Relapse and Recovery in Addictions

Relapse and Recovery in Addictions

Frank M. Tims
Carl G. Leukefeld
Jerome J. Platt
Copyright Date: 2001
Published by: Yale University Press
https://www.jstor.org/stable/j.ctt5hk12s
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  • Book Info
    Relapse and Recovery in Addictions
    Book Description:

    In this book leading experts in the field of addictions report on key aspects of addictive disorders. They focus particularly on relapse, the longterm course of addiction to drugs or alcohol, and interventions to prevent relapse and promote recovery. A critical and highly complex public health problem, addiction is seen today as having biological, psychological, social, and cultural aspects. This important volume brings together the major perspectives on addiction, treatment, and recovery along with the current findings of clinical and scientific research.For those working with addicted patients and those making policy decisions that affect treatment and its availability, this book is an essential reference.

    eISBN: 978-0-300-14348-5
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-xii)
  3. I. Understanding Relapse and Recovery in Drug Abuse
    • ONE RELAPSE AND RECOVERY
      (pp. 3-17)
      Frank M. Tims, Carl G. Leukefeld and Jerome J. Platt

      Understanding of relapse and processes underlying recovery are essential elements in both the science and treatment of addictions. In this volume, we have set out to review major scientific issues, research findings, and treatment insights relating to those processes. This volume was originally conceived as an opportunity to revise and update the National Institute on Drug Abuse (NIDA) research monographRelapse and Recovery in Drug Abuse(Tims and Leukefeld 1986). The reader will see that this new effort goes beyond that limited goal. For one thing, the field has enlarged greatly in terms of our understanding of addiction, the development...

    • TWO DRUG TREATMENT CAREERS: CONCEPTUAL OVERVIEW AND CLINICAL, RESEARCH, AND POLICY APPLICATIONS
      (pp. 18-39)
      M. Douglas Anglin, Yih-Ing Hser, Christine E. Grella, Douglas Longshore and Michael L. Prendergast

      To obtain knowledge necessary for improving program practices and for informing policy makers, researchers have increasingly focused on drug use, its consequences, and its treatment from the perspective of the natural history of a person’s life, contextually embedded in social conditions and recording major life events and transitions among them that are meaningful to the subject (Hser, Anglin, & Powers, 1993; Hser, Anglin, Grella, Longshore, & Prendergast, 1997; Tims & Ludford, 1984; Vaillant, 1966). Numerous natural history studies conducted over the past thirty years have examined both the course of drug use and its treatment. This research has demonstrated that, once initiated, drug...

    • THREE RECOVERY AND THE CRIMINAL JUSTICE SYSTEM
      (pp. 40-59)
      David Farabee and Carl G. Leukefeld

      Although every arrested drug dealer is almost immediately replaced by another drug dealer, the successful rehabilitation of chronic drug users can result in actual decrements in the illicit drug market (Boyum and Kleiman, 1995). Reduced substance use is also associated with lower rates of criminal activity (Nurco et al., 1988), increased employment (Simpson & Sells, 1982), and reduced health care costs (Harwood et al., 1988; Rice et al., 1990). Indeed, the potential impact of substance abuse treatment for criminal offenders reaches well beyond the individual user, as do the financial and social costs of not providing treatment.

      In this chapter, we...

    • FOUR EUROPEAN PERSPECTIVES ON RELAPSE AND RELAPSE PREVENTION
      (pp. 60-106)
      Gerhard Bühringer, Michael Gossop, Dilek Türk, Shamil Wanigaratne and Charles Kaplan

      For many years the issues of relapse and relapse prevention were neglected in European clinical practice as well as in research into the course of addictive behaviours or treatment outcome. Despite the knowledge about high relapse rates learned from early follow-up studies (e.g., Polich, Armor & Braiker, 1980; Vaillant, 1983; Hubbard, Rachal, Craddock, & Cavanaugh, 1984) little attention was directed toward relapse issues by treatment providers. Thus, patients were not made aware of the significance of relapse risk, and treatment did not include strategies for successfully dealing with the problem of relapse.

      Litman and her colleagues in London in the 1970s conducted...

  4. II. Research on Relapse and Recovery in the Addictions
    • FIVE RELAPSE AFTER DRUG ABUSE TREATMENT
      (pp. 109-121)
      Robert L. Hubbard, Patrick M. Flynn, S. Gail Craddock and Bennett W. Fletcher

      Previous research has consistently documented that treatment for drug abuse reduces use during and after treatment (Gerstein et al., 1994; Hubbard et al., 1989; Hubbard et al., 1997; Institute of Medicine, 1996; McLellan et al., 1997; National Opinion Research Center at the University of Chicago, 1997; Simpson, 1997; Simpson & Curry, 1997; Simpson & Sells, 1990). The major national multisite studies of treatment (e.g., DARP—Drug Abuse Reporting Program, TOPS—Treatment Outcome Prospective Study, DATOS—Drug Abuse Treatment Outcome Studies) all provide evidence of treatment effectiveness (Institute of Medicine, 1996). Notwithstanding the overall effectiveness of treatment, relapse can and does occur. In...

    • SIX RELAPSE: CONTRIBUTING FACTORS, CAUSATIVE MODELS, AND EMPIRICAL CONSIDERATIONS
      (pp. 122-142)
      David S. Festinger, David F. Rubenstein, Douglas B. Marlowe and Jerome J. Platt

      Increasing attention on relapse prevention and its utility as a drug-free intervention has inspired interest in the multitude of possible correlates that might prevent, reduce, or predict the return to drug or alcohol use once abstinence has been achieved.

      Prior to the 1970s and 1980s, very little was known about the determinants of relapse among addicted individuals. Although researchers noted the high relapse rates found in their studies (e.g., Emrick, 1974; Hill & Blane, 1967; Hunt & Matarazzo, 1973; Hunt, Barnett, & Branch, 1971), scant information existed regarding the characterization, determinants, or consequences of relapse. Following the then-current Zeitgeist, most research on alcoholism...

    • SEVEN THE ROLE OF MOTIVATION AND READINESS IN TREATMENT AND RECOVERY
      (pp. 143-171)
      George De Leon, Gerald Melnick and Frank M. Tims

      Substance abuse is a complex problem involving numerous subpopulations and comorbidities. Researchers have attempted to provide a general recovery-stage model that formulates a common process. Motivation for change is an underlying dynamic variable believed to dominate the early stages of such recovery-stage models. Clinicians have long recognized the importance of motivational and readiness factors in recovery from chemical dependency, and within the past decade or so several lines of inquiry have empirically established the relevance of these factors for both treatment and recovery. Stages of Change formulations have generated studies related to motivation and readiness, particularly in the areas of...

    • EIGHT THE ROLE OF COMORBIDITY IN RELAPSE AND RECOVERY
      (pp. 172-207)
      Rajita Sinha and Richard Schottenfeld

      Substance use disorders often exist in conjunction with psychiatric disorders, and their co-occurrence has profound implications for assessment, classification, etiology, and treatment of both disorders (Clarkin & Kendall, 1992). Altered mood and mental status and psychiatric symptoms may co-occur independently of the substance use disorder as part of a psychiatric disorder, or secondary to substance intoxication and acute and protracted withdrawal states, thus making assessment and diagnosis of comorbidity challenging for the clinician. Further, patients with concurrent psychiatric and substance use disorders generally have a worse prognosis than those with either disorder alone. Patients with comorbid substance use disorders and psychiatric...

    • NINE EFFICACY OF COERCION IN SUBSTANCE ABUSE TREATMENT
      (pp. 208-227)
      Douglas B. Marlowe, David J. Glass, Elizabeth P. Merikle, David S. Festinger, David S. DeMatteo, Geoffrey R. Marczyk and Jerome J. Platt

      Coercion in substance abuse treatment is commonly viewed as being synonymous with a legal mandate to receive services. Clients who are involuntarily committed to treatment or referred to treatment by criminal justice authorities are typically defined as “coerced,” while the remaining clients are defined as “voluntary.” This has had several untoward consequences for measuring the effects of coercion on treatment outcome. First, statistical power is substantially reduced (by up to a third) when a continuous variable is dichotomized (e.g., Cohen, 1988). It is reasonable to assume that coercion is a continuous variable, with patients experiencing varying degrees and types of...

    • TEN ADOLESCENTS: ISSUES IN RELAPSE AND RECOVERY
      (pp. 228-250)
      Sherilynn F. Spear, James R. Ciesla, Sharon Y. Skala and Edyta D. Kania

      Although the popular press gives a good deal of attention to adolescent substance abuse, articles in scholarly and professional journals are more likely to focus on adults. To the extent that it exists, scientifically sound literature on adolescents tends to concentrate on prevention and primary treatment. Only a relatively small body of literature deals with relapse and recovery among chemically dependent adolescents (Spear and Skala, 1995). Consequently, it is the adult literature that has largely directed the formulation of research issues on relapse and recovery among adolescents. Although the issues identified for adults certainly have implications for adolescents treated for...

  5. III. The Search for Interventions
    • ELEVEN CASE MANAGEMENT IN SUBSTANCE ABUSE TREATMENT: PERSPECTIVES, IMPACT, AND USE
      (pp. 253-274)
      Harvey A. Siegal, Richard C. Rapp, Li Li and Pranjit Saha

      Case management is seen as a useful intervention for persons with substance abuse problems. It is assumed that the specific activities that compose case management help substance abusers access needed community services and enhance the quality and prolong the duration of their participation in treatment. This enhancement can lead to improved treatment outcomes like diminished likelihood of relapse. Case management has also been used in substance abuse treatment to offer social skills training and affect an increased level of coordination between substance abuse treatment and collateral services such as housing and vocational programs.

      During the past twenty years several practitioners...

    • TWELVE SELF-HELP INITIATIVES TO REDUCE THE RISK OF RELAPSE
      (pp. 275-302)
      Barry S. Brown, Timothy W. Kinlock and David N. Nurco

      Self-help initiatives are sufficiently wide-ranging to have penetrated both the popular and scientific press, and to have been endowed with the status of having become a “movement” (Gartner and Reissman, 1977). Thus, self-help strategies have been employed to support efforts at weight loss, recovery from a variety of dysfunctional family relationships (e.g., both having and being abusive parents, child loss, divorce), living with and recovering from a variety of diseases (e.g., cancer, AIDS, arthritis, psychiatric disorder) as well as recovery from an equally wide assortment of addictions (e.g., gambling, sex, alcohol, and various forms of illicit drug use). As suggested...

    • THIRTEEN PHARMACOTHERAPIES USED IN COMMON SUBSTANCE USE DISORDERS
      (pp. 303-333)
      Carl Hart, Elinore F. McCance-Katz and Thomas R. Kosten

      This chapter provides an overview of the role of pharmacotherapies in preventing relapse and facilitating recovery from substance use disorders.¹ The problem of drug abuse and dependence has a long history and spans both licit and illicit drugs. Our discussion, however, focuses on alcohol, nicotine, cocaine, and opiates. These substances were selected because of their public health importance and because a large amount of research has been conducted regarding their use. The following discussion is prefaced with the proviso that the pharmacotherapies reviewed in this chapter should be utilized in conjunction with psychosocial therapies in order to maximize clinical benefits...

    • FOURTEEN RELAPSE TO OPIOID AND COCAINE USE FOLLOWING METHADONE TREATMENT
      (pp. 334-354)
      Kirk M. Broome, D. Dwayne Simpson and George W. Joe

      The major outcome studies in the area of drug abuse treatment have established several facts about addiction and treatment. Treatment has a generally rehabilitative effect, with longer stays resulting in greater improvement, but some clients will return to use despite therapeutic intervention (Hubbard et al., 1989; Simpson, 1993, 1997; Simpson & Sells, 1982, 1990). The reality of relapse is frustrating for treatment providers. In the case of opioids, for example, approximately 60% of clients who used heavily before treatment relapse to some level of use in the year following treatment (Hubbard & Marsden, 1986; Simpson & Marsh, 1986). Evaluators and clinicians share a...

    • FIFTEEN RELAPSE AMONG COCAINE ABUSERS: THEORETICAL, METHODOLOGICAL, AND TREATMENT CONSIDERATIONS
      (pp. 355-378)
      Damaris J. Rohsenow and Peter M. Monti

      Cocaine abuse generates considerable concern because of its impact on medical and social problems, criminal activity, and overdose deaths, causing huge resulting costs to society (RAND 1992). The large-scale NIDA-sponsored Cocaine Treatment Outcome Study (CTOS) of results from treatment of cocaine abusers has found nationwide increases in abstinence from cocaine after treatment (Flynn et al., 1995), suggesting that various forms of treatment result in improvement. Because many cocaine abusers return to heavy use, however, improvements in prevention and treatment interventions remain important to develop.

      Many general approaches to the treatment of substance abusers have been reviewed in other chapters and...

    • SIXTEEN ARE MANAGED CARE AND RELAPSE PREVENTION COMPATIBLE?
      (pp. 379-398)
      Dennis McCarty and Shelley Steenrod

      Programs and health plans that impose standardization, control, measurement, and accountability on the delivery of health care in order to balance the utilization of services with cost management while maintaining quality of care are frequently labeled “managed care” (Goldstein, 1989; Mechanic, Schlesinger, & McAlpine, 1995; Wells, Astrachan, Tischler, & Unutzer, 1995). Managed care initiatives achieve their goals using (a) utilization management through preauthorization, case management, and utilization review, (b) selective contracting with practitioners on the basis of price and/or quality, and (c) risk sharing and other financial incentives (Goplerud, 1995; Mechanic et al., 1995).

      Organizations and individuals that deliver care often experience...

  6. IV. Evaluating Our Understanding of Recovery and Preventing Relapse
    • SEVENTEEN FUTURE DIRECTIONS IN SUBSTANCE ABUSE RELAPSE AND RECOVERY
      (pp. 401-413)
      Carl G. Leukefeld, Frank M. Tims and Jerome J. Platt

      Because substance abuse is a chronic and relapsing condition, this chapter explores future possibilities for substance abuse relapse and recovery initiatives with emphasis on practice and research. Relapse has been a consistent concern. Early relapse estimates (Wanberg and Horn, 1970) were that more than 90% of patients at twelve-month follow-up from alcohol treatment used substances, and almost half returned to pretreatment use. These findings highlight a reality that recovery is an ongoing process. In fact, relapse and recovery are practically and clinically intertwined.

      There are a number of persistent questions related to relapse and recovery. As examples: Is recovery the...

  7. INDEX
    (pp. 414-420)