There is a large volume of research on addiction, and more specifically, the mechanisms that cause relapse in individuals undergoing drug addiction treatment. The majority of people who enter a rehabilitation program also begin substance addiction treatment while they undergo detoxification. However, nearly half of detox clients never finish their treatment and are likely to begin using again. Therefore, it is imperative to understand what causes relapse. Some evidence points to cravings as one of the leading factors affecting relapse. But attitudes toward cravings, intensity of cravings, and frequency of cravings have not been studied together with relation to drug addiction and relapse. Reshmi Marhe of the Institute of Psychology at Erasmus University Rotterdam in the Netherlands recently led a study that addressed these issues.
For the study, Marhe evaluated 68 participants who were receiving inpatient treatment for heroin dependency. The participants received a digital device that assessed their cognitions and attentional bias toward drugs at random times (RA) throughout the day over the course of one week. They were also instructed to report their feelings and appraisals when they felt tempted to use (TA). Marhe discovered that the participants exhibited three classes of relapse: early relapse, late relapse which occurred after the one week assessments, and no relapse. Those who relapsed, whether early or late, did not have more frequent temptations than those who did not relapse. However, they did experience stronger cravings and more implicit positive attitudes toward drug use when they were tempted. But when the relapsers were compared to non-relapsers, RAs were the same.
This finding suggests that it is not the number of cravings that affects relapse risk, but the intensity of the cravings and how they are received. The relapsers had more positive attitudes toward drug use and had more attentional bias toward drug use during the temptations than the non-relapsers. But when cravings were not present, the overall cognitive appraisals were the same for all the participants. Marhe believes that these results have considerable clinical implications and added, “The data suggest that attentional bias (and implicit attitudes) may be an appropriate cognitive target for intervention.”
Marhe, R., Waters, A. J., van de Wetering, B. J. M., and Franken, I. H. A. (2012). Implicit and explicit drug-related cognitions during detoxification treatment are associated with drug relapse: An ecological momentary assessment study. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030754
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