PSYCHOLOGICAL AND BEHAVIORAL-FACTORS ASSOCIATED WITH RELAPSE AMONG HEROIN ABUSERS TREATED IN THERAPEUTIC COMMUNITIES

The authors carried out a comparative study on two groups of heroin ab users treated in several therapeutic communities: One group consumed h eroin on at least three occasions between the fifth and sixth months o f treatment (n = 130), and the other continued without consuming heroi n after 7 months of treatment (n = 130). The instruments used for data collection were a structured interview and urine analysis. The relaps ed group includes older patients with more medical problems, lower edu cational and occupational level, and major chronicity in heroin consum ption. The collection of retrospective data referring to the treatment period shows that relapsed patients more frequently consumed alcohol, hashish, cocaine, and amphetamines: suffered more heroin cravings; us ed fewer coping strategies to overcome the craving; and justified the craving or the heroin consumption in more situations than those who ab stained. The last heroin craving during the treatment period arose in different temporal, social, and physical contexts in the two groups, a nd it was accompanied more frequently by inadequate responses in the r elapsed group: psychophysiological alterations, depressed feelings, ne gative thoughts, and coping behaviours. The two groups are different i n their attitudes toward heroin abstinence. The authors discuss the fi ndings from a cognitive-behavioural perspective and come to the conclu sion that various models need to be integrated. (C) 1998 Elsevier Scie nce Ltd.