Factors Associated with Relapse in Men with Alcohol Dependence Versus Opioid Dependence: A Comparative Study From Western Nepal

Abstract

Introduction: Drug abuse is a worldwide problem that affects millions of people and Nepal is no exception. Relapse is a major problem in management of substance use disorder. Hence it becomes important to understand the factors contributing to relapse in order to ensure relapse prevention. This study was done with the aim to compare clinico-demographic correlates of relapse in alcohol dependence and opioid dependence and also to know the reasons for relapse in both groups.
 Method: This is a cross sectional comparative study with the sample collected from three different rehabilitation centers from Nepalgunj. The sampleinclude those male clients with alcohol dependence and opioid dependence who had relapsed at least once in past after some period of abstinence. Total of 80 male subjects i.e. 40 in each group were enrolled in the study. Structured questionnaire was developed by the researcher and was used to collect the data from respondents. The data were statistically analyzed.
 Result: Some clinic-demographic disparity was observed in both groups. Alcohol group had more subjects from Bahun and Chettri caste, longer total duration of illness whereas opioid group had more Muslims, younger age and greater number of middle socio-economic clients, more number of substances used in past and higher prevalence of criminal act. The commonest reason for relapse in both groups found to be desire for positive mood. Peer pressure, social or family problems, craving, negative mood state and concentration difficulties were other factors found to be contributing to relapse. Narcotic Anonymous was the most preferred modality of treatment opted by both groups in past in order to quit substance whereas only 22.5% of subjects consulted to doctor.
 Conclusion: Social determinants play a critical role in substance use and its relapse and should be addressed alongside physical and psychological determinants for better outcome. Common factors play role for relapse in both groups. Study warrants increased need of mental health awareness programme among substance abusers.

Prevalence and characteristics of relapse in patients with Alcohol Dependence Syndrome

“…In our study, the most common reason for relapse was peer pressure (42.37%) which was similar to different studies (7,(22)(23)(24)(25) but in contrast to a few other studies (14,26). Other factors such as stress, craving, and availability during cultural rituals also contributed to relapse in our study.…”

“…Stress is a well-known factor to increase relapse risk directly and indirectly (27). This factor has also been reported by our study and others (14,(21)(22)(23). Craving has been postulated as an important factor for relapse in various studies (7,14,25,28,29).…”

“…A family history of substance dependence was significantly associated with relapse (5,21,22). Our study had a family history of substance use in 47.45% which is similar to other studies (23,32) This finding could reflect the high proportion of study participants being hospitalized for the treatment of alcohol-related problems.Knowledge of substance use by the family helps in the treatment prevention of relapses.…”

“…The abstinence was maintained mainly by self-motivation (50.85%) and hospitalization for medical problems.Other studies have shown the use of self-help groups for maintaining abstinence (23). This finding could be explained by the notion that one can handle the drinking problem oneself, the lack of awareness about alcohol problems as addiction, lack of awareness about the need for treatment for preventing relapses.…”

A comparison of risk factors for relapse in opiate‐related and stimulant‐related substance use disorders: A cross‐sectional multicenter study

“…Relapse from stimulant‐related disorders (SRDs) is also higher than for opiates (e.g., Amirabadizadeh et al, 2020). One of the reasons for the higher failure rate of stimulant treatment is that programs to treat SRDs have been modeled after services used for opiate and opioid use disorder without the positive effects seen in the opiate/opioid substance use groups (e.g., Khan, et al, 2018). In addition, psychosocial interventions, counseling, and strategies used to reduce stimulant and opiate misuse have been the same for each substance and have had a weak effect on positive outcomes and recovery (Farrell, et al, 2019; Kassani, et al, 2015).…”