Abuse Relapse Research Articles

Selective inhibition of cocaine-seeking behaviour by a partial dopamine D3 receptor agonist.

Environmental stimuli that are reliably associated with the effects of many abused drugs, especially stimulants such as cocaine, can produce craving and relapse in abstinent human substance abusers. In animals, such cues can induce and maintain drug-seeking behaviour and also reinstate drug-seeking after extinction. Reducing the motivational effects of drug-related cues might therefore be useful in the treatment of addiction. Converging pharmacological, human post-mortem and genetic studies implicate the dopamine D3 receptor in drug addiction. Here we have designed BP 897, the first D3-receptor-selective agonist, as assessed in vitro with recombinant receptors and in vivo with mice bearing disrupted D3-receptor genes. BP 897 is a partial agonist in vitro and acts in vivo as either an agonist or an antagonist. We show that BP 897 inhibits cocaine-seeking behaviour that depends upon the presentation of drug-associated cues, without having any intrinsic, primary rewarding effects. Our data indicate that compounds like BP 897 could be used for reducing the drug craving and vulnerability to relapse that are elicited by drug-associated environmental stimuli.

Preventing relapse and maintaining change in addictive behaviors.

While a variety of cognitive-behavioral interventions are efficacious in reducing substance abuse, posttreatment relapse rates remain considerably high, contributing to a belief that substance use disorders are chronic and episodic conditions. For over two decades, cognitive-behavioral relapse prevention has become incorporated into substance abuse treatment by offering a specific perspective on relapse and a set of strategies aimed at maintaining behavioral change over the long haul and to reduce the impact of the fall should a slip occur. We first review Mariatt's original relapse prevention model, followed by an overview of substance abuse relapse prevention treatment outcome literature and review of studies testing components of the original model. We conclude with a discussion of recommendations for future directions.

Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders

A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.

Case management services for adolescent substance abusers: A program description

A case management model for adolescent substance abusers whose problems are severe enough to warrant residential treatment is presented, based on the experience of a demonstration project. The five integral functions of case management (assessment, planning, linking, advocacy, and support) are described within the framework of each phase of an adolescent's treatment program (screening, residential treatment, and continuing care). Detailed descriptions of case management activities and the philosophy underlying case management are addressed. The integrated client tracking and program evaluation monitoring system developed for the case management project is described, and evaluation data are presented. Among the advantages case managers are able to offer to the entire treatment process include encouragement of family involvement in the youth's recovery; providing support; tracking substance abuse relapse episodes following treatment; connecting the youth with school, work, and community resources; and helping youth to fulfill legal obligations.

The role of attributions in abstinence, lapse, and relapse following substance abuse treatment.

This study examined the role of attributions in the lapse and relapse process following substance abuse treatment. According to Marlatt and Gordon's theoretical framework, attributions made after a lapse (e.g., the Abstinence Violation Effect [AVE]) determine whether it progresses to a relapse. Also examined were the attributions of recovering drug users who were tempted but remained abstinent (never lapsed). Ninety-seven participants were recruited from an inpatient treatment center for substance abuse and completed an interview 6 months after leaving treatment. Findings partially confirmed predictions made by the AVE. Predictions made by the AVE were not supported in that lapsers and relapsers were similar regarding their internal/external attributions following a return to drug use; predictions were supported as relapsers made more stable and global attributions as compared to lapsers. Also as predicted, abstainers made more internal, stable, and global attributions regarding their abstinence (as compared to lapsers following their slip). Abstainers' attributions for their success in remaining abstinent tended to be similar to the attributions made by relapsers for their failure to remain abstinent (i.e., for their relapse). Combined, these findings highlight the complexity of the attributional process in early recovery from substance abuse. Clinical and research implications of the findings are discussed in relation to substance abuse relapse prevention.

Can Cocaine Craving Be a Medication Development Outcome?

Craving, which ranges from a sustained desire for drugs persisting for weeks to an acute desire passing within minutes, has been described as an important clinical precipitant of relapse in cocaine and opioid abusers and may be a useful surrogate outcome for developing new drug abuse pharmacotherapies. Whereas craving for opioids frequently has been conceptualized as the negative reinforcer of protracted withdrawal or “drug hunger,” craving for cocaine has been conceptualized as the positive reinforcer of remembered euphoria. Medications can reduce both sustained cocaine craving and acute craving induced by a single dose of cocaine, and reductions in both types of craving are correlated with reductions in cocaine use. Furthermore, high levels of craving during treatment or during cue‐induced challenges predict poor treatment response and later relapse to cocaine abuse in those who have attained abstinence.

Can Cocaine Craving Be a Medication Development Outcome?: Drug Craving and Relapse in Opioid and Cocaine Dependence

Craving, which ranges from a sustained desire for drugs persisting for week to an acute desire passing within minutes, has been described as an important clinical precipitant of relapse in cocaine and opioid abusers and may be a useful surrogate outcome for developing new drug abuse pharmacotherapies. Whereas craving for opioids frequently has been conceptualized as the negative reinforcer of protracted withdrawal or “drug hunger,” craving for cocaine has been conceptualized as the positive reinforcer of remembered euphoria. Medications can reduce both sustained cocaine craving and acute craving induced by a single dose of cocaine, and reductions in both types of craving are correlated with reductions in cocaine use. Furthermore, high level of craving during treatment or during cue-induced challenges predict poor treatment response and later relapse to cocaine abuse in those who have attained abstinence.

Social resource characteristics and adolescent substance abuse relapse

Abstract Social environment features have been implicated in the addiction relapse process. The present study examined social resource network characteristics of adolescent substance abusers to determine whether the alcohol/drug use, perceived similarity and/or perceived support of individuals in the social resource network was associated with drug use outcome. Perceived similarity to one's social network emerged as an important moderator of whether the social network provides support to remain abstinent or elevates risk for relapse. Increased perceived support predicted continued post‐treatment abstinence when recovering teens perceived their social resource network as similar to themselves. Conversely, post‐treatment relapse was most likely when recovering teens perceived themselves as similar to a social resource network comprised of using and/or abusing individuals.

Relationship of marital structure and interactions to opiate abuse relapse

Relationship of marital structure and interactions to opiate abuse relapse

Relationship of marital structure and interactions to opiate abuse relapse.

Several aspects of marital functioning were associated with subsequent relapse to opiate abuse in 17 married addicts. The addicts and spouses were evaluated in a task-oriented interview and rated using the Beavers Timberlawn Family Assessment instrument. The global health-pathology ratings on this instrument indicated that most couples had rigid patterns of interacting, rather than a chaotic lack of structure or a flexible, negotiated partnership. Within this range of rigid functioning, higher ratings were associated with longer times drug-free (up to 18 months with a mean of 7 months). On the seven subscales of the Beavers', five were significantly correlated with the time drug-free: effective and clear leadership, closeness between the spouses, a nonhostile mood, empathy, and efficient negotiation and problem solving. The subscales associated with drug abstinence were quite different for a group of seven single ex-addicts participating in the same outpatient program, but living with their parents. For these single ex-addicts three subscales were correlated with the time drug-free: parental reaction to separation strivings, the open expression of thoughts and feelings, and empathy. This difference in the subscales associated with abstinence for married versus single addicts suggested some specificity in the characteristics of family structure and interaction that may be related to drug abstinence.