Printer Friendly

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

Substance dependence is a major problem worldwide, India being no exception. Although short-term treatment of this condition is quite effective, preventing relapse often proves to be far more challenging. A majority of such patients relapse within a year of starting treatment, with the first three months being the most vulnerable period (1). Relapse can be a frustrating experience and usually has several adverse consequences for patients, caregivers and therapists.

Relapse is a complex and dynamic phenomenon that appears to be determined by both neurobiological neu·ro·bi·ol·o·gy  
n.
The biological study of the nervous system or any part of it.



neuro·bi
 and psychosocial processes. In the recent past, there has been an increasing focus on gene-environment interactions in the genesis of relapse (2). Studies on humans and animal models have also indicated the role of dysfunctional brain areas and circuits, changes in neurotransmitters such as dopamine dopamine (dōp`əmēn), one of the intermediate substances in the biosynthesis of epinephrine and norepinephrine. See catecholamine.
dopamine

One of the catecholamines, widely distributed in the central nervous system.
 or gamma aminobutyric acid Noun 1. gamma aminobutyric acid - an amino acid that is found in the central nervous system; acts as an inhibitory neurotransmitter
GABA

amino acid, aminoalkanoic acid - organic compounds containing an amino group and a carboxylic acid group; "proteins are
, disturbances in hypothalamo-pituitary-adrenal axis, and the enduring biological effects of chronic drug exposure as key mediators of relapse. Altered neural responsiveness is proposed to impair the central nervous system's ability to mount an appropriate response to environmental stressors, heightening the probability of relapse. These theories thus place particular emphasis on biological changes and their interactions with psychosocial factors in perpetuating the vulnerability to relapse (3-5).

In one of the most influential social-cognitive-behavioural models proposed by Marlatt (6,7), relapse has been viewed as an unfolding process in which resumption of substance use is the last event in a long sequence of maladaptive Maladaptive
Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.

Mentioned in: Cognitive-Behavioral Therapy
 responses to internal or external stressors. Like most other models, this one also proposes that an individual experiences a sense of perceived control while maintaining abstinence. This perception of self-control continues till the person encounters a 'high risk' situation. Three categories of such situations viz., negative emotional states, interpersonal conflicts, and social pressures have been proposed. If the individual is able to execute an effective coping response in such problem-situations, the probability of a relapse is considerably lessened. Effective coping depends on the person's self-efficacy, defined as his/her expectations concerning the capacity to cope with several 'high risk' situations. An increased perception of self-efficacy helps in maintenance of abstinence. On the other hand, ineffective coping leads to lowering of self-efficacy and a sense of helplessness. This can precipitate minor slips or lapses into substance use, which eventually snowball into a full relapse.

Despite the enormous influence of this and other similar models of relapse, very few studies have actually put these models to test. It has been reported that negative mood states and other high-risk situations, self-efficacy, coping resources, etc., are singly or jointly predictive of relapse (7-11). This lends credence to the preeminence of such factors and validity of such models of relapse. However, several methodological problems including variable definitions of relapse and differences among the populations studied continue to afflict af·flict  
tr.v. af·flict·ed, af·flict·ing, af·flicts
To inflict grievous physical or mental suffering on.



[Middle English afflighten, from afflight,
 this area (12). Though it is proposed that similar mechanisms underlie relapse in persons with different kinds of substance dependence, research has mainly focused on alcohol dependence. Other types of substance dependence have been examined far less frequently.

Therefore in this study we attempted to examine the association between demographic variables, clinical parameters, relapse precipitants (or 'high risk' situations), coping strategies The German Freudian psychoanalyst Karen Horney defined four so-called coping strategies to define interpersonal relations, one describing psychologically healthy individuals, the others describing neurotic states. , self-efficacy, stressful life events and perceived social support, and relapse among patients with either alcohol or opioid opioid /opi·oid/ (o´pe-oid)
1. any synthetic narcotic that has opiate-like activities but is not derived from opium.

2. any of a group of naturally occurring peptides, e.g.
 dependence. Based on predictions of the models of relapse and previous literature in this area it was expected that these variables would demonstrate significant associations with relapse among both groups of patients.

Material & Methods

Patients: The sample was drawn from the population of patients attending the Drug De-addiction and Treatment Centre (DDTC DDTC Directorate of Defense Trade Controls
DDTC Digital Deployed Training Campus
DDTC Discrete Donut Twisted Chain (model of space and matter)
DDTC Datalink Delivery of Taxi Clearance (aviation) 
) of the Department of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER PGIMER Postgraduate Institute of Medical Education and Research (India) ), Chandigarh. As the DDTC population comprises almost exclusively of males, only men were taken up for the study. Based on previous comparisons it was decided to include a minimum of 30 patients in each group. Power calculations suggested that this sample size was adequate for most of the comparisons attempted. Purposive pur·po·sive  
adj.
1. Having or serving a purpose.

2. Purposeful: purposive behavior.



pur
 sampling, over a period of about 1 yr (July 2002 to June 2003) was carried out to induct in·duct
v.
To produce an electric current or a magnetic charge by induction.
 the sample. The sample consisted of (i) the abstinent group consisting of 30 patients of alcohol/opioid dependence who following treatment for their condition had managed to remain abstinent for a minimum period of 6 months and (ii) the relapsed group consisting of 30 patients of alcohol/opioid dependence who following treatment for their condition had maintained in a remitted state for at least two weeks, but had then relapsed within the next 6 months.

An episode of relapse was defined as the person meeting ICD ICD International Classification of Diseases (of the World Health Organization); intrauterine contraceptive device.

ICD
abbr.
 10 classification of mental and behaviour disorders diagnostic criteria for research (ICD-10-DCR) (13) for alcohol/opioid dependence for a minimum period of 1 month.

Inclusion criteria
For Wikipedia's inclusion criteria, see: What Wikipedia is not.


Inclusion criteria are a set of conditions that must be met in order to participate in a clinical trial.
 for patients to be inducted included 18-65 yr of age, have fulfilled ICD-10 DCR DCR Department of Conservation and Recreation
DCR Decrease
DCR Digital Cable Ready (television)
DCR Dark Crisis (Yu-Gi-Oh! cards)
DCR Debt Coverage Ratio
DCR Dacryocystorhinostomy
 (13) criteria for alcohol/opioid dependence and have received treatment for their condition. Diagnoses were established conjointly con·joint  
adj.
1. Joined together; combined: "social order and prosperity, the conjoint aims of government" John K. Fairbank.

2.
 after detailed semi-structured interviews. Patients were excluded if they had comorbid psychiatric disorders, personality disorders, major physical illnesses, organic brain syndrome organic brain syndrome
n. Abbr. OBS
Any of a group of acute or chronic syndromes involving temporary or permanent impairment of brain function caused by trauma, infection, toxin, tumor, or tissue sclerosis, and causing mild-to-severe
 or mental retardation mental retardation, below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. . Patients with multiple substance abuse/dependence (e.g. those with alcohol dependence and co-morbid opioid dependence or vice versa VICE VERSA. On the contrary; on opposite sides. ) were excluded apart from those who were abusing or dependent on nicotine in addition to alcohol/opioids.

Assessments: Demographic and clinical data were obtained from patients, relatives or case notes and recorded using structured formats. Severity of dependence was rated using the Severity of Alcohol Dependence Questionnaire (SADQ) (14) and the Severity of Opioid Dependence Questionnaire (SODQ) (15).A Hindi version of the original Relapse Precipitant Inventory (RPI RPI - Rockwell Protocol Interface ) was used to assess 'high risk' situations (16). This version of the RPI has been standardized to cover relapse in all kinds of substances including alcohol. It is reliable and has a factor-structure similar to the original version. Coping was evaluated using the Coping Behaviour Inventory (CBI CBI
abbr.
cumulative book index


CBI Confederation of British Industry

CBI n abbr (= Confederation of British Industry) → C.E.O.E.
) (17), which was slightly modified to suit patients with opioid dependence. A Hindi translation of the original Self-Efficacy Scale (SES) was used to rate self-efficacy (18). Psychometric psy·cho·met·rics  
n. (used with a sing. verb)
The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and
 properties of the Hindi version have been found to be adequate and it consists of two factors similar to the original scale. Stressful life events in the past year were determined using the Presumptive pre·sump·tive  
adj.
1. Providing a reasonable basis for belief or acceptance.

2. Founded on probability or presumption.



pre·sump
 Stressful Life Events Scale (PSLES) (19), which is an Indian adaptation of the original Holmes and Rahe's Social Readjustment Rating Schedule (20); the scale has adequate psychometric properties and local norms. Perceived social support was measured using the Social Support Questionnaire (SSQ SSQ Society for Software Quality
SSQ La Sarre, Quebec, Canada (Airport Code)
SSQ Sun Red Capital Corporation (stock symbol)
SSQ Space Station Quality
SSQ Standardized Safety Questionnaire
SSQ Single Server Queue
) (21), an Indian adaptation of the scale of Pollack pollack: see cod.
pollack
 or pollock

Either of two commercially important North Atlantic species of food fish in the cod family (Gadidae).
 and Harris (22). It is a reliable and valid instrument with higher scores denoting greater support.

Assessments were conducted when patients were not in an intoxicated in·tox·i·cate  
v. in·tox·i·cat·ed, in·tox·i·cat·ing, in·tox·i·cates

v.tr.
1. To stupefy or excite by the action of a chemical substance such as alcohol.

2.
 state and were non-blind and cross-sectional.

Ethical considerations: The study was approved by the Research and Ethics Committees of the institute. It conformed to the ethical guidelines of the ICMR ICMR Indian Council of Medical Research
ICMR Institute for Coastal and Marine Resources
ICMR Interagency Committee on Medical Records
 (23) for biomedical research Biomedical research (or experimental medicine), in general simply known as medical research, is the basic research or applied research conducted to aid the body of knowledge in the field of medicine.  on human subjects. Written informed consent was obtained from patients before induction. Other ethical safeguards such as confidentiality, right to withhold or withdraw consent, etc., were also maintained during the study. Treatment was not altered in any manner whether the patient agreed or refused to participate in the study. No invasive investigations were carried out as a part of the study.

Data analysis: Comparisons between relapsed and abstinent groups were carried out using t tests for continuous variables and Chi-square for discontinuous discontinuous /dis·con·tin·u·ous/ (dis?kon-tin´u-us)
1. interrupted; intermittent; marked by breaks.

2. discrete; separate.

3. lacking logical order or coherence.
 variables. The Mann-Whitney test was used for data with non-normal distributions.

Results

Both groups consisted mostly of married, educated and employed men in their 30s from urban backgrounds. There were no significant differences between the two groups on any of the demographic parameters (Table I).

In the abstinent group the number of patients with alcohol dependence was more than those with opioid dependence and the opposite was true for the relapsed group, but these differences were not significant. Patients who had relapsed were significantly more likely to have a positive family history (P < 0.05) for substance use and higher number of previous relapses (P < 0.001) (Table II).

The patients relapsed after about 4 months of treatment and remained in a relapsed state for about 45-80 days. There were no significant differences between patients with alcohol or opioid dependence on any of the variables related to relapse (Table III).

On the RPI patients who had relapsed had significantly higher mean total scores as well as significantly higher mean scores on 3 high-risk situations viz., negative mood states (P < 0.05), external situations and euphoric states (P < 0.05) and lessened cognitive vigilance (P<0.01), compared to patients who had remained abstinent. Comparison of the CBI scores revealed that the relapsed group had significantly higher mean scores on maladaptive strategies such as negative thinking (P < 0.01) and significantly lower mean scores on adaptive strategies The expression adaptive strategies is used by anthropologist Yehudi Cohen to describe a society’s system of economic production. Cohen argued that the most important reason for similarities between two (or more) unrelated societies is their possession of a similar  such as positive thinking (P < 0.001) than the abstinent group. Patients who had relapsed also had significantly lower (P < 0.001) mean total scores on the CBI than patients who had remained abstinent. Scores on the SES showed that patients who suffered a relapse had significantly lower mean total scores as well significantly lower scores on the general- efficacy and social-efficacy factors (P < 0.001) than patients who were abstinent. The PSLES results revealed that patients who had relapsed had experienced a significantly higher number of undesirable life events (P < 0.05) in the past year. There were no significant differences between the 2 groups on the SSQ scores

(Table IV).

Comparisons were also carried out on all the above parameters between patients with alcohol dependence who were abstinent (N=17) versus those who had relapsed (N=12), as well as patients of opioid dependence who were abstinent (N =13) versus those who had relapsed (N=18). Though the numbers were rather small and the number of significant differences fewer, the differences were consistent with the overall trend. Accordingly, among patients with alcohol dependence significant differences between patients who had relapsed and those who remained abstinent emerged on age (P < 0.001), time to dependence (P < 0.05), number of previous relapses (P < 0.05), certain subscale scores on the RPI and the CBI, and on total/ subscale scores on the SES. Similarly, among patients with opioid dependence the relapsed and abstinent groups significantly differed on the number of previous relapses (P < 0.001), subscale and total scores of the CBI (P < 0.05) and the SES (P < 0.001). There was however, no clear pattern to these differences. The factors influencing relapse appeared to be largely similar among patients with alcohol and opioid dependence (Table V).

Discussion

The results of the present study showed that certain clinical and psychosocial variables were reliably and consistently associated with relapse among patients with alcohol/opioid dependence. Thus, it adds to the previous research in this area which has demonstrated that similar clinical/social variables are important correlates of relapse. Consequently, clinical parameters such as the number of previous relapses and positive family history of substance use emerged as significant determinants of relapse among patients with alcohol as well as opioid dependence, while a shorter time to dependence was significantly associated with relapse among patients of alcohol dependence. These observations are in line with previous suggestions that severity/outcome of substance dependence could be important correlates of relapse (24,25). At the same time, psychosocial factors such as relapse precipitants (or high risk situations), coping, self-efficacy and stressful life events appeared to be of greater import in determining relapse. Patients who had relapsed were significantly more likely than abstinent ones to have been exposed to a higher total number of high risk situations, including the ones described earlier. These results are not only consistent with proposals regarding the pivotal role of exposure to high risk situations in the onset of relapse26, but also in accordance with the results of a number of earlier studies (27-31). Patients with alcohol/opioid dependence who remained abstinent tended to use significantly more number of coping strategies including adaptive strategies such as 'positive thinking', while those who had relapsed used maladaptive strategies such as 'negative thinking' more often. It has been reported previously that the number and effectiveness of coping strategies among patients are important in determining relapse (28,31). Further, abstinent patients scored significantly higher on all measures of self-efficacy, confirming previous research (32,33) on the importance of self-efficacy as a determinant of relapse. Lastly, patients who had relapsed in this study had experienced a significantly higher number of undesirable life events than those who were abstinent, which is in line with some (30), but not all (11,34), of the earlier studies which have documented such an association.

In addition, the current study extends the results regarding correlates of relapse further by demonstrating the operation of largely similar mechanisms of relapse among patients with both alcohol and opioid dependence. This is noteworthy because much of the earlier research on relapse has been conducted among patients with alcohol problems, with other substances such as nicotine (24,25) or opiates Opiates
Analgesic, pain killing drugs, such as heroin and morphine that depress the central nervous system.

Mentioned in: Withdrawal Syndromes
 (24,30) being addressed only occasionally.

Finally, the models of relapse referred to earlier have been developed in the West and much of the research evidence also originated from the western countries. Thus, the present findings are useful in illustrating the universal nature of relapse in substance dependence and its proposed mechanisms.

If the variables identified in the current and earlier studies are indeed important correlates of relapse in substance dependence, these could be of considerable help not only in predicting relapse, but also in identifying key areas to be targeted in order to prevent this common and distressing occurrence. If similar mechanisms of relapse operate across several categories, the findings could also be applicable to a wide-range of substance abuse disorders (35), as well as problem behaviours such as impulse control disorders Impulse Control Disorders Definition

Impulse control disorders are characterized by an inability to resist the impulse to perform an action that is harmful to one's self or others.
 (e.g. pathological gambling pathological gambling: see compulsive gambling. , pyromania pyromania /py·ro·ma·nia/ (-ma´ne-ah) the compulsion to set or watch fires in the absence of monetary or other gain, the act being preceded by tension or arousal and resulting in pleasure or relief. , kleptomania kleptomania (klĕp'təmā`nēə) [Gr.,=craze for stealing], irresistible compulsion to steal, motivated by neurotic impulse rather than material need. No specific cause is known. , etc.), eating disorders, obesity, etc., currently conceptualised as behavioural addictions (36). Since relapses also constitute a significant aspect of such behaviours, extending the findings from the field of substance dependence could help in understanding and preventing relapses in these conditions as well.

This study has several methodological limitations and this evidence can only be regarded as preliminary. The sample size of the current study was small and the sample was restricted to men with substance dependence attending a specialized unit of a general hospital. The findings thus can not be generalized to other patient-populations with substance dependence. Biases could have arisen from the fact that the assessments were nonblind. One time cross-sectional evaluations employed may have failed to capture the dynamic nature of the process of relapse. The study was exclusively limited to exploration of psychosocial correlates of relapse, and biological factors were not considered. Moreover, the significant associations between psychosocial parameters and relapse demonstrated do not prove that these were causal connections.

Received October 16, 2008

References

(1.) Saunders B, Allsop B. Relapse: a psychological perspective. Br J Addict 1987; 82 : 417-29.

(2.) Ciccocioppo RR, Hyytia P. The genetic of alcoholism: learning from 50 years of research. Addict Biol 2006; 11 : 193-4.

(3.) Johnson BA. The biologic basis of alcohol dependence. Adv StudNurs 2004; 2 : 48-53.

(4.) Feltenstein MW, See RE. The neurocircuitry of addiction: an overview. Br J Pharmacol 2008; 154 : 261-74.

(5.) Stewart J. Psychological and neural mechanisms of relapse. Philos Trans R Soc LondB Biol Sci 2008; 363 : 3147-58.

(6.) Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict 1984; 79 : 261-73.

(7.) Larimer ME, Palmer RS, Marlatt GA. Relapse prevention. An overview of Marlatt's cognitive-behavioral model. Alcohol Res Health 1999; 23 : 151-60.

(8.) Lowman C, Allen J, Stout RL, The Relapse Research Group. Replication and extension of Marlatt's taxonomy of relapse precipitants: overview of procedures and results. Addiction 1996; 91 (Suppl 1): 51-72.

(9.) Maisto SA, Connors GJ, Zywiak WH. Construct validation analyses on the Marlatt typology typology /ty·pol·o·gy/ (ti-pol´ah-je) the study of types; the science of classifying, as bacteria according to type.

typology

the study of types; the science of classifying, as bacteria according to type.
 of relapse precipitants. Addiction 1996; 91 (Suppl 1) : 89-98.

(10.) Stout RL, Longabaugh R, Rubin A. Predictive validity In psychometrics, predictive validity is the extent to which a scale predicts scores on some criterion measure.

For example, the validity of a cognitive test for job performance is the correlation between test scores and, for example, supervisor performance ratings.
 of Marlatt's relapse taxonomy versus a more general relapse code. Addiction 1996; 91 (Suppl 1): 99-110.

(11.) Miller RW, Westerberg SV, Harris JR, Tonigan SJ. What predicts relapse? Prospective testing of antecedent ANTECEDENT. Something that goes before. In the construction of laws, agreements, and the like, reference is always to be made to the last antecedent; ad proximun antecedens fiat relatio.  models. Addiction 1996; 91 (Suppl 1) : 155-71.

(12.) Donovan DM.Assessment issues and domains in the prediction of relapse. Addiction 1996; 91 (Suppl 1) : 29-36.

(13.) World Health Organization. The ICD 10 classification of mental and behavioural disorders: diagnostic criteria for research. Oxford: Oxford University Press; 1993.

(14.) Stockwell J, Murphy D, Hodgson R. The severity of alcohol dependence questionnaire: its use, reliability and validity. Br J Addict 1983; 78 : 145-56.

(15.) Sutherland G, Edward G, Taylor C, Phillips G, Gossop M, Brady R. The measurement of opiate opiate /opi·ate/ (o´pe-it)
1. any drug derived from opium.

2. hypnotic (2).


o·pi·ate
n.
1.
 dependence. Br J Addict 1986; 81: 485-94.

(16.) Mattoo SK, Malhotra R. Relapse Precipitant Inventory: Hindi adaptation and factor structure. Indian J Clin Psychol 2000; 27: 278-85.

(17.) Litman GK, Stapelton J, Oppenheim AN, Peleg M. An instrument for measuring coping behaviours in hospitalised alcoholics: implications for relapse prevention treatment. Br J Addict 1983; 78 : 269-79.

(18.) Mattoo SK, Malhotra R. Self-efficacy scale. Hindi translation and factor structure. Indian J Clin Psychol 1998; 25 : 154-8.

(19.) Singh G, Kaur D, Kaur H. Presumptive stressful life events scale for use in India. Indian J Psychiatry 1984; 26 : 107-14.

(20.) Holmes TH, Rahe RH. The Social Readjustment Rating Scale. JPsychosom Res 1967; 11: 213-8.

(21.) Nehra R, Kulhara P. Development of a scale for the assessment of social support. Initial try-out in an Indian setting. Indian J Social Psychiatry social psychiatry
n.
The branch of psychiatry that deals with the relationship between social environment and mental illness.
 1987; 4 : 353-9.

(22.) Pollack L, Harris R. Measurement of social support. Psychol Rep 1983; 53: 446-9.

(23.) Indian Council of Medical Research. Ethical guidelines for biomedical research on human participants. New Delhi New Delhi (dĕl`ē), city (1991 pop. 294,149), capital of India and of Delhi state, N central India, on the right bank of the Yamuna River. : Indian Council of Medical Research; 2006.

(24.) Marlatt GA, Gordon JR. Relapse prevention. Maintenance strategies in addictive behavioural change. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
: Guilford Press; 1980.

(25.) Shiffman SM. Analysis of relapse following smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. : a situational analysis. J Consult Clin Psychol 1980; 50 : 71-86.

(26.) Marlatt GA. Taxonomy of high-risk situations for alcohol relapse: evolution and development of a cognitive-behavioural model. Addiction 1996; 91 (Suppl1): 37-50.

(27.) Litman GK, Eiser JR, Rawson JCB JCB
Noun

trademark, Brit a large machine used in building, that has a shovel on the front and a digger arm on the back [initials of Joseph Cyril Bamford, its manufacturer]

JCB® n abbr
, Oppenheim AN. Differences in relapse precipitants and coping behaviour between alcohol relapsers and survivors. Behav Res Ther 1979; 17 : 89-94.

(28.) Litman GK, Stapleton J, Oppenheim AN, Paleg M, Jackson P. Situations related to alcoholism relapse. Br J Addict 1983; 78 : 381-9.

(29.) Maisto SA, O'Farrell TJ, Connors GJ, Mckay JR, Pelcovits M. Alcoholics' attributions of factors affecting their relapse to drinking and reasons for terminating relapse episodes. Addict Behav 1988; 13 : 79-82.

(30.) Mattoo SK, Basu D. Malhotra A, Malhotra R. Relapse precipitants, life events and dysfunctions in alcohol and opioid dependent men. Indian J Psychiatry 2003; 45 : 39-44.

(31.) Singhal S, Nagalakshmi SV, Singhal S. Relapse in alcoholism: psychosocial study. NIMHANS NIMHANS National Institute of Mental Health and Neuro Sciences (Bangalore, India)  J 1992; 10 : 47-9.

(32.) Burling Burling may refer to:
  • Carroll Burling
  • Daniel Burling
  • Robbins Burling

This page or section lists people with the surname Burling. If an internal link for a specific person referred you to this page, you may wish to add the given name(s) to that
 TA, Reilly PM, Moltzen JO, Ziff DC. Self-efficacy and relapse among inpatients with drug and alcohol abuse. J Stud Alcohol 1989; 50 : 354-60.

(33.) Mckay JR, Maisto SA, O'Farrell TJ. End-of treatment self efficacy, aftercare and drinking outcomes of alcoholic men. Alcohol Clin Exp Res 1993; 17 : 1076-83.

(34.) Finney JW, Moos RH, Mewborn CR. Post-treatment experiences and treatment outcome of alcoholic patients six months and two years after hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun)
1. the placing of a patient in a hospital for treatment.

2. the term of confinement in a hospital.
. J Consult Clin Psychol 1980; 48 : 17-29.

(35.) Shaffer HJ, LaPlante DI, LaBrie, RA, Kidman, RC, Donato, AN, Stanto MV. Towards as syndrome of addiction: multiple expressions, common etiology. Harv Rev Psychiatry 2004; 12 : 367-74.

(36.) Hollander E. Behavior and substance addictions: a new proposed DSM-V category characterized by impulsive im·pul·sive
adj.
1. Inclined or tending to act on impulse rather than thought.

2. Motivated by or resulting from impulse.



im·pul
 choice, reward sensitivity and fronto-striatal circuit impairment. CNS See Continuous net settlement.

CNS

See continuous net settlement (CNS).
 Spectr 2006; 11 : 814.

Reprint requests: Prof. S.K. Mattoo, Department of Psychiatry, Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India

e-mail: skm_ddtc@glide.net.in

S.K. Mattoo, S. Chakrabarti & M. Anjaiah

Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
Table I. Demographic characteristics of the study sample

Variables                  Abstinent group       Relapsed group
                              (N = 30)              (N = 30)

Age (yr)               35.5 [+ or -] 11.3 (a)     30.9 (9.36)
Marital status
Married                          18                    17
Not married                      12                    13
Years of schooling      11.3 [+ or -] 3.5 (a)      12.8 (3.0)
Occupation
Employed                         23                    20
Not employed                      7                    10
Income (Rupees/
month)
< 3000/-                          8                    10
[greater than or                 22                    20
  equal to] 3000/-
Residence
Urban                            24                    26
Rural                             6                    4

(a) Values are mean [+ or -] SD

Table II. Clinical profile of the patients in the two groups

Variables                                        Abstinent
                                                   group
                                                   (N=30)

Alcohol dependence                                   17
Opioid dependence                                    13
Age of onset of substance use (yr)           20.7 [+ or -] 5.3
Duration of substance use (yr)               14.1 [+ or -] 10.9
Time to develop dependence (yr)               8.2 [+ or -] 8.4
Age of onset of dependence (yr)              28.3 [+ or -] 9.3
Duration of dependence (yr)                   6.1 [+ or -] 5.8
No. of previous relapses **                   0.5 [+ or -] 1.0
No. of hospitalisations                       1.7 [+ or -] 0.9
Duration of last hospitalisation (days)      18.3 [+ or -] 7.1
Family history of substance use *
Present                                               3
Absent                                               27
Family history of substance dependence
Present                                              27
Absent                                                3

Variables                                         Relapsed
                                                    group
                                                   (N=30)

Alcohol dependence                                   12
Opioid dependence                                    18
Age of onset of substance use (yr)            20.2 [+ or -] 5.0
Duration of substance use (yr)                10.5 [+ or -] 8.4
Time to develop dependence (yr)                4.8 [+ or -] 4.8
Age of onset of dependence (yr)               23.4 [+ or -] 8.3
Duration of dependence (yr)                    6.3 [+ or -] 6.1
No. of previous relapses **                    1.4 [+ or -] 0.7
No. of hospitalisations                        1.6 [+ or -] 0.9
Duration of last hospitalisation (days)       11.9 [+ or -] 9.5
Family history of substance use *
Present                                              19
Absent                                               11
Family history of substance dependence
Present                                              27
Absent                                                3

Values are mean [+ or -] SD

P * <0.05 ** <0.001 between the two groups

Table III. Relapse profile of patients with alcohol and apioid
dependence

Relapse variables                Alcohol
                               dependence
                                 (N =12)

Time from treatment         73.5 [+ or -] 35.2
  to lapse (days)
Time from treatment        120.8 [+ or -] 53.7
  to relapse (days)
Duration of relapse         79.8 [+ or -] 78.1
  (days)
Time taken to seek help    370.1 [+ or -] 640
  after relapse (days)
SADD scores                 10.2 [+ or -] 3.3
SODQ scores                        --

Relapse variables                  Opioid
                                 dependence
                                  (N = 18)

Time from treatment          127.5 [+ or -] 163
  to lapse (days)
Time from treatment            120 [+ or -] 50.8
  to relapse (days)
Duration of relapse           44.5 [+ or -] 84.5
  (days)
Time taken to seek help        158 [+ or -] 86.7
  after relapse (days)
SADD scores                          --
SODQ scores                   20.2 [+ or -] 6.8

Values are mean [+ or -] SD

SADQ, Severity of alcohol dependence questionnaire

SODQ, Severity of opioid dependence questionnaire

Table IV. Scores on the Relapse Precipitant Inventory (RPI),
Coping Behaviour Inventory (CBI), Self-Efficacy Scale (SES),
Presumptive Stressful Life Events Scale (PSLES) and the Social
Support Questionnaire (SSQ)

Scales                                   Abstinent group
                                            (N = 30)

Relapse precipitant inventory
  Negative mood states                 4.63 [+ or -] 4.29
  External situations/euphoric         2.13 [+ or -] 2.22
  states
  Lessened cognitive                   1.03 [+ or -] 1.03
  vigilance
  RPI total score                      9.53 [+ or -] 8.50

Coping behaviour inventory
  Positive thinking                    1.33 [+ or -] 0.59
  Negative thinking                    0.69 [+ or -] 0.42
  Avoidance                            1.37 [+ or -] 0.39
  Seeking social support               1.83 [+ or -] 0.78
  CBI total score                      1.38 [+ or -] 0.42

Self-Efficacy Scale
  General self-efficacy               53.30 [+ or -] 7.75
  Social self-efficacy                15.76 [+ or -] 2.93
  SES total scores                    80.43 [+ or -] 8.83

Presumptive stressful life events
scale (stressful life events for
the past year)
  Desirable events                    0.87 [+ or -] 1.04
  Undesirable events                  0.06 [+ or -] 0.25
  Total events                        3.67 [+ or -] 4.30
  Total stress score                189.13 [+ or -] 214.26
  Lifetime stress score             429.13 [+ or -] 189.48

Social Support Questionnaire
  Total SSQ scores                   50.30 [+ or -] 5.28

Scales                                   Relapsed group
                                            (N = 30)

Relapse precipitant inventory
  Negative mood states                 6.77 [+ or -] 3.91 *
  External situations/euphoric         3.33 [+ or -] 2.21 *
  states
  Lessened cognitive                   1.77 [+ or -] 1.04 **
  vigilance
  RPI total score                     14.33 [+ or -] 7.19 *

Coping behaviour inventory
  Positive thinking                    0.79 [+ or -] 0.34 ***
  Negative thinking                    0.98 [+ or -] 0.39 **
  Avoidance                            1.59 [+ or -] 0.49
  Seeking social support               1.54 [+ or -] 0.58
  CBI total score                      1.03 [+ or -] 0.33 ***

Self-Efficacy Scale
  General self-efficacy               34.90 [+ or -] 4.58 ***
  Social self-efficacy                12.23 [+ or -] 1.79 ***
  SES total scores                    57.26 [+ or -] 5.97 ***

Presumptive stressful life events
scale (stressful life events for
the past year)
  Desirable events                     0.83 [+ or -] 0.91
  Undesirable events                   0.77 [+ or -] 2.1 *
  Total events                         4.97 [+ or -] 3.58
  Total stress score                 199.10 [+ or -] 166.80
  Lifetime stress score              376.33 [+ or -] 209.98

Social Support Questionnaire
  Total SSQ scores                     47.43 [+ or -] 7.28

P * <0.05; ** < 0.01; *** <0.001 compared to abstinent group.

Values are mean [+ or -] SD

Table V. Subgroup comparisons between alcohol and opioid dependence (a)

Variables                        Alcohol dependence (n=29)

                                     Abstinent group
                                         (N=17)

Age (yr)                            43.7 [+ or -] 5.3
Time to develop dependence (yr)     13.4 [+ or -] 7.6
No. of previous relapses             0.6 [+ or -] 0.9
RPI scores Lessened cognitive       1.05 [+ or -] 1.14
  vigilance
CBI positive thinking               4.50 [+ or -] 6.61
CBI Negative thinking               0.75 [+ or -] 0.37
CBI total score                     1.32 [+ or -] 0.50
SES-general self-efficacy          55.53 [+ or -] 8.29
SES-social self-efficacy           16.23 [+ or -] 3.30
SES total scores                   82.82 [+ or -] 9.32

Variables                          Alcohol dependence (n=29)

                                       Relapsed group
                                          (N=12)

Age (yr)                            32.2 [+ or -] 8.9 **
Time to develop dependence (yr)      8.1 [+ or -] 4.9 *
No. of previous relapses             1.1 [+ or -] 0.9 *
RPI scores Lessened cognitive       2.08 [+ or -] 0.79 *
  vigilance
CBI positive thinking               0.79 [+ or -] 0.29 *
CBI Negative thinking               0.90 [+ or -] 0.39 *
CBI total score                     1.02 [+ or -] 0.34 *
SES-general self-efficacy          34.50 [+ or -] 4.58 ***
SES-social self-efficacy           13.50 [+ or -] 1.73 ***
SES total scores                   59.16 [+ or -] 5.40 ***

Variables                          Opioid dependence (N=31)

                                       Abstinent group
                                           (N = 13)

Age (yr)                              24.8 [+ or -] 7.2
Time to develop dependence (yr)        1.4 [+ or -] 2.4
No. of previous relapses               0.5 [+ or -] 1.1
RPI scores Lessened cognitive         8.69 [+ or -] 6.21
  vigilance
CBI positive thinking                  1.4 [+ or -] 0.56
CBI Negative thinking                 0.60 [+ or -] 0.50
CBI total score                       1.41 [+ or -] 0.38
SES-general self-efficacy            50.38 [+ or -] 6.10
SES-social self-efficacy             15.15 [+ or -] 2.34
SES total scores                     77.30 [+ or -] 7.34

Variables                          Opioid dependence (N31)

                                        Relapsed group
                                           (N = 18)

Age (yr)                              28.1 [+ or -] 8.8
Time to develop dependence (yr)        2.5 [+ or -] 3.2
No. of previous relapses               1.3 [+ or -] 0.5 ***
RPI scores Lessened cognitive        14.22 [+ or -] 7.74 *
  vigilance
CBI positive thinking                 0.78 [+ or -] 0.42 *
CBI Negative thinking                 1.03 [+ or -] 0.40 *
CBI total score                       1.05 [+ or -] 0.37 *
SES-general self-efficacy            35.16 [+ or -] 4.31 ***
SES-social self-efficacy             11.39 [+ or -] 1.28 ***
SES total scores                     56.00 [+ or -] 6.12 ***

P *< 0.05; ** < 0.01; *** <0.001 compared to respective abstinent
group. (a)--Only significant results are depicted here.

RPI, Relapse Precipitant Inventory; CBI, Coping Behaviour
Inventory; SES, Self-Efficacy Scale; PSLES, Presumptive Stressful
Life Events

Scale; SSQ, Social Support Questionnaire
COPYRIGHT 2009 Indian Council of Medical Research
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Author:Mattoo, S.K.; Chakrabarti, S.; Anjaiah, M.
Publication:Indian Journal of Medical Research
Article Type:Report
Geographic Code:9INDI
Date:Dec 1, 2009
Words:4569
Previous Article:Novel applications of nanotechnology in medicine.
Next Article:Seroprevalence of subclinical HEV infection in pregnant women from north India: a hospital based study.
Topics:

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters