Factors associated with relapse among clients in Australian substance disorder treatment facilities

Perceived effectiveness of therapeutic community model as a rehabilitation approach for Sri Lankan individuals with substance use disorder

Purpose

This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use disorder (SUD).

Design/methodology/approach

A descriptive cross-sectional study was carried out in two selected residential treatment centers which follow the TC model as a rehabilitation approach. All the clients of the selected residential treatment centers were invited to take part in the study and data were collected from 75 consented male participants using an interviewer-administered questionnaire. The perceived effectiveness of the residential treatment was assessed using the Treatment Effectiveness Assessment instrument. Data were analyzed using descriptive statistics.

Findings

Most of the participants were Sinhalese (98.7%, n = 74) with a mean age of 27.0 ± 6.0 years. The average duration in which participants stayed at selected centers was 8.0 ± 4.0 months. Most of the participants reported that the encouragement during the program was sufficient (89.3%, n = 67), psychological support was satisfactory (89.3%, n = 67), freedom (69.5%, n = 52) and facilities were adequate (76.0%, n = 57) within the program. A higher proportion of participants said that the counselors and program guides were friendly (80.0%, n = 60), and participants were allowed to communicate with their family with restrictions (92.0%, n = 69). The mean perceived effectiveness score (score range 1–40) was 34.0 ± 7.0 and the four domain scores (score range 1–10) were substance use (9.0 ± 2.0), health (8.0 ± 2.0), lifestyle (9.0 ± 2.0) and community (9.0 ± 2.0). The majority (88.0%, n = 66) of the participants perceived a high level of treatment effectiveness.

Originality/value

There is a paucity of empirical evidence on effectiveness of TC model for individuals with SUD in South Asian countries including Sri Lanka. The findings of this study highlight that the participants perceived higher effectiveness of the residential treatment which follows the TC approach for Sri Lankan individuals with SUD.

Risk factors for relapse among methamphetamine users receiving a joint legal-medical treatment program as a diversion intervention: A one-year follow-up study

BACKGROUND

Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal-medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown.

METHODS

We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse.

RESULTS

Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61-5.68] and 1.71 [1.19-2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts.

CONCLUSIONS

Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program.

When Triggers Become Tigers: Taming the Autonomic Nervous System via Sensory Support System Modulation

Personalized recovery technologies may enable individuals with Substance Use Disorder (SUD) to monitor and manage acute craving and drug use urges in ways that improve drug-seeking decisions in real-time. Direct and indirect regulation of the autonomic nervous system through sensory input monitoring and modulation may enhance control over behavioral decisions and prevent relapse. A personalized sensory support system that monitors neurophysiological reactivity and offers non-pharmacological point-in-time personalized digital interventions may increase awareness of and control over craving reactivity. It is critical to be able to detect these warning signs and intervene early and effectively. The use of wearable technologies that assess point-in-time neurophysiological escalation and shape behavioral response through personalized interventions could be transformative in allowing individuals to better manage their recovery as they transition out of institutions and move back into community settings.

The phenotype of recovery V: Does delay discounting predict the perceived risk of relapse among individuals in recovery from alcohol and drug use disorders

BACKGROUND

Substance use recovery is a dynamic process. Relapse, often part of the recovery process, is a persistent problem for individuals seeking freedom from their harmful substance use and has become a focus of research on the improvement of recovery outcomes. Delay discounting is associated with substance use disorder severity, both its negative outcomes and the propensity to relapse. However, the association between delay discounting and perceived risk of relapse as measured by the Alcohol Warning of Relapse Questionnaire has not previously been examined in a population of individuals in long-term recovery from substance misuse.

METHODS

In this study, using data collected from the International Quit and Recovery Registry, we investigated the association between delay discounting, self-reported time in recovery, and perceived risk of relapse. Data from 193 individuals self-reporting to be in recovery from harmful substance use were included in the study.

RESULTS

Delay discounting rates were significantly negatively associated with length of recovery (p = 0.036) and positively with perceived risk of relapse (p = 0.027) even after controlling for age, gender, education, marital status, ethnicity, race, primary substance, and length in the registry. Moreover, a mediation analysis using Hayes' methods revealed that the association between the length of recovery and perceived relapse risk was partially mediated by delay discounting, accounting for 21.2% of the effect.

CONCLUSIONS

Our finding supports previous characterizations of delay discounting as a candidate behavioral marker of substance misuse and may help to identify individuals at higher perceived risk of relapse in an extended recovery population.

Correlates of Expressed Emotion Among Family Members of Individuals Who Sought Treatment for Opioid Use

Expressed emotion has been robustly associated with negative mental health outcomes. Understanding correlates of expressed emotion by family members of individuals with opioid use disorder is important, as this group faces high levels of stress and can play an important role in their loved ones' treatment. Thus, immediate family members of individuals who sought treatment for opioid problems (N = 195) completed a web-based survey that included measures of expressed emotion, self-stigma, social support, and demographic characteristics. Multiple linear regression analyses were conducted to examine correlates of two types of expressed emotion-criticism and emotional overinvolvement. Results indicated that higher self-stigma and lower social support were significantly associated with higher emotional overinvolvement. Higher self-stigma and having experienced debt related to a family member's opioid use were associated with higher criticism. Thus, self-stigma and financial burden may exacerbate likelihood of expressed emotion, whereas social support may buffer against expressed emotion.

Methadone-Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness

BACKGROUND AND OBJECTIVES

Treatment guidelines emphasize patients' readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined.

METHODS

Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone-assisted withdrawal in all settings. Time 2 (T2) was a 6-month follow-up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered.

RESULTS

At T1, inpatients had higher self-efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self-efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes.

DISCUSSION AND CONCLUSIONS

Self-efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research.

SCIENTIFIC SIGNIFICANCE

These findings advance existing literature and knowledge by highlighting the importance of self-efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users. (© 2020 The Authors. The American Journal on Addictions published by Wiley Periodicals LLC on behalf of The American Academy of Addiction Psychiatry). (Am J Addict 2021;30:11-20).

Alcohol use disorder relapse factors: A systematic review

A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.

Intrinsic Motivation and Psychological Connectedness to Drug Abuse and Rehabilitation: The Perspective of Self-Determination

This study adopts the perspective of the Self-Determination Theory to look at the psychological experience of drug users and their decisions to take drugs or not, with particular emphasis on the concept of relatedness. To achieve this objective, a qualitative methodology was employed to explore the experiences of these drug users regarding how they take drugs and/or relapse. Theory-driven thematic analysis was employed to identify themes related to this topic. Results show that one’s psychological need for relatedness is an important determinant of whether one will take drugs or not, via the interaction mechanisms that exist in dimensions of affiliation and intimacy. While drug taking is a result of the modeling behavior existing in affiliated relationships, it is also a coping strategy for the ultimate satisfaction of psychological needs when human relatedness disappears. The implication is that significant others can develop unconditionally warm, caring, and empathetic supportive relationships with drug users, so as to enhance their fulfillment of psychological needs and reduce the risk of drug relapse.

Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients

AIMS

To identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme. Design, participants, setting: Prospective follow-up study of consecutive detoxified opioid dependent patients treated in a specialist inpatient drug dependency unit.

MEASUREMENTS

The Maudsley Addiction Profile and a structured interview were administered to 109 patients, 18-36 months after discharge.

FINDINGS

Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%).

CONCLUSIONS

Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.