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Lyons, Suzi (2010) Lapse and relapse following inpatient treatment of opiate dependence. Drugnet Ireland , Issue 35, Autumn 2010 , pp. 21-22.

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A study published in 2010 (1) examined the factors associated with lapse and relapse (2) in a prospective follow-up study of opiate users who had been admitted to an Irish residential detoxification facility between June 1995 and December 1996. Follow-up interviews were conducted by out-reach workers between June 1998 and March 1999.  

Of the 109 participants, 99 (91%) reported a relapse. Within the first week of discharge, 72 (66%) had lapsed and 64 (59%) had relapsed. Only 42 (32%) of those recruited had completed the full six-week programme.
 
The study identified several factors independently associated with early relapse: being aged 20 to 24, not having a partner who used opiates, history of injecting drug use, heroin use of between 1.5 and 3 ‘quarters’ per day, and failure to complete treatment or enter aftercare (Table 1).
 
Table 1   Factors independently associated with early relapse following inpatient treatment*
Characteristic
Odds ratio
95% CI
P value
 
 
 
 
Age
 
 
 
Under 20
1.0
 
 
20 to 24
0.5
0.3 – 0.8
0.007
25 and over
0.6
0.4 – 1.1
0.11
 
 
 
 
Status of partner/spouse      
 
 
 
Partner has history of opiate use
1.0
 
 
Partner has not used opiates/no partner
1.7
1.0 – 2.7
0.04
 
 
 
 
Quantity of heroin used
 
 
 
Up to 1.5 ‘quarters’ per day
1.0
 
 
1.5 to 3 ‘quarters’ per day
2.2
1.2 – 3.9
0.008
More than 3 ‘quarters’ per day
1.4
0.7 – 2.5
0.3
 
 
 
 
Imprisonment
 
 
 
Never in prison
1.0
 
 
In prison
1.4
0.9 – 2.3
0.15
 
 
 
 
History of injecting drug use
 
 
 
No injecting
1.0
 
 
Injecting previously
1.8
1.0 – 3.3
0.05
 
 
 
 
Type of discharge
 
 
 
Planned
1.0
 
 
Unplanned
2.6
1.6 – 4.4
<0.001
 
 
 
 
Aftercare
 
 
 
None
1.0
 
 
Commenced aftercare
1.7
1.1 – 2.8
0.03
*Identified by multivariate analysis using the Cox proportional hazards model.
Source: Smyth et al. (2010)

This study, based on data collected in the late 1990s, found that lapse and relapse occurred very soon after opiate detoxification: 80% of participants had lapsed within the first month. The study findings are similar to those of international studies based on more recent data. The authors recommend that clients should be provided with improved psychological supports both before and after entering residential opiate detoxification. These include encouraging clients to remain for the full treatment period, improving relapse prevention supports, especially during the first week after discharge, and providing prompt access to aftercare.

 
 
1. Smyth BP, Barry J, Keenan E and Ducray K (2010) Lapse and relapse following inpatient treatment of opiate dependence. Irish Medical Journal, 103(6): 176–179. Available at www.drugsandalcohol.ie/13405
2. A lapse was defined as any misuse of an opiate after discharge, and a relapse as a return to a pattern of daily opiate use.
Item Type:Article
Issue Title:Issue 35, Autumn 2010
Date:2010
Page Range:pp. 21-22
Publisher:Health Research Board
Volume:Issue 35, Autumn 2010
EndNote:View
Accession Number:HRB (Available)
Related URLs:
Subjects:HJ Treatment method > Treatment outcome
HJ Treatment method > Drugs and alcohol disorder treatment method
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Residential facility
J Health care, prevention and rehabilitation > Rehabilitation
B Drugs and alcohol substances > Opioids (opiates)

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