Factors Causing Substance Abuse Relapse

Factors create centre Ab amicable occasion go byRe steal away among content insultrs laterwards discussion is an old phenomenon that has eer been the nemesis of nations tot anyy around the world (Golestan, Abdullah, Ahmad Anjomshoa, 2010). For long, studies open found that through several generations, sink to mental object handle after manipulation remains whiz of the greatest challenges in the intervention of all forms of mall subvert including intoxicant, marijuana, heroin and cocaine (Marlatt George, 1984 Polivy Herman, 2002 Witkiewitz Marlatt, 2004).Many a get word posits that when multitude attempt to change an undesired or problematic sort, at that place is a high possibility of an initial lapse (Golestan et al., 2010 Marlatt George, 1984 Witkiewitz Marlatt, 2004). Drug dependence has been typified as a persistent relapsing disorder (McLellan, Lewis, OBrien Kleber, 2000). In clinical terms, pass is defined as a return to a maladaptive use of s ignificance, much(prenominal) as marijuana, alcohol, tobacco, heroin, cocaine or new(prenominal) illicit psychoactive drugs after having been previously treated for the same nubble step disorder (Witkiewitz Marlatt, 2004).Researches on the sum of m maviny abuse phenomenon posit that on the average, within a year of receiving treatment, virtually patients revert to previous levels of substance use (Hall, Havassy Wasserman, 1990 Witkiewitz Marlatt, 2004). Substance abuse clients and counselors both consider return as a major challenge militating against substance abuse prevention strategies (Golestan et al., 2010). world(a) statistics on the rate of retrogress to substance use is disturbing. Both counselors and clients adopt that whereas it is tough for a client to quit the use of drugs, it is even tougher to occlusion off the drug after intense treatment (Ducray, Darker, Smyth, 2012 Moeller et al., 2001). Notwithstanding the client-focused and intensive treatment modu les available for substance abuse, most treated clients return to the use of the abused substance after a period of abstinence (Polivy Herman, 2002).Substance abuse is shrouded with personal and social problems including the intumesceness of society regarding its political, social, economical and heathen issues in dissimilar degree (Hendershot, Witkiewitz, George, Marlatt, 2011). The price for using and abusing illicit drugs ar weighty and incontestable. The attendant health complications, lamentable psychosocial functioning and unseemly economic implications such as governments expenditure on treatments and reformation of substance abusers down all been well attested (Burger, 2008 Parrott et al., 2004 Pressley McCormick, 2007 unit of measuremented Nations lieu on Drug and Crimes report, 2013). Piggot, Carson, Saha, Torbeyns, Stock and Ingenito (2003) find tell that relapse to substance abuse could organise to such consequences as cognitive impairment, non-adherenc e to medication, personal distress, imprisonment and hospitalization.Decades of explore on substance abuse hit implicated psychosocial factors such as mental health, significant action events and social functioning as playing censorious parts in influencing the relapse range and the abuse of drugs among clients who cook previously been treated for substance abuse disorders (Hammerbacher Lyvers, 2006 Melberg, Lauritzen, Ravndal, 2003). contextual factors such as living and working environments have been considered as relevant when accounting for relapse precipitants in substance abusers (Reece, 2007). Consistently, questioners have identified psychosocial factors including self-efficacy, minus affects, ineffective coping responses and a host of high-risk situations as effect the relapse to substance use (Connors, Maisto Zywiak, 1996 Larimer, Palmer Marlatt, 1999 Marhe, Waters, Van de Wetering Franken, 2013 Mattoo, Chakrabarti Anjaiah, 2009 Reece, 2007).Several former (a) psychosocial factors including fights and social conflicts, peer pressure, divorce, strained relationship with friends, family and co-workers (Broome, Simpson Joe, 2001 McLellan, Lewis, OBrien Kleber, 2000) have been found to subjoin the risk of relapse to substance abuse. Community supports (Ibrahim Kumar, 2009), support from family and friends (Broome et al., 2001) and stressful life events (Wills, Vaccaro McNamara, 1992) have also been found to determine clients relapse state after rehabilitation. Information about psychological and social (contextual) factors relating to relapse and substance abuse may both be critical and important for planning clinical intervention strategies as well as contri bute to afterc atomic number 18 and community-based interventions.Literature is fulfil with studies correlating cultural and religious variables to relapse to substance abuse. Ethno-cultural identity and religiosity have been found to moderate substance use among particular gr oups of bulk (Chen, Dormitzer, Bejaro Anthony, 2004). In particular, there has been a significant negative correlation found among people with higher levels of religious practice (religious devotion) and substance abuse (Chen et al., 2004 Kliewer Murrelle, 2007).Since four exs ago when scientific approach into the study of relapse has started (Marlatt Gordon, 1984), there has been ample secernate that suggest dissimilar relapse rates for various substances. In one earlier study, about 90% of alcoholics who received treatment experienced at least one relapse over a 4-year period (Polich, Armor, Braiker, 1981). In another study, Cornelius et al. (2003) found that 66% of the respondents had resumed their drug use within sextuplet months after treatment. There exist various relapse rates for the various substances of abuse. Differences in these rates could be attributed to several factors including the definition of relapse, individuals variables, characteristics of the addict ion and the effectiveness and success of treatment (Connors, G.J., Maisto Zwiak, 1996).Substance abuse and relapse phenomenon have been conceptualized and explained through a do of theories. In particular, the Cognitive-Behavioral simulate of Relapse Process (Marlatt Gordon 1984, 1985 Witkiezie Marlatt, 2004) and the Relapse Syndrome Model (Gorski Miller, 1982 Gorski, 1990) have expansively explained the process and indicators composite in relapse to substance abuse. Other theories that explicate relapse to substance abuse include the Stress-diathesis Model (Gatchel, 1993), the Self-medication Hypothesis (Duncan, 1974 Khantzian, Mack, Schatzberg, 1974), the Bidirectional Model (Biafora younger et al., 1994), the Psychological Distress Model (Mercier et al., 1992) and the Behavioral Choice Model (Bickel Vuchinich, 2000). The Cognitive-Behavioral Model of Relapse Process and the Relapse Syndrome Model the foundations of this study are discussed comprehensively in the next ch apter.In general, substance use is attributed to a number of factors, including, psychosocial, biological and contextual variables (Nordfjrn, 2011). In particular, psychosocial factors have been known to be critical determinants of relapse to substance abuse. Significant life events, psychosocial distress and self-efficacy have all been identified as significant predictors of relapse to substance abuse (Hendershot, Witkiewitz, George, Marlatt, 2011 Nordfjrn, 2011).Studies have found major positive and negative events, similar to those found in the general race, have significant influence in the lives of substance abusers (Melberg et al., 2003 Witkiewitz Marlatt, 2004). Periods such as the loss of a loved one, or social do and events such as funerals, wedding celebrations, and birthday parties have been found to have influenced the return to alcohol and drug abuse (Melberg et al., 2003 Saunders Kershaw, 2006). For instance, a client complete from a substance abuse rehabilitatio n facility after treatment could remain sober for a long period only to lapse during a funeral or wedding celebrations.Unquestionably, the role of psychological distresses, including depression, interpersonal conflicts, and trouble in substance abuse and relapse have long been celebrated (Grant et al., 2004). Continuous interpersonal conflicts with a spouse or a co-worker, for example, could lead to depression, or outburst of anger and frustrations. The individual could revert to alcohol and drugs to both help take cope the situation or to empower him or her to face the perpetrator. Empirical supports linking psychological distress to substance use and abuse exist. In one study, clients with psychological distress were found to abused alcohol and drugs than those without any psychological distresses (Grella, Hser, Joshi, Rounds-Bryant, 2001).Self-efficacy, defined as ones smell that a task can be carried out successfully to hit a desired outcome (Bandura, 1997), has been assoc iated with substance abuse and relapse (Nordfjrn, 2011). Clients who memorialize low levels of self-efficacy, for instance, have been found to have shown high levels of alcohol and substance abuse (Hendershot, Witkiewitz, George, Marlatt, 2011). Individuals who lose confidence in themselves and in their efforts to succeed, no subject area the venture, could for long remain depressed and frustrated. The individual may then recede to substance use, amid the frustration, to enflame some happiness. Gradually from a lapse, the substance abuse behavior may continue and become a full blown relapse.1.1 rumor of the problemUnquestionably, the abuse of alcohol and drugs remains problematic in most countries of the world. The 2013 World Drug Report by the United Nations Office on Drug and Crime (UNODC) revealed that over 35 million people, representing 0.8% of the adult population worldwide use heroin, cocaine or a combination of both. Of this population, it is estimated that 10-13% depa rt become drug dependent and will forfeit their sobriety (UNODC Report, 2013). The UNODCs statistics for 2013 on the worldwide estimate of substance abuse is even more than frightening. The report revealed that in 2012, between 167 and 315 million people aged 1564 were estimated to have used an illicit substance in the preceding year.West Africa is not excluded from the problem of drug trafficking and abuse. About a decade ago the region was declared as a transit alley for hard drugs (Drug News Africa, 2012). According to the gold coast Demographic Health great deal Report (GDHS) for 2009, the sub-region had become not only a transitory route, but more disturbingly, a consumer market of these illicit psychoactive drugs (GDHS Report, 2009). The report reason out that the abuse of hard drugs was on the increase and had attracted the attention of most health professionals in Ghana (GDHS Report, 2009).The Out-patient Monthly Morbidity Returns (OMMR) records for 2012 from the Depart ment of Psychiatric of the regional Hospital, Sunyani, showed that of the 2,284 patients who accessed the facility for the year, about 596(26%) were alcohol and drug abuse related cases. In the same year, out of the 1,047 new cases seen, 413 were substance abuse related disorders, with 138 having been any re-admitted or treated on at least one other occasion for the same diagnosis. This statistics showed a 12% increase in substance abuse and relapse cases as compared to that of the preceding year (OMMR for Psychiatric Unit Regional Hospital, Sunyani, 2012).The Drug News Africa states that about 1.25 million Ghanaians in 2012 had drug addiction problems, mostly marijuana (Drug News Africa, 2012). Studies on substance abuse in Ghana (Affinnih, 1999a Lamptey, 2005 Redvers et al., 2006) estimate more worrisome statistics. In no doubt, more people may be abusing drugs in Ghana than is estimated. This is in truth disturbing since the rates of relapse to substance abuse after treatment re main high. For instance, Brandon, Vidrine and Litvin (2007) renowned that the relapse rates for most individuals after the goal of alcohol or tobacco for a year ranges from 80 95%. Notwithstanding the type and frequency of the drug in use, the penalties are always grave. Witkiewitz and Marlatt (2004) noted that violence, legal problems, depression and suicide attempts are some of the unfortunate consequences of substance use. The availability and the increasing use of these illicit psychoactive drugs results in its dependence with its attendant psychosocial adverse effects.Undoubtedly, substance abuse has profound health, economic and psychosocial consequences to the individual, family, community and nation. Studies (Berk, 2007 Large, Sharma, Compton, Slade, Olav, 2011 Witkiewitz Marlatt, 2004) have shown a number of corporal, psychological and health-related consequences following the unvarying use and abuse of substances. At the personal level, substance abuse has been ass ociated with adverse biopsychosocial consequences, including heart failure, erectile dysfunction, hypertension, cancer, stroke and capillary haemorrhages, irritability and restlessness, mild paranoia, physical exhaustion, mental confusion, loss of weight fatigue or depression and unemployment (Davison, Neale, Kring, 2004 Kring, Davison, Neale, Johnson, 2007). Similarly, the families of substance abusers also share in the consequences. In particular, the loss of productive hours in care of the substance abuser and the cost of treatment have been documented (Moos, 2007 Redvers et al., 2006). A number of social and economic implications have also been noted at the community and national levels. Increase in crime rates, unemployment, poor academic or job performance, school dropout, divorce and the diversion of meagre national resources for treatment and rehabilitation of substance abusers have been associated with substance abuse (Burger, 2008 Parrott et al., 2004 Pressley McCormic k, 2007).1.2 Aim and objectives of the studyWillig (2008) argues from a pragmatic viewpoint that the aim of research is not about generating abstract truth free from the experience of people but rather to provide insight that will inure to the acquire of humanity. Hence the aim of this study is to explore the psychosocial precipitants of relapse and the rate of relapse among substance abusers in the Sunyani Metropolis. More specifically, the objectives of this study areTo explore the various psychosocial factors that contribute to relapse of substance abusers in the Sunyani MetropolisTo estimate how oft respondents return to pre-treatment levels of substance abuse after treatmentTo explore the role of the family, culture and religion in relapse or abstinence among respondents.To explore the handicap/coping strategies clients use to prevent relapse.To explore the psycho-socioeconomic consequences of relapse to the respondents, their families and society.1.3 relevancy of the studyI n 2005, a total of 86,003 outpatient attendances were recorded by the leash psychiatrical hospitals in Ghana (Ofori-Atta et al., 2010). Substance abuse disorders were among the top psychiatric diagnoses for the attendance, accounting for about 22.8%. Even more frightening was the number of substance abusers projected to develop psychological disorders in the course of time.The passage of the Ghana Psychological Bill and the Ghana Mental Health Law in 2012 mandates the Ghana Health Service to employ Clinical Psychologists to all regional and district hospitals in the country to treat and manage the myriad psychological problems faced by clients. In no doubt, substance abuse and relapse would be one of the major clinical diagnoses these clinicians would encounter. Reece (2007) has postulated that contextual and environmental factors are critical determinants of relapse among substance abusers. Certainly the environmental conditions of Europe and elsewhere are significantly different from those in Ghana and the rest of Africa. Consequently, one cannot readily attribute the factors found to have precipitated substance abuse and the successive relapse of a different context to that in Ghana.More widely, findings from this research would aid Clinical Psychologists, Psychiatrists, Psychiatric Nurses, policymakers and relatives of clients to better understand the psychosocial factors that precipitate the relapse phenomenon and the rates at which relapse to substance abuse occur when decision making how best to offer treatment options to develop effective relapse preventive strategies which are contextual in the management of the relapse phenomenon.Furthermore, although there are studies on substance abuse in Ghana (Affinnih, 1999a Lamptey, 2005 Redvers et al., 2006), there is a paucity of data regarding the psychosocial factors that influence relapse to substance abuse. The rates of relapse to substance abuse among substance abusers have also not been well documen ted. Of equal importance, the findings from this study would add to the literature on the relapse