Relapse Precipitants in Opiate Addiction : Assessment in Community Treatment Setting

Drug and alcohol dependence is a chronic relapsing disorder so that there is a need for continued care to prevent relapses. Relapse is generally understood as a return to earlier pattern of use for a drug after a period abstinence. The factors leading to relapse can be intra-psychic and interpersonal. In an attempt to understand the factors leading to first use and relapse in opioid dependence this study was conducted in a community treatment setting at the De-addiction centre of All India Institute of Medical Sciences. The sample consisted of 25 consecutive subjects with opioid dependence who had used the opioid after a period of 3 weeks of self reported abstinence in the 6 months prior to assessment. A semi-structured interview schedule was used to interview the subjects. The results showed that about 2/3rds of the sample had heroin dependence whereas the rest had buprenorphine dependence. After the first use, which occurred after a mean abstinence of 16.4 weeks. 19/25 subjects progressed to regular use (relapse) within a mean period of 8.7 days. The reasons for first use and regular use were almost the same and the common reasons were sleep disturbances, body ache and urges to take the drug. Some subjects reported sadness, family conflict and peer influences also as reasons for first as well as regular use. This preliminary study found that the factors leading to first use and regular use in our subjects are the same and that very soon after the first use the regular use ensues thus interventions that focus on preventing first use need to be emphasised.