Original Article

Lapse and Relapse Rates in Narcotics Anonymous versus Methadone Maintenance Treatment: A 12-Month Prospective Study

Abstract

Objective: The present study aimed to compare lapse and relapse-free survival between patients treated in Narcotics Anonymous (NA) groups and Methadone Maintenance Treatment (MMT) centers and to determine the relationship between social support scale and treatment outcome.

Method: This study was a prospective, 12-month cohort study using the random sampling method to select 100 newcomer patients treated by the NA Association as well as 100 patients in MMT centers. The data were collected using a demographic questionnaire and Social Support Appraisals (SSA) scale at the onset of the study along with follow-up phone calls every other week.

Results: All participants were male, aged between 18 and 65 with a mean (SD) age of 38.98 (± 10.85) years. Prevalence of relapse in 12 months was 60.5%. The lapses in the MMT group and relapses in the NA group were significantly higher (P < 0.001). The younger patients with lower levels of education are at greater risk of lapse/relapse. The mean score of SSA was significantly higher in the MMT group than the NA group in all subscales, including friends, family, and the others' support (P < 0.001). The mean scores of SSA subscales for the participants without relapse in the NA group was significantly higher in comparison to the MMT group.

Conclusion: Detection of factors related to drug abuse relapse/lapse may help addiction therapists to identify drug abuse patients with lapse/relapse and to develop treatment and policy guidelines to prevent relapse in addiction recovery.

1. UNODC. World Drug Report. United Nations: United Nations’ Office on Drugs and Crime, 2019 978-92-1-004174-4.
2. Roshanpajouh M, Mirkazemi R, Ehterami M, Narenjiha H, Malek Afzali H, Sarrami HR, et al. Drug use among Iranian population: results of a national household survey. J Subst Use. 2020;25(2):146-51.
3. Nikpour G. Drugs and drug policy in the Islamic Republic of Iran. Middle East Briefs. 2019;119:2-7.
4. Mokri A. Brief overview of the status of drug abuse in Iran. Iran Med.2002;5(3):184-90.
5. Melemis SM. Relapse Prevention and the Five Rules of Recovery. Yale J Biol Med. 2015;88(3):325-32.
6. Saberi Zafarghandi MB, Jadidi M, Khalili N. Iran's Activities on Prevention, Treatment and Harm Reduction of Drug Abuse. Int J High Risk Behav Addict. 2015;4(4):e22863.
7. Galanter M, White WL, Hunter BD. Cross-cultural Applicability of the 12-Step Model: A Comparison of Narcotics Anonymous in the USA and Iran. J Addict Med. 2019;13(6):493-9.
8. Kassani A, Niazi M, Hassanzadeh J, Menati R. Survival Analysis of Drug Abuse Relapse in Addiction Treatment Centers. Int J High Risk Behav Addict. 2015;4(3):e23402.
9. Pashaei T, Moeeni M, Roshanaei Moghdam B, Heydari H, Turner NE, Razaghi EM. Predictors of treatment retention in a major methadone maintenance treatment program in iran: a survival analysis. J Res Health Sci. 2014;14(4):291-5.
10. Zare H, Alipoor A, Aghamohammadhasani P, Nazer M, Mokhtaree M, Sayadi A. Assessment role of participation in narcotic anonymous in opiate dependents during abstinence. Zahedan J Rese Med Sci. 2012;14(9):42-6.
11. HAN B, AVERY J. Relapse Prevention. Pocket Guide to Addiction Assessment and Treatment. 2016.273p.
12. Marlatt AG, Donovan, D.M. Relapse Prevention, Maintenance Strategies in the Treatment of Addictive Behaviors. 2nd ed2005
13. Maisto SA, Pollock NK, Cornelius JR, Lynch KG, Martin CS. Alcohol relapse as a function of relapse definition in a clinical sample of adolescents. Addict Behav. 2003;28(3):449-59.
14. Hendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy. 2011;6:17.
15. Eliason MJ. Improving Substance Abuse Treatment: Sage; 2007.
16. Chung T, Maisto SA. Relapse to alcohol and other drug use in treated adolescents: review and reconsideration of relapse as a change point in clinical course. Clin Psychol Rev. 2006;26(2):149-61.
17. Sharma AK, Upadhyaya SK, Bansal P, Sharma MND. A study of factors affecting relapse in substance abuse. Indian J Life Sci. 2012;2(1):28-33.
18. Atadokht A, Hajloo N, Karimi M, Narimani M. The role of family expressed emotion and perceived social support in predicting addiction relapse. Int J High Risk Behav Addict. 2015;4(1):e21250.
19. Tracy K, Wallace SP. Benefits of peer support groups in the treatment of addiction. Subst Abuse Rehabil. 2016;7:143-54.
20. Vaux A, Phillips J, Holly L, Thomson B, Williams D, Stewart D. The social support appraisals (SS-A) scale: Studies of reliability and validity. Am J Community Psychol. 1986;14(2):195-218.
21. Asgari P, Sharafodin H. Relationship between social anxiety, social support and a sense of hope and well-being of students. N Find Psychol. 2010;3(9):25-36.
22. HAMZAVI ZN, Nazari M, Shayeghian Z, Shahmohammadi S. Social support in the pregnant and non-pregnant women and its associated dimensions. J Nurs Midwifery Sci. 2016;3(2):11-8.
23. Kassani A, Niazi M, Hassanzadeh J, Menati R. Survival Analysis of Drug Abuse Relapse in Addiction Treatment Centers. Int J High Risk Behav Addict. 2015;4(3):e23402.
24. Nikmanesh Z, Baluchi MH, Pirasteh Motlagh AA. The role of self-efficacy beliefs and social support on prediction of addiction relapse. Int J High Risk Behav Addict. 2017;6(1):e21209.
25. Shafiei E, Hoseini AF, Bibak A, Azmal M. High risk situations predicting relapse in self-referred addicts to bushehr province substance abuse treatment centers. Int J High Risk Behav Addict. 2014;3(2):e16381.
26. Hunt WA, Bespalec DA. Relapse rates after treatment for heroin addiction. J Community Psychol. 1974;2(1):85-7.
27. Mohammadpoorasl A, Fakhari A, Akbari H, Karimi F, Bostanabad M, Rostami F, et al. Addiction relapse and its predictors: A prospective study. J Addict Res Ther. 2012;3(01):122.
28. Smyth BP, Barry J, Keenan E, Ducray K. Lapse and relapse following inpatient treatment of opiate dependence. Ir Med J. 2010;103(6):176-9.
29. Gossop M, Stewart D, Browne N, Marsden J. Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses. Addiction. 2002;97(10):1259-67.
30. Termorshuizen F, Krol A, Prins M, Geskus R, van den Brink W, van Ameijden EJ. Prediction of relapse to frequent heroin use and the role of methadone prescription: an analysis of the Amsterdam Cohort Study among drug users. Drug Alcohol Depend. 2005;79(2):231-40.
31. Gutwinski S, Schoofs N, Stuke H, Riemer TG, Wiers CE, Bermpohl F. Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment. Harm Reduct J. 2016;13:7.
32. Mohamad N, Bakar NH, Musa N, Talib N, Ismail R. Better retention of Malaysian opiate dependents treated with high dose methadone in methadone maintenance therapy. Harm Reduct J. 2010;7:30.
33. Zafarghandi MBS, Nik MM, Birashk B, Assari A, Khanehkeshi A. Sexual dysfunction among males with opiate dependence undergoing methadone maintenance therapy (MMT). Int J High Risk Behav Addict. 2016;5(4): e37740.
34. Fareed A, Vayalapalli S, Stout S, Casarella J, Drexler K, Bailey SP. Effect of methadone maintenance treatment on heroin craving, a literature review. J Addict Dis. 2011;30(1):27-38.
35. Blum K, Schoenthaler SJ, Oscar-Berman M, Giordano J, Madigan MA, Braverman ER, et al. Drug abuse relapse rates linked to level of education: can we repair hypodopaminergic-induced cognitive decline with nutrient therapy? Phys Sportsmed. 2014;42(2):130-45.
36. Rollins AL, O'Neill SJ, Davis KE, Devitt TS. Substance abuse relapse and factors associated with relapse in an inner-city sample of patients with dual diagnoses. Psychiatr Serv. 2005;56(10):1274-81.
37. Brecht ML, Herbeck D. Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors. Drug Alcohol Depend. 2014;139:18-25.
38. Hogan BE, Linden W, Najarian B. Social support interventions: do they work? Clin Psychol Rev. 2002;22(3):383-442.
39. Ulug B. The Textbook of Substance Use and Related Disorders, Gulec C, Koroglu E1997. 299-320.
40. MacDonald EM, Luxmoore M, Pica S, Tanti C, Blackman JM, Catford N, et al. Social networks of people with dual diagnosis: the quantity and quality of relationships at different stages of substance use treatment. Community Ment Health J. 2004;40(5):451-64.
41. Shakiba M, Shakiba J, Sharifi H, Shakiba M, Rafaiee R. The effect of life skills training in group and behavior change on affective health of people addicted to methamphetamine crystal. Zahedan J Res Med Sci. 2014;16(5):6-10.
42. Best D, Beckwith M, Haslam C, Alexander Haslam S, Jetten J, Mawson E, et al. Overcoming alcohol and other drug addiction as a process of social identity transition: The social identity model of recovery (SIMOR). Addict Res Theory. 2016;24(2):111-23.
Files
IssueVol 17 No 1 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v17i1.8044
Keywords
Addiction Cohort Methadone Narcotics Recurrence Survival Analysis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mohseni F, Rahimi K, Niroumand Sarvandani M, Jamali Z, Seyedhosseini Tamijan SM, Rafaiee R. Lapse and Relapse Rates in Narcotics Anonymous versus Methadone Maintenance Treatment: A 12-Month Prospective Study. Iran J Psychiatry. 2021;17(1):1-13.