Commitment to Abstinence and Relapse to Tobacco, Alcohol, and Opiates

Sm, Hall; Be, Havassy

doi:10.1037/e496822006-009

Cited by 16 publications

(18 citation statements)

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“…In one study, only 54% with a TA goal relapsed, whereas 80% who selected a conditional abstinence (CA; i.e., an abstinence goal that allows for the possibility of future slips) goal relapsed (Hall et al, 1990). Those with TA goals also had a longer time between fi rst use and relapse (Hall and Havassy, 1986;Hall et al, 1990). Other baseline patient characteristics, including coping strategies, were not associated with 6-month outcome (Hall et al, 1991).…”

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confidence: 99%

“…An abstinence goal is the degree to which a patient's treatment goal is total and permanent abstinence versus a less restrictive goal (Hall et al, 1990). In early studies, TA goals predicted better treatment outcome (Hall and Havassy, 1986;Hall et al, 1990Hall et al, , 1991. In one study, only 54% with a TA goal relapsed, whereas 80% who selected a conditional abstinence (CA; i.e., an abstinence goal that allows for the possibility of future slips) goal relapsed (Hall et al, 1990).…”

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confidence: 99%

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Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

DeMartini

Devine

DiClemente

et al. 2014

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a signifi cant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. Method: Participants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were signifi cant relationships between predictor variables and pretreatment goal selection. Results: Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal. Conclusions: Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal. (J. Stud. Alcohol Drugs, 75, 438-446, 2014)

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confidence: 99%

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confidence: 99%

Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

DeMartini

Devine

DiClemente

et al. 2014

J. Stud. Alcohol Drugs

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“…43 The majority of adult cigarette smokers gain weight after quitting, 44 and this is associated with an increased likelihood of relapse. 45 Nicotine has long been considered an appetite suppressor, [46][47][48] and many studies have shown a sharp increase in eating during the first few weeks of smoking cessation. [49][50][51] However, food intake may not be the only operating factor, and recent studies have shown that postcessation weight gain may partially be under genetic influence.…”

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confidence: 99%

Association of the mu-opioid receptor gene with smoking cessation

et al. 2007

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We investigated the association of the OPRM1 genotype with long-term smoking cessation and change in body mass index (BMI) following a smoking cessation attempt among smokers who attempted to quit using the nicotine replacement therapy (NRT) patch or placebo in a randomized controlled trial, and were followed-up over an 8-year period following their initial cessation attempt. We also investigated possible sex differences in these relationships, given evidence for sex differences in smoking cessation and central opioid mechanisms, as well as some evidence for sex differences in response to NRT. Our results indicate that OPRM1 genotype may moderate the effect of transdermal nicotine patch compared to placebo during active treatment, with a benefit of active NRT treatment evident in the OPRM1 AA genotype group only and those carrying one or more copies of the G allele demonstrating no benefit of active NRT versus placebo patch. Our results also indicate a sex difference in change in BMI at 8-year follow-up following a smoking cessation attempt, with ex-smokers demonstrating an increase in BMI, and this increase being greater in female subjects than in male subjects. We did not observe any association of OPRM1 genotype with change in BMI, although there was a trend for genotype to influence the observed sex difference in change in BMI over time. Future studies should attempt to replicate these findings, and investigate the relationship between both short-and long-term weight gain and smoking cessation and investigate possible mechanisms that may underlie these processes. Future studies should also investigate the role of OPRM1 genotype and smoking cessation on other appetitive and reward behaviours such as alcohol consumption.

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“…It is conceivable that patients with a history of opiate or amphetamine dependence would find it more difficult to cope than other substance users under conditions of forced abstinence, and hence engage in more paralleling behaviours to satisfy the psychological needs previously met by substance use. Opiate users have been shown to have greater and quicker relapse rates than other substance users, again supporting the idea that risks associated with substance dependence are more pronounced for individuals who are dependent on these types of substances (Hall & Havassy, 1986;Marlatt, 1979;McAuliffe et al, 1986).…”

Section: Discussionmentioning

confidence: 88%

“…This phenomenon appears particularly common for opiate users. The average time-to-relapse after discharge from hospital for opiate users is between 32 and 43 days (Hall & Havassy, 1986;Marlatt, 1979). The fact that the majority of opiate users relapse, and that this relapse occurs soon after discharge raises questions about how effectively secure psychiatric hospitals are identifying and treating substance dependence and assessing and managing risk for relapse in these patients.…”

Section: Risk Of Relapse and Reoffendingmentioning

confidence: 99%

The prevalence and manifestation of substance use paralleling behaviours in a secure forensic psychiatric hospital

Schaefer

Daffern

Ferguson

2011

Mental Health and Substance Use

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Co-morbid substance dependence is common in patients of secure psychiatric services. Identifying opportunities for intervention, monitoring progress in treatment and assessing risk of relapse are compromised by this group's limited access to illicit substances. This research investigated the validity of the substance use paralleling behaviour (SUPB) framework, which was developed to assist staff in identifying behaviours indicative of substance dependence in controlled environments. Thirty-one patients admitted to the acute units of a secure forensic psychiatric hospital were interviewed and assessed with the Brief Psychiatric Rating Scales, the structured clinical interview for DSM disorders substance use disorders module, and an original questionnaire measuring motivations for drug use and behaviours indicative of substance dependence in a controlled setting (SUPBs). Results showed that patients with a history of substance dependence preceding admission engaged in more SUPBs during hospitalisation than patients without a history of substance dependence. Severity of psychiatric illness was unrelated to the frequency of requests for Pro re nata (PRN) medication and SUPBs. These results provide preliminary support for the SUPB framework and suggest that these behaviours might usefully be considered by staff of secure psychiatric hospitals when planning treatment, measuring progress and ascertaining risk of relapse. Opportunities for clinical application and future research are discussed.

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Commitment to Abstinence and Relapse to Tobacco, Alcohol, and Opiates

Cited by 16 publications

References 0 publications

Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

Predictors of Pretreatment Commitment to Abstinence: Results from the COMBINE Study

Association of the mu-opioid receptor gene with smoking cessation

The prevalence and manifestation of substance use paralleling behaviours in a secure forensic psychiatric hospital

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