Individual, Familial and Environmental Risk Factors for Treatment Relapse Among Patients with Substance Use Disorders in Kerala: A Mixed Method Study

Abstract

ABSTRACT A statewide mixed-methods study was conducted at government-funded deaddiction centers in Kerala, India, to examine the psycho-socioeconomic risk factors of addiction relapse. 435 randomly selected participants from 36 Government-funded centers were included in the quantitative assessment. Among them, 50 were purposively selected for qualitative assessment. The quantitative assessment examined self-esteem, personality dimensions, and various risk factors associated with relapse. On the other hand, the qualitative assessment explored individual, psychological, familial, societal, and economic challenges. Among the beneficiaries, 271 were current and 166 ex-beneficiaries, and among the latter, 73 had addiction relapse. Relapsed patients were younger, had relatively stable jobs, used multiple substances more frequently, and had a family history of addiction. Additionally, individual risk factors of impulsivity and environmental risk factors of association with deviant peers were prevalent. Qualitative analysis identified risk and protective factors under three major domains – individual, environmental and familial. In relapsed patients, the individual and psychological vulnerabilities were activated by social and familial triggers. Though the family was protective, the patient’s expectations from the family were dissimilar and vague, which would be clarified during the treatment process. Therefore, the research suggests developing a patient-centric and process-driven personal care plan to prevent the risk of addiction relapse.