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What makes them relapse?
RIA research teams look to literature on addictive behavior
By KATHLEEN WEAVER
Reporter Contributor
Two research teams at UB's Research Institute on Addictions recently explored the scientific literature focusing on relapse to addictive behavior. The first team reviewed studies of relapse to driving under the influence of alcohol or drugs, and the second team, the differences between men and women who relapse to alcohol and drug abuse.
The RIA researchers concluded that because those who drive under the influence (DUI) are such a diverse group, researchers and clinicians should focus on subgroups that share common characteristics to improve prevention and intervention. They also noted a need to integrate better criminal-justice and rehabilitation approaches to reduce DUI relapse.
When it comes to relapse to alcohol and drug abuse, they found differences between men and women. Women were less likely—and men more likely—to experience relapse to drug abuse. Marriage plays a different role in alcohol relapse for men and women. Alcoholic women seemed to be put at risk for relapse by marriage, marital stress and conflict. Alcoholic men, on the other hand, appeared to be protected from relapse by marriage.
Both research reviews appeared in the March issue of Clinical Psychology Review.
Driving under the influence is a major public health problem. Although there has been a decrease in fatality rates over the past two decades, there were 17,401 alcohol-related crash fatalities in 2003 alone.
Thomas H. Nochajski, associate professor in the School of Social Work and associate research scientist at RIA, and colleague Paul R. Stasiewicz, RIA senior research scientist and director of RIA's Clinical Research Center, looked at DUI research hoping to identify a new focus for research, treatment, the legal system and policymakers.
"We reviewed the data on DUI relapse, the characteristics of first-time and repeat DUI offenders, as well as studies that evaluated the impact of legal sanctions and rehabilitation programs on subsequent DUI behavior," Nochajski explained. "What we found was that DUI offenders are a diverse group of people."
They found that research and treatment that relied on only one or two characteristics of offenders to explain DUI relapse—for example, driving characteristics, age or socioeconomic status—did not offer a sufficient understanding of or response to the diversity of people convicted of repeat DUIs. Nochajski and Stasiewicz concluded that to understand DUI relapse as a public-health issue, researchers, health providers and policymakers should focus on the interplay of legal, social and psychological factors to describe, explain and reduce relapse.
"Due to the heterogeneity of the offender population," Nochajski advised, "we suggest that researchers and clinicians identify subgroups—people with certain drinking characteristics, depression, coping skills, attitudes about drinking and drugs, and other sub-issues of drinking or drugging—that may play a part in high-risk for relapse. This way, prevention and intervention programs can be targeted to those different subgroups and issues."
For example, DUI offenders with less-severe alcohol problems seem to have better outcomes with a brief intervention focused on reducing the individual's risk of DUI relapse rather than with a formal substance-abuse program that works better with heavy-drinking problems.
Lastly, Nochajski and Stasiewicz suggest there is a need for greater integration of criminal justice and rehabilitation approaches that focus on reducing DUI relapse. Research shows that greater reductions in DUI recidivism are realized when legal sanctions and rehabilitation programs are combined, as well as when the rehabilitation programs combine education and treatment. Multiple-layered treatment programs, such as intervention and follow-up, also show better outcomes. DUI courts have been more successful when they require evaluations of offenders, with assignment to intervention programs based on those evaluations. When researchers and local and state legal jurisdictions forge strong working relationships, policies and procedures are initiated that greatly reduce DUI relapse.
The second research team reviewed relapse to alcohol and drug use following treatment, among men and women. Differences were noted between genders, and between alcohol use and drug use.
"Both men and women may relapse to alcohol use because of negative moods, a history of childhood sexual abuse, weaker belief in their ability to deal with difficult situations and poorer coping ability in difficult situations," according to Kimberly S. Walitzer, RIA deputy director and lead author on the review. She also is a research associate professor in the Department of Psychology, College of Arts and Sciences. Her co-author is Ronda L. Dearing, research scientist at RIA.
Although alcohol relapse rates were similar for both men and women, women appeared less likely to experience relapse to drug abuse, while men appeared more likely to relapse to drug abuse.
Marriage played a different role in alcohol relapse for men and women. Alcoholic women appeared to be put at risk for relapse because of marriage, marital stress and conflict. They appeared more vulnerable to marital issues and interpersonal conflict. As one example, a partner's drinking may create marital stress and, in turn, marital stress is likely to influence alcoholic women's relapse to drinking. Women also are more likely to begin drinking again when with a romantic partner or with a male or female friend.
In contrast, alcoholic men appear to be protected from relapse by marriage in that it lowers their risk of returning to alcohol use. Men may, in fact, be more likely to relapse when they are alone. Men also are more likely to be in a good mood or positive emotional state when they start drinking again as compared to women, who return to drink from a negative emotional state.
"This may be a result of differences between men and women who are problem drinkers," Walitzer explained. Data show that alcoholic women are more likely to be married to heavy-drinking men, while alcoholic men are more likely to be married to light-drinking women. In the first case, women may find a reason to drink with a partner who shares in the same heavy-drinking behavior. Men who are alcoholic more often are married to women who drink very little or not at all.
Few studies exist to document gender differences in drug abuse relapse. The studies that do exist indicate that women appear less likely to experience drug-abuse relapse, compared to men. Women who relapse to drug abuse may be more sensitive to negative experiences and interpersonal problems in their lives. In contrast, men report having positive experiences prior to relapsing to drug use.
Walitzer's and Dearing's review found that treatment provided to women in alcohol and drug programs is successful in addressing their needs. However, women as the primary caregivers of children or other family members experience more barriers to entering treatment. Thus, women do not always have outside support that can free them to enter a treatment program.
The research team suggests that more study of the various cycles of relapse—a one-time return to drinking followed by abstinence, a return to continuous drinking or multiple drinking episodes and periods of abstinence—would provide greater understanding of the relapse process in general and gender differences in the relapse process.