ORIGINALARTICLE Objective: The current study objective was to identify and explore the common reasons of relapse after abstinence in drug addiction. Study Design: Cross sectional. Place and Duration of Study: The study was conducted at the Department of Psychiatry Combined Military Hospital, Abbottabad from January to August 2019. Key Words: Abstinence, Rehabilitation, Substance Abuse. Conclusion: It is concluded that the main reasons of relapseare emotional instability, lack of family cooperation and confinement at rehabilitation centers against the will of individual for longer time. Therefore, rehabilitation process should be initiated with the motivation of the individual, followed by psycho education of the family and avoidance of unnecessary prolongs admission without consent of the individual. Materials and Methods: Individuals who were drug dependent and reported for detoxification were included in the study. Individual interviews were conducted through thematic guide regarding demographic details, name of substance of abuse, duration of substance abuse, number of previous self-attempts to quit the drug, average period of abstinence after self-attempt, reason of relapse after self-attempt, previous assisted attempts to quit the habit, average period of abstinence after assisted attempt, reason of relapse after assisted attempts. The responses were analyzed by using content analysis. Results: Participants (N=34) were males, age range 25 to 40 years, 58% married, 11% uneducated, 79% employed, 47% heroin addiction and 11% were using cannabis. The common reasons of relapse among self –attempt and assisted-attempt addicts after abstinence in drug addiction were peer pressure (social pressure), negative emotions from family (aggression discouragement and lack of empathy/sympathy), stress (traumatic events, bad physical/mental health)/ lack of motivation and easy availability of drugs (cheap, affordable and distributors are approachable). Resentment against confinement at rehabilitation centers was found only among assisted-attempt addicts after abstinence. Half of the self-attempt participants of the study, were abusing drugs for about last 5 years, 20% had tried to quit the drug on their own at least twice, 41.18 % for two weeks, 32.35 % for 1 month, and 26.47% remained abstinent after self-attempt to quit the drug for more than 6 months. On the contrary, 47 % of these individuals had two previous assisted attempts at rehabilitation centers to quit the drug. After assisted attempts 32.35 % remained abstinent for less than one day, 52.94% for one day, and 14.71 % for less than one week. How to cite this: Javed S, Chughtai K, Kiani S. Substance Abuse: From Abstinence to Relapse. Life and Science. 2020; 1(2): 68-71. doi: http://doi.org/10.37185/LnS.1.1.94 ABSTRACT Introduction Pakistan is one of the highest-ranking countries in the world with maximum number of drug addicts i.e., Substance abuse is 6.7 million drug users. conceptualized as one of the chronic ailments, accompanied with many physical and psychiatric issues that also poses substantial economic burden, not solely for an individual itself but for rest of family 1 members and society too. In every culture or nation, prevention of relapse is one the biggest and most 2 important challenge. The phenomenon of relapse is not easy to understand. It is complex, unpredictable Substance Abuse: From Abstinence to Relapse 1 2 3 Saira Javed , Kamran Chughtai , Shoaib Kiani Correspondence: Ms. Saira Javed Department of Social and Behavioral Sciences National University of Medical Sciences, Rawalpindi E-mail: [email protected] 1 Department of Social and Behavioral Sciences National University of Medical Sciences, Rawalpindi 2 Department of Psychiatry Combined Military Hospital, Abbottabad 3 Personal Administration Directorate GHQ, Rawalpindi Life & Science 2020 Vol. 1, No. 2 Substance Abuse Funding Source: NIL; Conflict of Interest: NIL Received: Jan 16, 2020; Revised: Feb 25, 2020 Accepted: Mar 05, 2020 68
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ORIGINAL�ARTICLE
Objective: The current studyobjectivewas to identify andexplore the common reasonsof relapseafterabstinenceindrugaddiction.StudyDesign:Crosssectional.PlaceandDurationofStudy:ThestudywasconductedattheDepartmentofPsychiatryCombinedMilitaryHospital,AbbottabadfromJanuarytoAugust2019.
KeyWords:Abstinence, Rehabilitation, Substance Abuse.
Conclusion:Itisconcludedthatthemainreasonsofrelapseareemotionalinstability,lackoffamilycooperationandconfinementatrehabilitationcentersagainstthewillofindividualforlongertime.Therefore,rehabilitationprocessshouldbeinitiatedwiththemotivationoftheindividual,followedbypsychoeducationofthefamilyandavoidanceofunnecessaryprolongsadmissionwithoutconsentoftheindividual.
MaterialsandMethods:Individualswhoweredrugdependentandreportedfordetoxificationwereincludedinthestudy.Individualinterviewswereconductedthroughthematicguideregardingdemographicdetails,nameofsubstanceofabuse,durationofsubstanceabuse,numberofpreviousself-attemptstoquitthedrug,average period of abstinence after self-attempt, reason of relapse after self-attempt, previous assistedattemptstoquitthehabit,averageperiodofabstinenceafterassistedattempt,reasonofrelapseafterassistedattempts.Theresponseswereanalyzedbyusingcontentanalysis.Results: Participants (N=34)weremales, age range 25 to 40 years, 58%married, 11% uneducated, 79%employed,47%heroinaddictionand11%wereusingcannabis.Thecommonreasonsofrelapseamongself–attemptandassisted-attemptaddictsafterabstinenceindrugaddictionwerepeerpressure(socialpressure),negativeemotionsfromfamily(aggressiondiscouragementandlackofempathy/sympathy),stress(traumaticevents,badphysical/mentalhealth)/lackofmotivationandeasyavailabilityofdrugs(cheap,affordableanddistributors are approachable). Resentment against confinement at rehabilitation centerswas foundonlyamongassisted-attemptaddicts afterabstinence.Halfof the self-attemptparticipantsof the study,wereabusingdrugsforaboutlast5years,20%hadtriedtoquitthedrugontheirownatleasttwice,41.18%fortwoweeks,32.35%for1month,and26.47%remainedabstinentafterself-attempttoquitthedrugformorethan6months.Onthecontrary,47%oftheseindividualshadtwopreviousassistedattemptsatrehabilitationcenterstoquitthedrug.Afterassistedattempts32.35%remainedabstinentforlessthanoneday,52.94%foroneday,and14.71%forlessthanoneweek.
How to cite this: Javed S, Chughtai K, Kiani S. Substance Abuse: From Abstinence to Relapse. Life and Science. 2020; 1(2): 68-71. doi: http://doi.org/10.37185/LnS.1.1.94
ABSTRACT
IntroductionPakistan isoneof thehighest-ranking countries intheworldwithmaximumnumber of drug addictsi.e., Substance abuse is6.7 million drug users.conceptualized as one of the chronic ailments,accompanied with many physical and psychiatricissuesthatalsoposessubstantialeconomicburden,notsolelyforanindividualitselfbutforrestoffamily
1membersandsocietytoo. Ineverycultureornation,preventionof relapse isone thebiggestandmost
2importantchallenge. Thephenomenonofrelapseisnoteasytounderstand.Itiscomplex,unpredictable
SubstanceAbuse:FromAbstinencetoRelapse1 2 3SairaJaved ,KamranChughtai ,ShoaibKiani
Correspondence:Ms. Saira JavedDepartment of Social and Behavioral SciencesNational University of Medical Sciences, RawalpindiE-mail: [email protected]
1Department of Social and Behavioral Sciences
National University of Medical Sciences, Rawalpindi2Department of Psychiatry
Combined Military Hospital, Abbottabad3Personal Administration Directorate
GHQ, Rawalpindi
Life&Science2020Vol.1,No.2 SubstanceAbuse
Funding Source: NIL; Conflict of Interest: NIL
Received: Jan 16, 2020; Revised: Feb 25, 2020
Accepted: Mar 05, 2020
68
Inthisstudythirtyfourpatientswereincludedwhowere relapsed addicts undergoing treatment atrehabilitation centers.Allparticipantsweremales,mostly25to40yearsofage,58%weremarried,11%were uneducated, 79% were employed. Mostcommon drug of abuse was heroin and cannabis
anddynamic.Manystudieshavefoundrelapseaftersuccessfuldetoxificationandrehabilitation.Thecore
3,4feature of addiction is relapse to drug usage.However,inidealsituation,substancedependencyisthoughttocondenseafterefficaciousdetoxificationandrehabilitationdeterminations,butevidencehasshown thehardest job for drug addicts is to keepawayfromdrugs.Mostoftherelapsedcases(90%)hadbeenreportedintimedurationofsixmonths,after been discharged from rehabilitation center.
4Withmostoftheaddictswereheroineabuser. ManynationalandinternationalprogramsarebeingrunbyvariousrehabilitationcentersinPakistan.Evidenceshave shown that 70% to 90% substance abusersreturn to the practice within one year afterdetoxification from hospitals or rehabilitationcenters,iftheyareconstrainedandapprehendedat
4,5the recovery centers. Relapse is a complexphenomenonwhich resulted in clusters of factorslikepersonalitytypes,temperaments,lackofcopingskills, emotional instability, pessimistic approach,traumatic events, aggression, peer pressure,f i n anc i a l con s t ra i n t s , de fe c t i ve fam i l y communication, culture and other environmental
5,6,7factors. The aim of this study is to explore thereasonsforrelapseaftersuccessfulabstinence,andto provide empirical insight for health care
7-8professionals.
MaterialsandMethodsThe study was conducted at the Department ofPsychiatry from Combined Military Hospital,Abbottabad, from January to August 2019.Questionnaire was designed after extensiveliterature review of reasons of relapse afterabstinence. In depth psychiatric inquiry was alsodoneafter fillingof structureddemographic sheet(tendencies for relapse, interpersonal conflicts,socialpressures,self-efficacy,social/familysupportandemployerattitudetowardsdrugabuse)fromtheparticipants.Onlythoseindividualswereincludedinthisstudywhowereabletosigntheconsentform.
Results
about 47% and 32% respectively in addition withotherdrugslikeice,coughsyrupsandbarbiturates.In this study it is evident to mention that 14.7%participants have shown no specific evidence ofrelapse after self and assisted attempt.Reasonofrelapseafterself-attemptwererecorded26.5%duetopeerpressure(socialpressure),41.2%have reported thatnegativeemotions from family(aggression discouragement and lack of empathy/sympathy) resulted in re lapse. Furthermore, 14.7% participants reported stress(traumaticevents,badphysical/mentalhealth)and2.9%easyavailabilityofdrugs(cheap,affordableanddistributorsareapproachable)weremaincauseofrelapseafter-selfattemptofabstinent.Incontrast,reasonoffailureafterassistedattemptorrelapsein20.6% were because of peer pressure (socialpressure), negative emotions from family(aggression discouragement and lack of empathy/sympathy) were the cause in 5.9% onlydrugaddicts,whereaslackofmotivationwasin2.9%and55.9%wasresentmentagainstconfinementatrehabilitationcentersasshownintable1.
In self-attempt, 50% of participants were abusingdrugsforaboutlast5years.20%oftheseindividuals
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had tried to quit the drug on their own (self-attempted)atleasttwiceinlastfiveyears,41.18%fortwo weeks, 32.35% for 1 month, and 26.47%remained abstinent after self-attempt to quit thedrugformorethan6months.Onthecontrary,47%of these individuals had two previous assistedattemptsatrehabilitationcenterstoquitthedrug.Afterassistedattempts32.35%remainedabstinentforlessthanoneday,52.94%for1day,and14.71%forlessthan1weekasshownintable2.
wereabletomaintainabstinenceforsixmonthsormore There are numerous factors responsible for
8drugabuserrelapse. Identificationofcausesamongaddictsassociatedwithrelapsecanhelptodeviseamanagement plan so that patients can continue
9abstinent effectively. Studies have explained thatrelapse is more expected to happen among
8individualswhohavemaladaptivecopingstrategies ,10 11,13
low socioeconomic status , higher distress and12,13anxiety. Similar trends have been seen in this
study,where highest relapse rate has been foundamong individual with negative emotions and
14,15receiveinsufficientsupportfromtheirlovedones. Respondents 41% have reported that negativeemotions from the family demotivates them.Furthermore, 26% individuals explained that peerpressure leads to relapse in otherwise motivatedindividuals.
Conclusion
It is important to document that duration ofabstinence was higher among those participantswhowereconvincedandencouragedtoquithabitascomparedtothoseparticipantswhowereforcedto
16,17chooseabstinentagainsttheirchoice. Apartfrommanyotherbio-psycho-socialcausesthateventuallycontribute to relapse, social/peer pressure andnegative emotions from family are the mostdominant. Positive support from family membersinduce confidence, brings emotional stability anddevelop optimistic approach in addicts thatmotivates them to quit drug abuse by bringingpositivereinforcement. It is important tomotivatethedrugabusertoquitbutequallyimportantistoeducatemembertoidentifynegativebehaviorsandapproachessothatrehabilitationandabstinenceofthe individual is more operative, efficient and
17,18,19persistent.
Itisconcludedthatefficientrehabilitationprogramsare required to avoid relapse after abstinence asnumber of successful cases are lower than theexpected rate. It is also important tobring insightamong drug abusers through various formal andnon-formal education programs. Individuals mustnotbeconfinedtorehabagainsttheirconsent.Thefamilyneedstobeeducatedaboutconsequencesofissue. Finding a tailor-made solution for theseindividualsmay substantiate tobe likeexploringaneedleinhaystack,butit'sworthtryingtofacilitate
Ithasbeenseenthatsubstanceabuserswhowereself-motivatedwereabletoretaintheirabstinencefor an extendedperiodof sixmonths. Conversely,those participants who were forced to leave thehabitagainsttheirwillinrehabilitationcenters,theabstinencetimeislessthanoneweekandonlyfew
Themostcommonchallenge facedbycommunity,family or by drug abuse individual himself is ofrelapse. Relapse is accompanied bymany psycho-
9,10social factors that lead to abstinent. The studyexplored the common reasons for the relapse ofsubstance abuse. Evidences have shown that theexcessive abuse of heroine drug is followed bycannabis.Interestingly,manydrugaddictsreportedthattheyintenttostopthehabitofsubstanceabuse,72%participantstriedtoquitthehabitofdrugabusewillinglybynoticingitsconsequencesindailylifeandontheirhealth,buttheyalsoreportedthatdespitethefactorofmotivationandinsightofconsequencesthey were unable to quit and were not able tocontinueabstinence.Theempiricalevidenceofthecurrent study is opposing to the previous studieswhere researchers found it was difficult for the
8,11abuserstoquitdrugs.
Discussion
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theseindividualswhohavebeencastedoutofthesociety.
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