What is a relapse? Fifty ways to leave the wagon

Miller, William R.

doi:10.1080/09652149638773

Cited by 36 publications

(62 citation statements)

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“…High rates of lapse (65-80%) have been reported for alcohol, opiates, and tobacco dependence treatments, 6,[18][19][20] and low rates for cocaine dependence. 7,14 Do these results suggest that users of psychostimulants have lower rates of lapse or relapse after treatment than users of other drugs?…”

Section: Discussionmentioning

confidence: 99%

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Chiang

Chan

Chen

et al. 2006

Psychiatry Clin Neurosci

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Illicit drug users are generally considered both patients and criminals in Taiwan. This study presents drug use behaviors and criminal recidivism of male subjects incarcerated for illicit drug use in Taiwan after detoxification at a detention center. This study also examined the relationship between drug use behaviors and subsequent recidivism. Charts and crime records of 794 male patients from the acute detoxification unit in a detention center in northern Taiwan were reviewed. These subjects were incarcerated for methamphetamine or/and heroin use. The authors examined the relationship between the variables collected during detoxification and subsequent recidivism of illicit drug use in the following 5 years after detoxification. Of 794 subjects, 539 (67.9%) were repeat offenders during the following 5 years after detoxification. Their recidivism occurred primarily within the first 2 years after being released into the community. The recidivism rate for heroin users was significantly higher than that of methamphetamine users. Aged under 30 years, a previous criminal record, and a positive urine analyses test for illicit drugs upon entering the detoxification unit were significantly associated with recidivism. Recidivism rates of illicit drug users in Taiwan after detoxification in the detention center were substantially high. The efficacy of detoxification programs at detention centers in Taiwan needs to be re-evaluated.

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Section: Discussionmentioning

confidence: 99%

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Chiang

Chan

Chen

et al. 2006

Psychiatry Clin Neurosci

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“…Authors infrequently cited a theoretical or even an empirical precedent for the definitions of relapse used. It could be argued that exceptions are the large minority of studies that defined relapse (or "lapse" or "slip") as any use of alcohol or other drugs, in that such definitions imply application of the medical disease model of AUD (e.g., Miller, 1996;Moskalewicz, 2012). Yet, none of the "any use" studies were explicitly guided by a medical disease model of relapse.…”

Section: Relapse As a Heuristicmentioning

confidence: 99%

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Maisto

Witkiewitz

Moskal

et al. 2016

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Alcohol use disorder (AUD) relapse is a construct that has been of major clinical and research interest but has been inconsistently defined. The purpose of this study was to review the definitions of AUD relapse that have been used in clinical research as a basis for drawing conclusions about its heuristic value. Method: A systematic review of the literature was conducted on empirical studies that (a) were published in peer-reviewed journals, (b) were published between 2010 and 2015, (c) were written in English, and (d) provided a definition of alcohol relapse (or lapse) that was used in the study. Results: The review yielded 139 individual studies that met inclusion criteria. The studies showed wide variability in how relapse was defined and interpreted in the literature, and there was little direct empirical or theoretical rationale provided for the definitions of relapse that were chosen. Furthermore, the concept of AUD relapse as a discrete state is not consistent with the empirical literature on the clinical course of alcohol consumption. Conclusions: We conclude that the heuristic value of AUD relapse as currently studied is low. An alternative approach that embeds the construct in theory and data on the clinical course of alcohol consumption and aligns with current trends in healthcare would seem to have a better chance of improving AUD clinical decision-making and knowledge about AUD in general. (J. Stud. Alcohol Drugs, 77, 849-858, 2016 T HE TERM RELAPSE is part of the common discourse with respect to addictive behaviors. For example, a simple Google search for either "relapse and addiction" or "relapse and alcohol" yields millions of results. The purpose of this article is to examine the use of the term relapse in the area of alcohol use/alcohol use disorder (AUD) change, whether by self-initiation, the use of mutual-help groups, formal treatment services, or some combination of the three. The ultimate goal of this line of inquiry is to appraise the heuristic value of the term relapse in advancing clinical research and treatment. Heuristic value in this article means value in aiding the discovery of knowledge about AUD clinical course through the generation of research. The article begins with an overview of conceptual definitions of AUD relapse followed by reporting the findings of a systematic review of recently published (2010)(2011)(2012)(2013)(2014)(2015) empirical studies that have included relapse as an independent or dependent variable. Definition of relapseAccording to the online edition of the Merriam-Webster Dictionary (n.d.), "relapse" is derived from the Latin word relabi, which means "to slide back." Relapse as a verb means "to become ill again after a period of improvement in health," or "to return to a bad condition, form of behavior, etc." The noun form of relapse simply means a return of illness or a return to a former and undesirable condition.The construct of relapse is often applied in reference to what typically are considered physical illnesses. In this conte...

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“…Keywords alcohol relapse; drinking trajectories; growth mixture modeling; catastrophe modeling; self-efficacy Alcohol relapse has been described as a discrete phenomenon and as a process of behavior change (Brownell, Marlatt, Lichtenstein, & Wilson, 1986;Miller, 1996). More recent conceptualizations of relapse have defined lapse as the initial setback (e.g., a discrete drinking episode) after a period of abstention, prolapse as a return to abstinence or moderate drinking goals, and relapse as a dynamic process of continual lapses and prolapses (e.g., Donovan, 1996;Witkiewitz & Marlatt, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy. These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.Keywords alcohol relapse; drinking trajectories; growth mixture modeling; catastrophe modeling; self-efficacy Alcohol relapse has been described as a discrete phenomenon and as a process of behavior change (Brownell, Marlatt, Lichtenstein, & Wilson, 1986;Miller, 1996). More recent conceptualizations of relapse have defined lapse as the initial setback (e.g., a discrete drinking episode) after a period of abstention, prolapse as a return to abstinence or moderate drinking goals, and relapse as a dynamic process of continual lapses and prolapses (e.g., Donovan, 1996;Witkiewitz & Marlatt, 2004).…”

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confidence: 99%

Nonnormality and divergence in posttreatment alcohol use: Reexamining the Project MATCH data "another way."

Witkiewitz¹,

Maas²,

Hufford³

et al. 2007

Journal of Abnormal Psychology

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Alcohol lapses are the modal outcome following treatment for alcohol use disorders, yet many alcohol researchers have encountered limited success in the prediction and prevention of relapse. One hypothesis is that lapses are unpredictable, but another possibility is the complexity of the relapse process is not captured by traditional statistical methods. Data from Project Matching Alcohol Treatments to Client Heterogeneity (Project MATCH), a multisite alcohol treatment study, were reanalyzed with 2 statistical methodologies: catastrophe and 2-part growth mixture modeling. Drawing on previous investigations of self-efficacy as a dynamic predictor of relapse, the current study revisits the self-efficacy matching hypothesis, which was not statistically supported in Project MATCH. Results from both the catastrophe and growth mixture analyses demonstrated a dynamic relationship between self-efficacy and drinking outcomes. The growth mixture analyses provided evidence in support of the original matching hypothesis: Individuals with lower self-efficacy who received cognitive behavior therapy drank far less frequently than did those with low self-efficacy who received motivational therapy. These results highlight the dynamical nature of the relapse process and the importance of the use of methodologies that accommodate this complexity when evaluating treatment outcomes.Keywords alcohol relapse; drinking trajectories; growth mixture modeling; catastrophe modeling; self-efficacy Alcohol relapse has been described as a discrete phenomenon and as a process of behavior change (Brownell, Marlatt, Lichtenstein, & Wilson, 1986;Miller, 1996). More recent conceptualizations of relapse have defined lapse as the initial setback (e.g., a discrete drinking episode) after a period of abstention, prolapse as a return to abstinence or moderate drinking goals, and relapse as a dynamic process of continual lapses and prolapses (e.g., Donovan, 1996;Witkiewitz & Marlatt, 2004). The characterization of the alcohol relapse process as a dynamic and "complex" phenomenon has been described by several authors (Brownell et al., 1986;Hufford, Witkiewitz, Shields, Kodya, & Caruso, 2003;Marlatt, 1996;Shiffman, 1989), yet the most commonly used statistical analyses to assess alcohol treatment outcomes (e.g., multiple regression, repeated measures analysis of variance [ NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript complexity in the observed data. For example, the use of a continuous linear model a unit change in some risk factor predicts a unit change in drinking behavior, but in reality an ostensibly insignificant change in risk often corresponds with sudden changes in drinking. Drawing from this clinical and empirical observation, we propose that the alcohol relapse process is best characterized as a nonlinear dynamical system, and we evaluate two methods for testing dynamical models of alcohol consumption following treatment.The complexity of the alcohol relapse process is easily observed by examining the betwee...

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What is a relapse? Fifty ways to leave the wagon

Cited by 36 publications

References 0 publications

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Is the Construct of Relapse Heuristic, and Does It Advance Alcohol Use Disorder Clinical Practice?

Nonnormality and divergence in posttreatment alcohol use: Reexamining the Project MATCH data "another way."

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