Relapse and Recovery in Drug Abuse, 72

205 Pages·2002·1.38 MB·English

RESEARCH ANALYSIS
and
UTILIZATION SYSTEM
Relapse and
Recovery
in Drug Abuse
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Alcohol, Drug Abuse, and Mental Health Administration
Relapse and Recovery
in Drug Abuse
Editors:
Frank M. Tims, Ph.D.
Carl G. Leukefeld, D.S.W.
Division of Clinical Research
National Institute on Drug Abuse
NIDA Research Monograph 72
1986
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Alcohol, Drug Abuse, and Mental Health Administration
National Institute on Drug Abuse
5600 Fishers Lane
Rockville, Maryland 20857
For sale by the Superintendent of Documents, Congressional Sales Office
U.S. Government Printing Office, Washington, DC 20402
NIDA Research Monographs are prepared by the research divisions of the
National institute on Drug Abuse and published by its Office of Science. The
primary objective of the series is to provide critical reviews of research problem
areas and techniques, the content of state-of-the-art conferences, and
integrative research reviews. Its dual publication emphasis IS rapid and targeted
dissemination to the screntific and professional community.
Editorial Advisors
MARTIN W. ADLER, Ph.D. MARY L. JACOBSON
Temple University School of Medicine National Federation of Parents for
Philadelphia, Pennsvlvania Drug-free Youth
Omaha, Nebraska
SYDNEY ARCHER, Ph.D.
Rensselaer Polytechnic lnstitute
Troy, New York REESE T. JONES, M.D.
Langley Porrer Neuropsychiatric lnstitute
RICHARD E. BELLEVILLE, Ph.D.
San Francisco, California
NE Associates, Health Sciences
RockviIle, Maryland
DENISE KANDEL, Ph.D.
KARST J. BESTEMAN
College of Physicians and Surgeons of
Alcohol and Drug Problems Association
Columbia University
of North America
New York, New York
Washington, D.C.
GILBERT J. BOTVIN, Ph.D.
HERBERT KLEBER, M.D.
Cornell University Medical College
Yale University School of Medicine
New York, New York
New Haven, Connecticut
JOSEPH V. BRADY, Ph.D.
The Johns Hopkins University School of
RICHARD RUSSO
Medicine
Baltimore, Maryland New Jersey State Department of Health
Trenton, New Jersey
THEODORE J. CICERO, Ph.D.
Washington University School of
Medicine
St Louis, Missouri
NIDA Research Monograph Series
CHARLES R. SCHUSTER, Ph.D.
Director, NIDA
THEODORE M. PINKERT, M.D., J.D.
Acting Associate Director for Science, NIDA
Parklawn Building. 5600 Fishers Lane, Rockville, Maryland 20857
Relapse and Recovery
in Drug Abuse
This monograph is based upon papers and discussion from the RAUS
Review Conference on Relapse and Recovery in Drug Abuse which took
place on September 19 and 20, 1985, in Rockville, Maryland. The
review was sponsored by the Office of Science and the Division of
Clinical Research, National Institute on Drug Abuse.
COPYRIGHT STATUS
The National Institute on Drug Abuse has obtained permission from
the copyright holders to reproduce certain previously published
material as noted in the text. Further reproduction of this
material is permitted only as part of a reprinting of the entire
publication or chapter. For any other use, the copyright holder's
permission is required. All other material in this volume except
quoted passages from copyrighted sources is in the public domain
and may be used or reproduced without permission from the Institute
or the authors. Citation of the source is appreciated.
The U.S. Government does not endorse or favor any specific
commercial product. Trade or proprietary names appearing in this
publication are used only because they are considered essential in
the context of the studies reported herein.
Opinions expressed in this volume are the views of the authors and
do not necessarily reflect the official position of the National
Institute on Drug Abuse or any other part of the U.S. Department of
Health and Human Services.
DHHS Publication No. (ADM)90-1473
Alcohol, Drug Abuse, and Mental Health Administration
Printed 1986, Reprinted 1988, 1990
NIDA Research Monographs are indexed in the Index Medicus. They
are selectively included in the coverage of American Statistics
Index, Biosciences Information Service, Chemical Abstracts, Current
Contents, Psychological Abstracts, and Psychopharmacology Abstracts
iv
Preface
The Research Analysis and Utilization System (RAUS) is designed
to serve four functions:
Collect and systematically classify the findings of all
intramural and extramural research supported by the
National Institute on Drug Abuse (NIDA);
Evaluate the findings in selected areas of particular
interest and formulate a state-of-the-art review by a
panel of scientific peers;
Disseminate findings to researchers in the field and to
administrators, planners, instructors, and other
interested persons;
Provide a feedback mechanism to NIDA staff and planners
so that the administration and monitoring of the NIDA
research program reflect the very latest knowledge
gleaned from research in the field.
Since there is a limit to the number of research findings that
can be intensively reviewed annually, four subject areas are
chosen each year to undergo a thorough examination.
Distinguished scientists in the selected field are provided with
copies of reports from NIDA-funded research and invited to add
any information derived from the literature and from their own
research in order to formulate a comprehensive view of the
field. Each reviewer is charged with writing a state-of-the-art
paper in his or her particular subject area. These papers,
together with a summary of the discussions and recommendations
which take place at the review meeting, make up a RAUS Review
Report in the NIDA Research Monograph Series.
Relapse and recovery are two related areas which are central to
drug abuse treatment and research. This view of drug addiction
and dependence as chronic, relapsing disease is supported by both
v
research and clinical experience. Recent research shows that
many drug abusers have relatively short "addiction careers" and
suggests that with a better understanding of relapse (and its
prevention), we may be able to assist clients more effectively in
reaching a state of recovery.
The meeting on which this monograph is based took place September
19-20, 1985, at the National Institute on Drug Abuse. Its focus
was on: (1) a review of available theoretical perspectives;
(2) reviews of long-term studies of treated samples to assess
patterns of relapse and recovery over protracted time spans;
(3) understanding relapse and recovery through examination of
controlled studies and shorter term followup research; and
(4) implications of research for clinical practice. The meeting
was jointly chaired by Frank M. Tims, Ph.D., and Carl G. Leuke-
feld, D.S.W. Ms. Jacqueline P. Ludford, Chief, Research Analysis
Branch, Office of Science, is coordinator of NIDA's RAUS system.
vi
Contents
Preface v
Relapse and Recovery in Drug Abuse: An Introduction
Frank M. Tims and Carl G. Leukefeld 1
Theories of Relapse and Recovery and Their Implications
for Drug Abuse Treatment
Donald R. Wesson, Barbara E. Havassy, and David E. Smith 5
The Drug Dependence Syndrome Concept as an Organizing
Principle in the Explanation and Prediction of Relapse
Thomas F. Babor, Ned L. Cooney, and Richard J. Lauerman 20
Acquisition, Maintenance, Cessation, and Reacquisition:
An Overview and Behavioral Perspective of Relapse to
Tobacco Use
John Grabowski 36
Relapse and Recovery in Substance Abuse Careers
James F. Maddux and David P. Desmond 49
Multivariate Description of Alcoholism Careers:
A 10-Year Followup
Colin Taylor, David Brown, Anni Duckitt, Griffith
Edwards, Edna Oppenheimer, and Margaret Sheehan 72
Relapse and Recovery Among Opioid Addicts 12 Years
After Treatment
D. Dwayne Simpson and Kerry L. Marsh 86
The Process of Smoking Relapse
Thomas H. Brandon, Stephen T. Tiffany,
and Timothy B. Baker 104
Commitment to Abstinence and Relapse to Tobacco, Alcohol, and
Opiates
Sharon M. Hall and Barbara E. Havassy 108
vii
Explaining Relapse to Opiate Addiction Following Successful
Completion of Treatment
William E. McAuliffe. Barry Feldman, Rob Friedman,
Elaine Launer, Elizabeth Magnuson, Carl Mahoney,
Susan Santangelo, and William Ward 136
Relapse to Use of Heroin, Cocaine, and Other Drugs
in the First Year After Treatment
Robert L. Hubbard and Mary Ellen Marsden 157
Smoking Cessation and Relapse Among Cardiac Patients
George E. Bigelow, Cynthia S. Rand, Janet Gross,
Thomas A. Burling, and Sheldon H. Gottlieb 167
Clinical Implications of Relapse Research
Bruce J. Rounsaville 172
Relapse and Recovery: Some Directions for Research and
Practice
Carl G. Leukefeld and Frank M. Tims 185
List of NIDA Research Monographs 191
viii
Relapse and Recovery
in Drug Abuse: An Introduction
Frank M. Tims and Carl G. Leukefeld
From the treatment perspective, relapse and recovery are key
issues. The high rate of relapse is an especially frustrating
problem, and the notion of a "cure" remains elusive. Substance
abuse careers are episodic, with periods of abstinence, reduction
of use, and relapse the prevailing pattern, often with the course
of events being influenced by external factors such as availability
of drugs and societal pressures. Given the patterns of relapse and
remission, a variety of interpretations of the nature of substance
abuse as a disease condition, how it should be treated, and what
the goals of treatment should be, have evolved.
High relapse rates among substance abusers remain old news.
Numerous studies have documented that high relapse rates prevail
across classes of substances--for example, Marlatt (1979) has found
that the average time from abstinence to relapse varies from 4 to
32 days for tobacco, alcohol, and opiates. But there are a host of
questions which should be addressed in attempts to understand
relapse, as well as recovery. Prominent among these questions is
one of definition. What constitutes relapse in treatment
populations where a variety of post-treatment substance use
patterns may be observed? If treatment is for a particular
substance abuse problem, how are we to consider such issues as
controlled or occasional use, substitution, and continuation of use
of another, perhaps lesser, substance which may constitute abuse?
A common solution to this dilemma of classifying relapse to a
specific substance is to apply a criterion of loss of control or
return to some level of use (For example, see Hall, this volume).
There is also a problem presented by the complexity of substance
use patterns, as seen in the contrast between polydrug abusers and
opiate addicts. As Hubbard and Marsden (this volume) point out,
multiple drug use among clients being admitted to treatment is
common, and use of a given substance in the early posttreatment
period is often continuation of the pattern present at termination
of treatment. It appears that some subgroups maintain positive
treatment outcomes and have lower relapse rates, although these
groups need sharper definition and elaboration. Also, there is a
need to better understand how treatment brings about desired
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