All Relapses Are Not The Same

Recurrent drinking is common among patients with alcohol dependence who have received treatment. This study assessed whether certain types of relapses are more likely to recur, are more severe, or are more amenable to a particular psychosocial therapy.

Researchers examined data from 592 of 952 outpatients with alcohol dependence who had been randomized in a larger trial to receive motivational enhancement therapy, cognitive-behavioral therapy, or twelve-step facilitation therapy. These 592 subjects had experienced a relapse (i.e., drinking after being abstinent for at least 14 days) and completed the relapse-onset section of the Relapse Questionnaire, which assesses patient-perceived influences that contribute to relapse.

• Relapses were divided into 3 types: negative affect/family influences, craving/cued, and social pressure.
• When relapses recurred, they were often (about half the time) the same type as the initial relapse. Social pressure relapses were most likely to repeat (58% of the time).
• Negative affect relapses were the most severe (i.e., associated with a greater number of drinks consumed per day).
• The 3 therapies affected the overall risk of relapse similarly. However, motivational enhancement therapy offered less protection than the other therapies against social pressure relapse.

Comments:

This study provides a typology that can help clinicians efficiently assess relapse risk among patients with alcohol dependence. Clinicians who understand their patients’ prior types of relapses have the opportunity to provide individualized relapse prevention counseling or referral.

Peter D. Friedmann, MD, MPH

Reference:

Zywiak WH, Stout RL, Longabaugh R, et al. Relapse-onset factors in Project MATCH: the Relapse Questionnaire. J Subst Abuse Treat. 2006;31(4):341–345.