Developmental models of substance abuse relapse

Most models of addiction treatment outcome and relapse have been formulated on adult populations, with only modest consideration of developmental factors which are salient issues for substance use disordered (SUD) youth. The dominant cognitive behavioral model of addiction relapse (Marlatt & Gordon, 1985) has been compelling in its description of how situational context (e.g., high risk situations) interacts with cognitive factors (e.g., self-efficacy, coping resources) to elevate risk for relapse after treatment in adults. The Youth Addiction Relapse Model (Brown & Ramo, 2005) is a developmentally specific framework from which the relapse process in adolescents can be evaluated. The present series of studies consider developmental aspects of addiction relapse by testing the Youth Relapse Model. The first study examines the situational and personal (internal) factors associated with relapse in SUD youth with comorbid psychiatric disorders. Adolescents (N=81) with a SUD and another Axis I mental health disorder were recruited from inpatient substance abuse and psychiatric treatment, and assessed monthly for one year. Youth who relapsed within the first month were more likely to report use of drugs other than alcohol or marijuana in their first post- treatment substance use episode, and substance use among late relapsers was more often preceded by direct social pressure to use. Lower self-efficacy was associated higher likelihood of relapsing in two situations: when youth were experiencing significant conflict/life stress, and when youth reported cravings during the two weeks prior to relapsing. The second study compares the latent class structure of relapse precursors in adolescents and adults. Adults (N=160) and adolescents (N=188) in substance abuse and psychiatric treatment were followed up to eighteen months after discharge. The best-fitting models in both age groups were able to classify all individuals into one of two classes. Adult classes were labeled Social and Urge situations (67%), and Negative Affect and Urge situations (33%), while teen classes were labeled Social and Positive situations (69%) and Complex situations (31%). The third study examines the role of concomitant depression in substance use relapse for adults and youth. Specifically, this study compares whether self-efficacy mediates the relationship between depression symptoms and initial abstinence duration after treatment for SUD adolescents (N = 208) and adults (N = 160). In adolescents, self-efficacy fully mediated the relationship between depression and time to initial post treatment substance use. In adults, a higher number of depression symptoms was associated with lower self-efficacy, and lower self-efficacy predicted shorter time to first substance use; however, depression was not independently associated with time to first use. Findings for all three studies are discussed in relation to the Youth Relapse Model. Developmental and clinical considerations in treating clients with substance use disorders and comorbid psychopathology are addressed across these three studie