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There are several factors affecting the tendency to readmit to drug treatment programme. Even though individuals who got relapse do not necessarily readmitted, but as stated in the previous section, those who got readmitted were because they got relapse. Therefore it is also important to study the factors affecting relapse as they gave a broad idea of factors of getting readmitted. Many qualitative studies as well as quantitative studies have been conducted to determine the factors associated with drug relapse using different approaches.
However, only a few studies concentrate on investigating factors of getting readmitted to drug treatment programme.
According to a recent study by Arning (2017) that was using logistic regression analysis, heroin addiction (p < 0.001), polydrug use (p = 0.011), mood disorders (p = 0.029) and prob- lems related to the social environment (p = 0.033) were found to be significant predictors related to readmission to detox. Another study by Trujols et al (2007) have determined that route of administration of drugs and reason for discharge are significant to the first episode of readmis- sion.
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Precisely, routes of administration other than injecting such as snorting or smoking were found to be increasing the readmission rate (HR = 1.98) while patients who were discharged regularly have significantly lower readmission rate (HR = 0.56).
By using proportional hazard regression, Luchansky and He (1999) have reported that com- pleting an episode of treatment decreased the risk of readmission for both The Alcohol and Drug Abuse Treatment and Support Act (ADATSA) clients by 19% and non-ADATSA by 37%. Having a current mental health problem was found to be increasing the risk of readmission for non-ADATSA clients.
In a relapse survival study conducted by Kassani et al (2015), the log rank test analysis showed that the association between survival time of getting relapse and marital status, job sta- tus, education and type of drugs were statistically significant (p = 0.03, 0.01, 0.02 and 0.03 respectively).
It was revealed that widowed or divorced subjects have lower survival time with 15.11 (95% C.I. = (9.27, 20.94)) months compared to married and single subjects which were 31.23 (95% C.I. = (26.81, 35.65)) and 22.94 (95% C.I. = (18.70, 27.17)) months respectively. Unemployed subjects, subjects with primary and middle school education, and subjects who used type of drugs other than opium were found to have lower survival time compared to other categories with 19.89 (95% C.I. = (15.90, 23.89)), 19.13 (95% C.I. = (14.52, 23.75)) and 24.11 (95% C.I. = (19.68, 28.55)) months respectively. The final model of Cox regression indicated that age (HR = 0.932, 95% C.I. = (0.89, 0.97)), family size (HR = 1.197, 95% C.I. = (1.02,4.94)), marital status (HR = 1.553, 95% C.I. = (1.21, 1.88)) and job status (HR = 2.638, 95% C.I. = (1.35, 5.19)) were significant and after adjusting the other factors.
Findings by Swanepoel et al (2016) suggest that stigmatization by community and difficulty in finding job play important roles in leading the subjects to relapse. Swanepoel et al (2016) have discovered in their study that 88.9% of females in South Africa were found to be more prone to relapse as a result of contact with drug dealers upon release from treatment centers. The main factors affecting a relapse to drug use were found to be job loss or unemployment and changes in income or poverty (Seraji et al, 2010). It has been found in Lexington that 94% of unemployed past users returned to drug use (Ting, 1999). In Brunei, it has been reported that unemployment is one of the leading factors contributing to relapse with 68% of respondents admitted that they repeat their past behavior due to the factor mentioned (Zulhilmi, 2009). Zul- hilmi (2009) also mentioned that the label factor obviously affects the employer's judgment in the employment of workers. However, employment turns out to be a risk factor for drug abuse treatment outcomes as well, which supports the assumption that employment with providing an income source can stir them up to go back to addiction (Richardson et al, 2012; Magura et al, 2004). This is because there were enabling factors such as the availability of money that makes returning to drugs is unpreventable.
According to Hosseini et al (2014), by using shared frailty model, the age at the onset of ad- diction (p = 0.046; HR = 1.30) and marital status (p = 0.06; HR = 0.027) also have significant role in the relapse time to using opium again. Devi (2015) agrees that age is significant as he also found that probability of relapse increases as subjects are older. Sau et al (2013) believe that lower relapse rate in married people rather than singles and divorced or separated persons can be due to family support and financial security, which are fundamental for recuperation and social rehabilitation. Hosseini et al (2014) have also found that history of chronic disease (p = 0.005; HR = 249.635) can push them further into relapse.
In a study carried out by Harvey et al (2016), Cox proportional hazards regression indicated the number of previous treatments for alcohol and drug were significant, such that one addi- tional treatment episode was associated with a 6.7% and an 8.4% increase in the hazard ratio respectively. Addiction Severity Index (ASI) alcohol composite scores and psychiatric com- posite were also significant, such that for each 0.10 increase in the ASI alcohol or psychiatric composite was associated with an increase in the hazard ratio by 82% and 28% respectively. The effect of alcohol abstinence self-efficacy (AASE) was also significant, such that each ad- ditional unit in alcohol self-efficacy at each 120-day time point was associated with a decrease the hazard ratios by 1.2%.
Luchansky and He (1999) have reported that only 8% of ADATSA clients were readmitted for inpatient treatment in the first year. Readmissions to inpatient treatment decreased in the next following year by 2%. They also found that most of the clients which is 17% of them chose to enter outpatient in the first year. According to Trujols et al (2007), there were 36.99% inpatient readmissions in the first episode in their multi-episode study of readmission of heroin depen- dents at an inpatient detoxification unit.
In addition, recent study by Polenberg (2015) stated that 43.11% of the study sample have self-reported that they got relapsed while only 5.97% of the sample got re-arrested within 18 months. Arning (2017) reported that 29.9% of participants who were entered in a detox pro- gramme between 1st January 2012 and 30th June 2014 were readmitted to detoxification after they were followed up for at least one year. According to Robbins et al (2007), 27.9% of women prisoners who were followed up for 18 months after their release from prison got re-arrested. Another study by Wolfe et al (2002) have reported that 39% of 618 drug court participants and 37% of 75 non-participants got rearrested within 3 years of following up period.
The factors discussed in the preceding sections are significant for treatment procedures and 23
could help to ascertain whether a setting in the treatment is suitable for the individual (Melnick et al, 2001; Walters, 2002). Hence, the treatment implemented will be more effective and thus, relapse and readmission rate can be decreased. There are numerous effective treatment proce- dures which have been implemented for drug abusers to treat addiction as well as to prevent another relapse and readmission such as cognitive therapy, therapeutic community, spirituality and religious based treatment, methadone maintenance treatment and mindfulness-based re- lapse prevention.
Cognitive therapy is a medium for converting negative to positive thinking of individuals and developing healthy coping strategies (Beck et al, 1993; Hendershot et al, 2011). This ther- apy can help individuals abstaining from doing old habits and teaching them on how to create a new and healthier of thinking (Frewen et al, 2008; Holzel et al, 2011). It also helps individuals to realize that recovery is not based on willpower but rather on coping skills and to see that re- covery is fun even though sometimes it required hard word but addiction is even harder. Larimer et al (1999) also state that during cognitive therapy, individuals are challenged to reminiscing their past successes and recognizing their strengths when they wanted to recover. Moreover, it trains individuals to think that negative feelings are a normal part of life and moment of growth.
Therapeutic community (or TC) is a prevalent form of drug abuse treatment in a long-term residential setting. It was founded in 1958 in California and now has been adopted in more than 65 countries around the world (Bunt et al, 2008). The main goal of this treatment is to bring out drug-free individuals who are employed, in school or in training. TC is following a concept of "community as method" where individuals are living in a group and have to participate actively to push forward their behavioral change and to accomplish the therapeutic goals (Vanderplass- chen et al, 2014).
Dye et al (2012) have divided the TC program into three treatment stages. In the first stage, individuals are supposed to substitute their past drug-using life with overall new positive lifestyle which based on honesty, taking responsibility, and increasing their knowledge about drug awareness. The second stage of treatment include ongoing process of cognitive therapy and motiva- tional interviewing. Lastly, in the third stage, individuals are preparing to re-entry into commu- nities outside treatment centre by looking for employment or entering school or training centre. Since recovery is an ongoing process, continuous support from people around the recovered individuals are needed to aid a heathy drug-free lifestyle and help them preventing from relapse (Hendershot et al, 2011).
Spirituality and religious based treatment has been found to be a significant factor of re- covery and to improve the outcome of treatment (Avants et al, 2001; Piedmont, 2004). Poage et al (2004) have proven that the length of abstinence is positively correlated with spirituality. This type of treatment basically encourages individuals to actively practice their religion as it is believed that religion can develop individuals' spirituality, thus individuals can improve their coping skills, reduce their cravings and change their attitude and behavior to the better.
Since 1950s, methadone maintenance treatment (or MMT) has been implemented to treat drug dependence (WHO, 2004). Methadone is also a drug like heroin and opium but it is taken daily under medical supervision to reduce withdrawal symptoms and cravings. WHO (2009) have found that being in MMT in the closed setting can reduce the risk of relapse. However, some MMT patients may experience side effects such as sleep disturbance, nausea and vomiting, constipation, dry mouth, increased perspiration, sexual dysfunction, menstrual irregularities in women and weight gain.
Mindfulness-based Relapse Prevention (or MBRP) is a mindfulness intervention treatment particularly for drug abuse which is merged in psychotherapeutic relapse prevention method (Lancaster et al, 2006). "Mindfulness" is derived from Buddhist theory which involves a de- termined attention to the current time with an openness to accept things as they are (Segal et al, 2007). In a medical treatment setting, individuals stimulate mindfulness to identify, ac- knowledge and quit negative perceptions (Brown & Ryan, 2003). Neurologically, it is hypothe- sized to reduce cravings and to stimulate cognitive self-regulation or behavior (Way et al, 2010;Hasenkamp et al, 2012). The main goal of MBRP is to further reduce the risk of relapse by helping individuals to handle psychological discomfort which can lead to relapse. According to Witkiewitz et al (2014), the core components of MBRP are to teach individuals meditation practices related to a central themes of MBRP sessions include automatic pilot and relapse, awareness of thoughts and emotions related to cravings, mindfulness practices in daily life and in high-risk situations, balancing acceptance and skillful action, the role of thoughts in relapse, balancing self-care and lifestyle and lastly, building social support and continuing mindfulness practices.
Drug Treatment Readmission: Factors & Interventions. (2019, Dec 11). Retrieved from https://studymoose.com/drug-treatment-program-essay
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