Indian Journal of Psychiatric Nursing

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 12  |  Issue : 1  |  Page : 14--18

Relapse precipitants, life events & coping behaviors among substance users


Rajesh Kumar1, Sushil K Maheshwari2,  
1 Assistant Professor, College of Nursing, AIIMS, Rishikesh, Uttarkhand, India
2 Associate Professor, University College of Nursing, BFUHS, Faridkot (Pb), India

Correspondence Address:
Rajesh Kumar
Assistant Professor, College of Nursing, AIIMS, Rishikesh, Uttarkhand
India

Abstract

Relapse is common and stressful aspect among substance abusers. In the present study there has been an attempt to study relapse precipitants, life events and coping behaviors among opioids, alcohol and multiple substance dependent men. A descriptive survey was conducted after enrolling 45 substance dependent men. Clients were interviewed by using socio-demographic profile and clinical sheet, relapse precipitate inventory (RPI), presumptive stressful life scale (PSLES), and coping behaviour inventory (CBI). Study results reveals that onset of substance abuse was earlier in alcohol dependents in contrast to long duration of substance abuse and hospitalization in opioids dependents. The relapse phenomena was significantly associated with age, marital status, occupation, number of previous relapse, frequency of detoxification, duration of follow up, substance abuse and hospitalization. Factors influencing relapse appeared to be largely similar with more use of coping strategies in multiple substance dependents, especially behavioral one. Future researchers are encouraged to replicate this study and explore more dynamic nature of relapse phenomena.



How to cite this article:
Kumar R, Maheshwari SK. Relapse precipitants, life events & coping behaviors among substance users.Indian J Psy Nsg 2016;12:14-18


How to cite this URL:
Kumar R, Maheshwari SK. Relapse precipitants, life events & coping behaviors among substance users. Indian J Psy Nsg [serial online] 2016 [cited 2021 Dec 2 ];12:14-18
Available from: https://www.ijpn.in/text.asp?2016/12/1/14/132848


Full Text

 Introduction



Substance abuse is common problem worldwide, India being no exception. The close geographical propinquity to Pakistan and Rajasthan borders that produces illicit drugs has intensify drug use in Punjab. Abuse of alcohol, cannabis and raw opium is reported in literature in ancient Indian history. The abuse of synthetic derivatives is comparatively new[1]. The substance abuse has devastating effects on nation’s socio-economic status[2].

United Office on drugs and crime reported 62.5 million alcoholics, 8.75 million cannabis users, 2 million opiates and 0.29 million of hypnotic sedative user in India [3],[4]. It has been estimated that 14% patients admitted in hospital have alcohol and drug abuse and addiction disorders and almost 20% of all medical cost spends on inpatient care is associated with substance use[5].

Substance use is to be viewed as chronic disorders in which relapse is the natural part of recovery process in which a person returns to even a single usage of a substance or process of which they had previously abstinence. Family pressure, initiation in young age, male gender, unemployment, single status, grief or heavy loss, peer pressure, negative/poor coping skills, personality traits, social stress, co-morbid physical and psychiatric conditions, and family history of substance abuse as relapse precipitant for substance users[2],[3]. Literature also cited many other reasons for relapse [6],[7]

Coping methods broadly includes such behaviour as that protect people from being harmed psychologically by problematic life and social experiences[8]. The coping behaviors in drug dependence have been classified as either cognitive or behavioral [9].

Despite advances in treatment, client compliance is generally poor, with relapse to problematic drug/alcohol use a common occurrence. Therefore, the study designed with the objective to identify relapse precipitants, life events and coping behaviors among substance abusers.

 Material and Methods



The sample was drawn from the population of patients admitted in the psychiatric ward at Sri Guru Ram Dass Hospital (SGRDH) Vallah, Amritsar (Punjab). As the treatment center population comprises almost exclusively of males, only men were recruited for the study. On the basis of availability of sample size and study time frame, it was decided to include 45 patients in the study, as the sample size was compared with previous Indian study over similar population and was found adequate. By using purposive sampling technique, over a period of about 5 months (Nov 2013 to Mar 2014), study was conducted to collect required sample size. The inclusion criteria were, 1) patients should be more 15-65 years age group, 2) patient meeting the criteria of ICD-10 for alcohol, opioids and multiple substance dependence, relapse, & abstinence. Patients with co-morbid physical, psychological, and psychiatric disorders were excluded from study.

Socio-demographic data were obtained from case notes, and conducting interview with patients and relatives present at the time of data collection. A Hindi version of Relapse Precipitant Inventory (RPI) was used to assess high risk situation[10]. This Hindi version of RPI was standardized to cover relapse of all kinds of substance abuse including alcohol. Coping strategies was identified by using Coping Behaviour Inventory (CBI)[11]. Presumptive Stressful Life Events Scale (PSLES)[12] was used to assess stressful life events in the past one year that predisposed the patient for relapse. Prior permission was obtained from concerned authorities before using these tools. The instrument was found reliable and valid for study. Assessment was conducted on 3rd day of the admission once the detoxification process was claimed over by psychiatrist.

The study was approved by the ethical committee of the Sri Guru Ram Dass Institute of Medical Sciences and Research Center (SGRDIMSR), Vallah, Amritsar (Punjab). Written informed consent was also collected from subjects before proceeding to data collection after explaining the study objectives, their involvement, duration, and possible use of findings, as patients were admitted under different admission criteria but it was sought to take ethical approval before proceeding to final data collection. Researcher also kept in mind that data collection process will not interfere in usual treatment process of patients. Patients were also informed for not using any invasive investigation to collect data. Total 45 patients were enrolled and remaining 5 patients took discharge in between against medical advice and been excluded from the study analysis. Relevant descriptive and inferential statistics were implicated to analyze the result of the study.

 Results



[Table 1] shows that the study subjects mean age was 26.13±5.80 years, were married (64.4%), were educated above secondary and above (53.3 %), and were unemployed with monthly income of more than 3001. rupees. In terms of habitat and family structure, around 77.8% of subjects were belonged to rural area and living in nuclear family (57.8%) with 2-5 dependents in the family. Around 48.9% of subjects reported family history of substance abuse followed by 24.4% psychiatric illness while 75.6% reported history of chronic physical illness in past.{Table 1}

[Table 2] Clinical profile revealed that around 46.7% of subjects had onset of substance abuses in 21-25 years of age. The mean duration of substance abuse was 4.66±4.52 years. The mean number of relapses was 2.73±1.65 with more than 2 detoxification episode (55.6%). It is also evidenced that approximately 53.3% of subjects have no follow up visit. The mean duration of hospitalization was 11.58±6.40 days.{Table 2}

[Table 3] reveals the association of various subjects’ variables with occurrence of relapse phenomena. It shows that age (p=.004), marital status (p=.007), occupation(p=.020), number of previous relapse( p=.000), frequency of detoxification episode (p=.000), follow up status (p=.000), duration of substance abuse (p=.047), and duration of hospitalization (p=.005) was found statistically significant with the occurrence of relapse phenomena among substance dependent men.{Table 3}

The most common cited reason for relapse was negative mood states, with far fewer clients citing external pressure to use, positive mood states, or social family problems. On the RPI, opioids dependent subjects had significantly higher mean scores as well as significantly higher mean score on 3 high risk situations viz., negative mood state (8.08±1.62), external/euphoric events (8.08±1.62), and lessened cognitive vigilance (1.42 ±.51), as compared to alcohol and mixed substance abuser subjects. Comparison on stressful life events for the past one year showed that mixed substance abusers had significantly higher mean score (7.13±2.0) as well as significantly higher mean score on undesirable stressful life events (1.25±.93) in past one years, as compared to higher mean score on desirable events (1.0±.95) in last one year for opioids abusers.[Table 4]{Table 4}

Comparisons of the CBI scores revealed that multiple substance abusers had significantly higher mean score as well as significantly higher mean scores on two types of coping strategies viz., cognitive (31.06±5.64) and behavioral response (28.38±4.44), as compared to coping strategies adopted by alcoholic and opioids substance abusers. The groups did not shows any significant difference for relapse precipitants, stressful life events and coping strategies use.

 Discussion



The study was undertaken to study the relapse precipitants, stressful life events, and coping strategies adopted by various substance abusers. The result of present study showed that certain individual, family and clinical variables were reliably and consistently associated with relapse phenomena among substance abusers. The result shows that certain individual/social variables are important correlates of relapse. Consequently, clinical parameters such as number of previous relapse, frequency of detoxification episode, follow up status, duration of substance abuse, and duration of hospitalization was found statistically significant with the occurrence of relapse phenomena among substance dependent men.

Current study findings found consistent with the previous study[1],[14],[13] that reported that number of previous relapse and positive family history, were significant determinant of relapse among patient with alcohol and opioids dependence. These findings are also in line with previous study findings that reported consistent findings related to determinants to relapse[1],[11],[14] .At the same time, psychological factors such as relapse precipitants (or high risk situations), coping and stressful life events appeared to be more important in determining relapse. Opioids dependent that had relapse were significantly more likely to expose to a higher number of risk situation. The previous study also reported findings in accordance to determinants of high risk situations to relapse occurrence in different groups of substance abusers[9],[15],[16],[17],[18]

Present study evidenced that patient with multiple substances dependence was more significantly exposed to undesirable stressful life events than alcohol and opioids dependents. The present findings found in line in previous study which reported higher number of desirable stressful life events in relapse patients[20]. Similar findings also reported in studies[9],[18] which reported that the number and stress profile of life time events were similar across opioids and multiple substance abusers except that the alcohol group reported significantly lower number of and lower stress from desirable life events.

Patients with substance abuse tend to use multiple overwhelming coping strategies to overcome to modify the situation to avoid craving and conditioned withdrawal. It is reported that people with multiple substance dependence used more number of coping strategies, including more cognitive and less behavioral strategies. Previous research also reported similar findings for same[14]. It is also supported in the study that dysfunction in cognitive and personal area was also common among substance dependents and determinant to relapse[20].

 Conclusion



In summary, the findings of the present study suggest that relapse in substance dependents is associated with similar personal, social and clinical variables. Study also suggest role of relapse precipitant events, life events, and use of type of coping strategies in determining relapse in substance dependents.

The study follow certain methodological limitations and these findings can only considered as a preface in this field. The small sample size and only men as sample, were two major limitations that hinder the generalization of the findings to the other population.

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