Substance Abuse Relapse in Oxford House Recovery Homes: A Survival Analysis Evaluation

Abstract

Background This study used survival analysis to examine risk factors for substance abuse relapse among residents in Oxford Houses (OH) a national network of self-run, self-financed aftercare homes for individuals recovering from substance use disorders. Methods Participants who entered OH within 60 days of a one-year longitudinal study (N=268) were selected from of a nationally representative U.S. sample. Discrete-time survival analysis compared baseline risk of relapse to four hypothesized survival models that included time-invariant and time-varying factors across three subsequent time periods. Results The model predicting higher risk for more severe substance use disorders and psychiatric problems was supported. The hypothesized model that predicted time-varying increases in alcohol (but not drug) abstinence self-efficacy significantly affected risk of relapse. Hypothesized demographic and employment variables did not significantly predict relapse risk. Conclusions Results suggested that OH recovery homes may reduce relapse by providing closer monitoring and referring additional services to new residents with more severe prior addiction severity. Risk for relapse may also be reduced by enhancing abstinence self-efficacy for alcohol regardless of drug of choice.

The role of the orbitofrontal cortex and the nucleus accumbens for craving in alcohol use disorder

“…According to the World Health Organization (WHO) more than 3 million deaths worldwide are caused by harmful use of alcohol each year 4 . AUD is characterized by very high rates of post-residential treatment relapse (80–92%) 5 , 6 , especially in the first 3 months after residential treatment 7 , 8 . Thus, there is a need for more effective treatment regimens.…”

Telephone‐ and Text Message–Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study

“…Proactive high‐frequent contact by the psychotherapist, in which the psychotherapist asks questions about consumption, discusses coping skills in risk situations, and reinforces previous achievements, is related to higher self‐efficacy at 6‐month follow‐up. Regarding the enhanced risk for relapse in the first 3 months after residential treatment for patients with AUD (Harvey et al, 2016; Stohs et al, 2019), high‐frequency proactive contact by a psychotherapist especially in this vulnerable phase may provide significant support for the patient to overcome alcohol‐related problems. Further, the life table showed that the most vulnerable period for relapse is the first 4 weeks after residential treatment.…”

“…Continuing care, referred to as ongoing care after an initial phase of intensive care, is provided in different modalities and formats, such as group counseling, telephone‐based continuing care (TEL) and counseling, text message‐based continuing care (TEX), and individual self‐help groups (Lucht et al, 2014; Mckay, 2009). In particular, in the first 3 months after residential treatment, there is a high risk of relapse (Harvey et al, 2016; Stohs et al, 2019). However, many patients with AUD do not attend any continuing care or abandon attending care too early.…”

“…Regarding the evidence that relapse is common in the first 3 months following residential treatment (Harvey et al, 2016; Stohs et al, 2019), we hypothesized that high‐frequency personal contact with a psychotherapist during this time might prevent relapse more efficiently than low‐frequency personal contact and no contact. Therefore, in the high‐frequency TEL and TEX group, the frequency of contacts was carried out in the form of step‐down continuing care (contiguous episode of care at a lower level of intensity) with weekly contacts in the first month.…”

The phenotype of recovery V: Does delay discounting predict the perceived risk of relapse among individuals in recovery from alcohol and drug use disorders

“…In addition, increased stress response (i.e., cortisol levels; Wemm & Sinha, 2019), sleep deprivation (Brower & Perron, 2010), depression scores (Cornelius et al, 2003; Hammerbacher & Lyvers, 2006; Nguyen et al, 2020), and lack of social support (Cornelius et al, 2003; Hammerbacher & Lyvers, 2006; Rustad et al, 2015) predicted rates of relapse to substance use. Further, a higher number of pretreatment quit attempts, higher severity scores, and psychiatric severity predicted relapse in Oxford houses, sober living environments, after treatment (Harvey et al, 2015). For a recent comprehensive review of factors associated with relapse, see Sliedrecht et al (2019).…”