Variety in Alcohol Use Disorder Relapse Definitions: Should the Term "Relapse" Be Abandoned?

OBJECTIVE: The definition of relapse has been the subject of debate for decades, and a semantic ambiguity highlighted in a 2016 article in the Journal of Studies on Alcohol and Drugs remains. The current article replicates and extends the 2016 findings on alcohol use disorder (AUD) relapse definitions. METHOD: We conducted a systematic review of 321 articles that examined relapse in patients with AUD, published from 2000 to 2019. Relapse definitions were extracted and a narrative review of definitions was conducted. RESULTS: One hundred and one different definitions of relapse were used in 251 (78%) of the reviewed articles. In 70 (22%) of articles, no definition of AUD relapse was provided. Fifty-three articles used diagnostic criteria (i.e., alcohol use after remission of AUD), whereas 99 articles defined relapse as "any alcohol use" or "any use of alcohol/drugs." Additional articles defined relapse by alcohol outcomes (e.g., percent drinking days), alcohol-related problems, or hospitalizations (n = 97). Only 12 articles described the time window of abstinence preceding a relapse. We observed relatively no meaningful intercontinental or time-related differences in relapse definitions, although the outcome "percent heavy drinking days" was used more frequently in recent studies. CONCLUSIONS: A wide variety of relapse definitions were identified. Despite decades of research and discussion, there is still no widely accepted consensus definition of AUD relapse. We propose to shift the focus toward clinical continuous outcomes, course specifiers based on the number of AUD symptoms present, and quality-of-life-related criteria instead of using current dichotomous AUD relapse terminology.

The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review.

AIM: Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. METHODS: A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of 'trait impulsivity'-typically measured by self-report questionnaires-and 'behavioural impulsivity', i.e. 'motor impulsivity', 'impulsive choice' and 'reflection impulsivity, assessed with cognitive-behavioural tasks. RESULTS: Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of 'trait impulsivity', and nine studies included 'behavioural impulsivity' measures, from which five studies dealt with the 'impulsive choice' subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. CONCLUSIONS: All three included facets of impulsivity ('trait-, motor- and impulsive choice impulsivity') were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.

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.