Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;41(4):743-758.
doi: 10.1111/dar.13401. Epub 2021 Nov 18.

Is the relapse concept in studies of substance use disorders a 'one size fits all' concept? A systematic review of relapse operationalisations

Fredrik D Moe  1 , Christian Moltu  2 , James R McKay  3   4   5 , Sverre Nesvåg  5   6 , Jone Bjornestad  1   2   7
Affiliations

Is the relapse concept in studies of substance use disorders a 'one size fits all' concept? A systematic review of relapse operationalisations

Fredrik D Moe et al. Drug Alcohol Rev. 2022 May.

Abstract

Issues: Relapse is a theoretical construct and empirical object of inquiry. It is unclear how relapse is operationalised with regard to the various phases in substance use disorders (SUD). The aim was to investigate relapse operationalisations in SUDs studies after short- and long-term abstinence and remission, recovery and slip/lapse.

Approach: Systematic review using the following databases: Epistemonikos, Cochrane Central Register of Controlled Trials (CENTRAL and DARE), MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science and PsycINFO. Search returned 3426 articles, with 276 meeting the following inclusion criteria: empirical study published in English in a peer-reviewed journal; samples meet diagnostic criteria for dependence syndrome or moderate-severe drug use disorder or alcohol use disorder; reports relapse, abstinence, recovery, remission, slip or lapse. Review protocol registration: PROSPERO (CRD42020154062).

Key findings: Thirty-two percent of the studies had no definition of 'relapse'. Most relapse operationalisations were defined according to measure (26%), time (17%), use (26%) and amount and frequency (27%). Of the 16 studies with a follow-up duration of up to 2 years, one (6%) contained a definition of 'long-term abstinence'. Of the 64 studies with a follow-up duration of more than 2 years, four (6%) contained a definition of 'long-term abstinence'. Of those, one (2%) mentioned 'early relapse' and one (2%) mentioned 'late relapse'.

Implications: Future research is needed to explore the possible difference between early and late relapse. Moreover, working to increase consensus on relapse operationalisations in SUD research is warranted.

Conclusions: We identified no consensus on relapse operationalisations nor agreement on the differentiation between early and late relapse. The clinical utility of current relapse operationalisations seems low and may compromise knowledge accumulation about relapse and implementation of research into treatment.

Keywords: long-term abstinence; recovery; relapse; substance use disorder; systematic review.

PubMed Disclaimer

References

    1. Scott CK, Dennis ML, Laudet A, Funk RR, Simeone RS. Surviving drug addiction: the effect of treatment and abstinence on mortality. Am J Public Health 2011;101:737-44.
    1. Arria AM, McLellan AT. Evolution of concept, but not action, in addiction treatment. Subst Use Misuse 2012;47:1041-8.
    1. McKay JR, Hiller-Sturmhöfel S. Treating alcoholism as a chronic disease: approaches to long-term continuing care. Alcohol Res Health 2011;33:356-70.
    1. Miller WR. What is a relapse? Fifty ways to leave the wagon. Addiction 1996;91:15-28.
    1. Witkiewitz K, Wilson AD, Pearson MR et al. Profiles of recovery from alcohol use disorder at three years following treatment: can the definition of recovery be extended to include high functioning heavy drinkers? Addiction 2019;114:69-80.

Publication types