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

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.

The Role of Alcoholics' Insight in Abstinence from Alcohol in Male Korean Alcohol Dependents

This study was performed to examine the relationship between the abstinence results of alcohol dependents after discharge and the level of insight at the time of discharge. 117 male Korean alcohol dependents discharged from a community-based alcohol treatment center were followed up to determine the initial months of abstinence on a successive basis (IMA), total months of abstinence during 12-month period (TMA), and complete abstinence for one full year after discharge. Analyses of abstinence results with adjustment for the differences in baseline characteristics were performed for subjects' insight levels (poor, fair and good). The mean IMA of patients with good insight was significantly (p<0.01) longer than that of patients with poor insight and TMA of patients with good insight was significantly (p<0.001) longer than that of others. Using patients with good insight as the reference, patients with poor insight showed an adjusted odds ratio (OR) of 0.07 (95% confidence interval [CI]=0.01-0.75, p<0.05) for complete abstinence for one full year after discharge and patients with fair insight, adjusted OR of 0.17 (95% CI=0.03-0.81, p<0.05). These results suggest that alcohol dependents' insight could be regarded as a factor related with abstinence.