Relapse in opioid dependence: Role of psychosocial factors

BACKGROUND: Although our understanding about neurobiology of opioid dependence and availability of pharmacological treatment has gone a long way in the last few decades, psychosocial interventions play a pivotal role in the prevention of relapse owing to reasons such as less treatment-seeking behavior and poor penetrance of opioid substitution treatment. There are many studies assessing psychosocial factors in alcohol and nicotine dependence, yet the availability of such studies for opioid dependence is sparse. This study aimed at evaluating the association of relapse in opioid dependence with various psychosocial factors. MATERIALS AND METHODS: This was a cross-sectional study with two groups of opioid dependence patients: In abstinence (N = 28) and relapse (N = 33). Psychosocial variables such as high-risk situations, coping behavior, stressful life events, self-efficacy, and social support were assessed in the two groups and analyzed for the association with opioid relapse. RESULTS: This study reports that more high risk situations (odds ratio [OR] =1.58; 95% confidence interval [CI] =1.22–2.03; P = 0.017), especially negative mood state and undesirable stressful life events (OR = 2.08; 95% CI = 1.28–3.37; P = 0.05) were significantly associated with higher odds of relapse in patients of opioid dependence. Further, higher self-efficacy (OR = 0.92; 95% CI = 0.87–0.96; P = 0.017) was significantly associated with lower odds of relapse. CONCLUSION: Psychosocial factors such as high risk situations, undesirable stressful life events, and self-efficacy were significantly associated with relapse in opioid dependence. Hence, practice of a holistic, multimodal, and individualized treatment plan addressing these factors might help in reducing the relapse rates in them.