Elsevier

Addictive Behaviors

Volume 29, Issue 4, June 2004, Pages 753-758
Addictive Behaviors

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High-risk relapse situations and self-efficacy: Comparison between alcoholics and heroin addicts

https://doi.org/10.1016/j.addbeh.2004.02.003Get rights and content

Abstract

The main purpose of the present study is to investigate the differences between alcoholics and heroin addicts in some relapse dimensions and self-efficacy. The sample consisted of 180 inpatient males, who admitted to Al-Amal Hospital, Jeddah, Saudi Arabia, for treatment from substance abuse. The total sample was divided into two groups: 105 participants were heroin addicts and 75 were alcoholics. Two standardized questionnaires [inventory of drug taking situations (IDTS) and situational confidence questionnaire (SCQ)] were used. Heroin addicts have statistically significant high mean IDTS scores compared with the alcoholics sample, whereas the alcoholics have significantly higher mean SCQ scores than did their heroin counterpart. Again, the alcoholics had significantly lower admission and relapse rates compared with the heroin group. Furthermore, the results indicate that the highest high-risk relapse situations are negative emotions (NE), testing personal control (TPC), social pressure (SP), and urge and temptations (UT).

Introduction

For many years, there appeared to have been little attention paid to relapse. However, the most systematic and comprehensive studies have been conducted by Marlatt (1978) and Marlatt and Gordon (1985). Substance uses have long been identified as chronic relapsing processes. Research showed that about 35–58% from treated alcoholics relapsed at 2 weeks to 3 months, respectively.

Many models of relapse have been suggested, essential of which are the psychological and psychobiological models. The most impressive one among psychological model is the cognitive behavioral approach Marlatt, 1996, Marlatt & Gordon, 1985. During this time, the concept of high-risk situations emerged, and there were two major categories of high-risk situations. Intrapersonal environmental determinants refer to relapse episodes where response is primarily psychological, physical in nature, or to environmental events. This category consists of negative emotions (NE), physical discomforts (PD), urge and temptation (UT), positive emotions (PE), and testing personal control (TPC). The second category is interpersonal determinants. It comes out when the relapse episodes involve the significant influence of other individuals. It includes conflicts with others (CO), social pressures (SP), and pleasant times with others (PT). Marlatt and Gordon (1985) reported that 35% of relapses occur in the NE, 16% in CO, and 20% for SP. Lowman, Allen, and Stout (1996) concluded that 62 –73% of relapse episodes coded under NE and SP. Bradly, Gossop, Brewin, Philips, and Green (1989) and Heather, Stallard, and Debbutt (1991) found that SP determinants were not the only important factors in relapse, but craving, temptation, and substance cues can also do so. Some research showed that heroin addicts relapse primarily because of NE and lack of social supports. Mood state, along with social isolation and family factors, was more likely to be repeated as high-risk situations of the coming relapse incidences. Connors, Maistro, and Zywiak (1996) argued that negative life events and the exposure to the high-risk situation had not been related to relapse probability. Furthermore, another feature of relapse determinants is related to cognitive appraisal and self-expectancy. Marlatt and Gordon (1985) postulated that the high-risk situation leading to relapse is associated with individual construction of strong expectancy, that the use of alcohol will have positive and desirable outcome. Sanchez-Craig (1976) stated that the first positive appraisal might lead to relapse. Based on the taxonomy of high-risk situations of Marlatt & Gordon, 1985, Annis & Martin, 1985 constructed the inventory of drug-taking situations (IDTS). The tool measures the situations where the client was taking substance heavily during the past years. It is a multiscale measure, which is sensitive to changes in drug-use pattern. Heather et al. (1991) recommended that multidimensional assessment is a more sensitive tool to measure lapse precipitants than is the categorical system that was employed by Marlatt.

Bandura (1977) introduced the concept of self-efficacy beliefs as a final common pathway, mediating behavioral changes. Accordingly, the self-efficacy theory verified that behavioral changes produced by different types of treatment are mediated by a common cognitive mechanism, “efficacy expectancy.” However, the expectancy of being able to cope with successive high-risk situations as they develop is closely associated with the idea of self-efficacy. Expectancy has two components: (i) cognitive (informational) components, which are associated with what a person “knows” or expects to happen, as a result of performing significant behavior and (ii) motivational (incentive) components, which are related to the interest “reinforcement values” of the specific outcomes or effects. The feeling of confidence to cope effectively with high-risk situations is enhancing the perception of self-efficacy. One of the famous self-efficacy measurements is the situational confidence questionnaire (SCQ; Annis & Graham, 1988). It was constructed to assess a client's perceived ability to deal successfully with high-risk situations. There were two hypotheses tested. (i) Alcoholics and heroin addicts have no differences on high-risk relapse situations when are measured by the IDTS and (ii) heroin addicts and alcoholics have no differences on self-efficacy when measured by the SCQ.

Section snippets

Sample

The sample consists of substance abusers from the Al-Amal hospital, Jeddah, Saudi Arabia. The heroin group (n=105) had a mean age of 32.2 years and 66.7% were single and divorced. The majority, 75.2%, was jobless, while 64% had completed 6–9 grades of education. About 77% reported poor financial status. From the sample, 78.1% had admissions and relapses more than four times. This group represents about 60% of the total admissions and constitutes 58% of the sample. The alcoholics group (n=75)

Results

The heroin group has higher total IDTS mean scores than the alcoholics group did, and the difference is significant (t=5.864, df=7, P<.001). The mean SP score within the heroin group statistically exceeds the alcoholics group's mean SP score (t=3.00, df=74, P<.01). Similarly, the heroin group significantly differs from the alcoholics regarding the mean PD and PT scales scores (t=1.990, df=74, P=.018 and t=2.428, df=74, P<.050, respectively). The heroin group has a higher admission rate mean

Discussion

The main goal of the present study is to compare alcoholics and heroin addicts on both high-risk relapse situations and situational confidence. The findings revealed significant mean differences on the basis of high-risk situations. High mean scores on PD, SP, and PT can be explained by clinical observations: Heroin patients argued that they always use drugs to relieve the physical pain or some other sickness trouble, and most relapse triggers are that of negative nature. Furthermore, high

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