the association between demographic variables, clinical parameters and certain psychosocial factors and relapse among patients with either alcohol or opioid dependence. Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, coping strategies, self-efficacy, stressful life events and perceived social support were carried out among patients with alcohol/opoid dependence (n=30) who had relapsed and compared with those (n=30) who had managed to remain abstinent. Similar comparisons were also carried out between relapsed and abstinent patients in the individual subgroups of alcohol and opioid dependence. Results: Patients who had relapsed were significantly more likely (i) to have a positive family history of substance use and higher number of previous relapses; (ii) to be using maladaptive coping strategies; (iii) to have been exposed to a higher total number of ‘high risk’ situations; and (iv) have experienced a higher number of undesirable life events. Those who had remained abstinent tended to use significantly more number of coping strategies, principally adaptive ones and scored significantly higher on all measures of self-efficacy. Factors influencing relapse appeared to be largely similar among patients with alcohol and opioid dependence. Interpretation & conclusions: This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It extended these results to substances other than alcohol and provides the basis for investigating correlates of relapse in a wide range of behavioural and substance use problems.

SYSTEMATIC APPRAISAL OF SUBSTANCE ABUSE THEORIES AND MODELS OF RELAPSE PREVENTION

African Journal of Social and Behavioural Science. 14(4), 2024

Substance use disorder is recognized as a chronic, relapsing condition, with a significant percentage of individuals experiencing relapse within one year of treatment. Understanding the intricate factors contributing to relapse is paramount for developing effective prevention and intervention strategies. Various theoretical frameworks offer insights into addiction relapse, shedding light on its underlying mechanisms. Social learning theory underscores the influence of observational learning, modelling behaviours, and reinforcement on addictive behaviours, advocating for tailored interventions to enhance relapse prevention. Marlatt and Gordon's Relapse Prevention (RP) Model targets cognitive processes and behavioural strategies, offering a comprehensive approach that is effective for overcoming addiction, despite its complexity. The transtheoretical model (TTM) provides a dynamic framework, tailoring interventions to an individual's stage of change and emphasizing longterm behaviour maintenance. The biopsychosocial model considers biological, psychological, and social factors and advocates for a holistic and individualized approach to relapse prevention. While these models share the need for tailored interventions and recognition of relapse complexity, they differ in their emphasis and application, highlighting the necessity of integrating multiple perspectives for a comprehensive understanding of addictive behaviours and relapse prevention. Therefore, it is recommended that clinicians and experts in the field of substance abuse employ multiple perspectives in approaching substance abuse relapse interventions.

Predictor Factor on Relapse among Former Addicts

International Journal of Academic Research in Business and Social Sciences

The inclination to relapse among drug addicts is related to the desire of former addicts to relapse drugs after the end of their treatment and rehabilitation process. Identifying the predictor factor for the inclination to relapse among former addicts could not only prevent relapse, but also recognise the largest influence in their lives that contribute to their relapse. This study uses the questionnaires of the Inventory of Drug-Taking Situations, General Self Efficacy, Coping Strategy and Social Provisions Scale. The findings show there are six identifiable significant predictor variables and the main contributors to the inclination to relapse; problem-focused coping, emotion-focused coping, avoidance coping, self-efficacy, family support, and peer support towards the inclination to relapse. Based on the results, it could be concluded that these six predictor variables have been identified as significant and the main contributors to the inclination to relapse. The findings also found self-efficacy to have a significant effect on the inclination to relapse. This study could indirectly aid the government in their efforts to overcome the drug problem, and benefit the affected parties in formulating various rehabilitation and prevention programmes for former addicts, as failure to solve this problem not only threatens the lives of individuals, but also the national social and economic development.

The reinstatement model of drug relapse: history, methodology and major findings

Psychopharmacology, 2003

Rational and objectives: The reinstatement model is currently used in many laboratories to investigate mechanisms underlying relapse to drug seeking. Here, we review briefly the history of the model and describe the different procedures that have been used to study the phenomenon of reinstatement of drug seeking. The results from studies using pharmacological and neuroanatomical techniques to determine the neuronal events that mediate reinstatement of heroin, cocaine and alcohol seeking by acute priming injections of drugs, drug-associated cues and environmental stressors are summarized. In addition, several issues are discussed, including (1) the concordance between the neuronal mechanisms involved in drug-induced reinstatement and those involved in drug reward and discrimination, (2) the role of drug withdrawal states and periods in reinstatement of drug seeking, (3) the role of neuronal adaptations induced by exposure to drugs in relapse, and (4) the degree to which the rat reinstatement model provides a suitable preclinical model of relapse to drug taking. Conclusions: The data derived from studies using the reinstatement model suggest that the neuronal events that mediate drug-, cue-and stress-induced reinstatement of drug seeking are not identical, that the mechanisms underlying drug-induced reinstatement are to some degree different from those mediating drug discrimination or reward, and that the duration of the withdrawal period following cocaine and heroin self-administration has a profound effect on reinstatement induced by drug cues and stress. Finally, there appears to be a good correspondence between the events that induce reinstatement in laboratory animals and those that provoke relapse in humans.