What predicts relapse? Prospective testing of antecedent models

Abstract

Predictors of relapse to drinking were examined in a clinical sample of 122 individuals seeking outpatient treatment for alcohol problems. Drinking status and a variety of predictor variables were measured every two months for one year following presentation for treatment. In addition to pretreatment characteristics, potential antecedents of relapse were assessed at each point within five domains: (1) the occurrence of negative life events; (2) cognitive appraisal variables including self‐efficacy, alcohol expectancies, and motivation for change; (3) client coping resources; (4) craving experiences; and (5) affective/mood status. Although the occurrence of adverse life events did not predict 6‐month relapse, all other domains singly accounted for significant variance in drinking outcomes. Proximal antecedents (from the prior 2‐month interval) significantly and substantially improved predictive power over that achieved from pretreatment characteristics alone. When analyzed jointly, these predictors accounted for a majority of variance in 6‐month relapse status. A prospective test supported Marlatt's developmental model of relapse, pointing to two client factors as optimally predictive of resumed drinking: lack of coping skills and belief in the disease model of alcoholism.

Understanding Recovery Barriers: Youth Perceptions About Substance Use Relapse

“…The principal investigator (PI) moderated each group using scripted questions. 34 A research assistant (RA) trained in focus group procedures assisted with moderating the focus groups.…”

“…To date, conceptual models tend to categorize relapse using 4 major precursors/antecedents, 34,35 including the specific drug (agent), characteristics of the user (personal), characteristics of the user’s social relationships/setting (interpersonal), and environmental (situational) factors. Relapse precursors that have received the most support include negative affective emotional states, 34,36,37 cognitive-behavioral factors including self-efficacy/confidence, 38 outcome expectancies, 39 urges/temptations, 40 coping, 41,42 and motivation/readiness to change.…”

“…Relapse precursors that have received the most support include negative affective emotional states, 34,36,37 cognitive-behavioral factors including self-efficacy/confidence, 38 outcome expectancies, 39 urges/temptations, 40 coping, 41,42 and motivation/readiness to change. 34,44,45 …”

Retire the Concept of “Relapse”

“…As a black-or-white dichotomy the term inherently contains what Marlatt called the "abstinence violation effect," that having once broken a rule all is lost (Cummings, Gordon, & Marlatt, 1980). In a prospective study of drinking outcomes, clients who most accepted this disease model of alcoholism were also those most likely to "relapse" (Miller, Westerberg, Harris, & Tonigan, 1996). Outcomes are not so binary, and we create a needlessly gloomy public and professional impression of addiction treatment by promulgating such black-or-white thinking.…”

An empirical study of attachment dimensions and mood disorders in inpatient substance abuse clients: The mediating role of spirituality

“…Individuals who struggle with these comorbid disorders are more likely to relapse once they experience depressive symptoms (Miller et al 1996;Strowig 2000). In addition, the severity of the drug abuse has been shown to be greater in the presence of co-occurring disorders (Tate et al 2004).…”