Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking

Abstract

On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months. There is a critical need to identify modifiable risk factors associated with relapse that can be addressed during AUD treatment. Candidate factors include mood disorders and cigarette smoking, which frequently co-occur with AUD. We predicted that co-occurrence of mood disorders, cigarette smoking, and other modifiable conditions will predict relapse within six months of AUD treatment. Ninety-five Veterans, 23-91 years old, completed assessments of multiple characteristics including demographic information, co-occurring psychiatric disorders, and medical conditions during residential treatment for AUD. Participants' alcohol consumption was monitored over six months after participation. Logistic regression was used to determine if, mood disorders, cigarette smoking status, alcohol consumption, educational level, and comorbid general medical conditions are associated with relapse after AUD treatment. Sixty-nine percent of Veterans (n = 66) relapsed within six months of study while 31% remained abstinent (n = 29). While education, comorbid general medical conditions, and mood disorder diagnoses were not predictors of relapse, Veterans with greater symptoms of anhedonia, active smokers, and fewer days of abstinence prior to treatment showed significantly greater odds for relapse within six months. Anhedonia and cigarette smoking are modifiable risk factors, and effective treatment

The effects of pharmacological interventions on smoking cessation in people with alcohol dependence: A systematic review and meta‐analysis of nine randomized controlled trials

“…Among them, smoking is closely related to drinking. Among individuals recovering from dangerous drinking habits, studies have shown that smoking is associated with excessive drinking, increased alcohol withdrawal symptoms, a higher probability of relapse and early relapse after treatment 13,14 . Therefore, the development of smoking cessation treatment programmes for this population is important for their long‐term health and recovery from addiction.…”

The phenotype of recovery V: Does delay discounting predict the perceived risk of relapse among individuals in recovery from alcohol and drug use disorders

“…Several individual characteristics are shown to predict the likelihood of relapse. For example, demographic variables including older age (Andersson et al, 2019; Naji et al, 2016; Nordfjærn, 2010), unemployment (Andersson et al, 2019; Moos & Moos, 2006; Nordfjærn, 2010), family history of substance use and disorder (Chalana et al, 2016; Domino et al, 2005; Golestan, 2010; Jauhar et al, 2004; Rustad et al, 2015; Schuckit, 1985; Swan et al, 1988), being male versus female (Xie et al, 2005), having less education (Moos & Moos, 2006), and smoking status (e.g., current or former smoker; Nguyen et al, 2020; Quisenberry et al, 2019) have been shown to be associated with increased risk of relapse to substance use. Lack of self‐efficacy and coping skills are also thought to contribute to rates of relapse (Moos & Moos, 2006).…”

“…Lack of self‐efficacy and coping skills are also thought to contribute to rates of relapse (Moos & Moos, 2006). In addition, increased stress response (i.e., cortisol levels; Wemm & Sinha, 2019), sleep deprivation (Brower & Perron, 2010), depression scores (Cornelius et al, 2003; Hammerbacher & Lyvers, 2006; Nguyen et al, 2020), and lack of social support (Cornelius et al, 2003; Hammerbacher & Lyvers, 2006; Rustad et al, 2015) predicted rates of relapse to substance use. Further, a higher number of pretreatment quit attempts, higher severity scores, and psychiatric severity predicted relapse in Oxford houses, sober living environments, after treatment (Harvey et al, 2015).…”

Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out

“…4,9 More concerning, even after receiving treatment, more than half of patients relapse within a year. 10,11 Relapse can be attributed to several psychosocial and biological factors. Among others, marital status, 12 traumatic experiences, 13 psychological distress, 14 and presence of co-existing psychopathology including anxiety, depression, 15 and attention deficit hyperactivity disorder (ADHD) 16 may influence relapse.…”