Personality, stress, and social support in cocaine relapse prediction A Program Evaluation

This study identified prospective psychosocial predictors of relapse status and drug abuse severity in male subjects in the first year after residential treatment for cocaine dependence.

Personality, stress, and social support measures from an intake assessment, and stress and support measures reflecting status during the three-month period prior to the one in which relapse was identified were used as predictors.

An accumulating body of research suggests that these three broad personality dimensions have significant implications regarding stress vulnerability and recovery from substance abuse

Detached Personalities Those with prominent detached personality features are assumed to be preoccupied by disturbing and conflictual cognitions which interfere with social communication and lead to dysphoric affect. Further, detached personalities are hypothesized to be vulnerable to the negative effects of life stressors because they have never learned complex coping skills. Although they may desire social acceptance, they are unable to tolerate close relationships and are expected to show limited ability of profit from social support.

Dependent Personalities Vulnerability to relapse in those with prominent dependent characteristics is thought to be associated with their excessive reliance upon others for feelings of worth and adequacy. They show little initiative, autonomy, or adult responsibility. Dependent types are hypothesized to be vulnerable to a wide range of life stressors because they have limited coping resources and experience pervasive feelings of inadequacy

Dependent The predominant coping strategy adopted by dependent types involves efforts to develop secure relationships with caretakers perceived as more competent than themselves. Thus, in contrast to detached types, those with prominent dependent characteristics are hypothesized to experience reduced relapse risk in a post-treatment environment that includes high levels of perceived social support.

Antisocial Personality Those high on the Antisocial personality factor factor tend to look to themselves as sources of need fulfillment either because of a deeply rooted confidence in themselves and/or because of pervasive mistrust of others

Antisocial They are expected to perceive comparatively few negative consequences associated with cocaine use and to resist social pressure for changes in attitude or behavior regarding substance use. For these reasons, it was predicted that antisocial types are considered unlikely to make a serious commitment to treatment or recovery in the posttreatment period. They were assumed likely to return to a sensation-seeking, rather than a stress-coping, pattern of substance abuse.

Participants Three hundred four program participants provided written informed consent, were evaluated, and met DSM III-R criteria for current cocaine dependence. The initial evaluation was conducted after detoxification but within two weeks after treatment admission. Follow-up evaluations were conducted prior to treatment discharge and at 3, 6, 9, and 12 months after treatment completion.

Evaluations Individually administered intake and follow-up evaluations were conducted by trained Ph.D. students in counseling psychology. These evaluations were conducted in a variety of settings (aftercare meetings at treatment centers, project research office, or during prescheduled telephone conferences).

Treatment Receipt All subjects recruited had completed a minimum of three weeks of residential treatment (see Table 1 for mean days of treatment by Group). Urine samples were collected regularly during residential treatment, and no positive tests were found for study participants.

Demographics Almost half (46.7%) of subjects were African American, another one-third (34.2%) were Caucasian, and most of the rest (12.5%) were Hispanic. The mean age was 29.3 years (SD = 6.5) and the average level of education was 12.2 years (SD = 2.2). Relatively few (13.2%) were currently married and living with a spouse prior to treatment entry.

Measures: Life Experience Survey The LES lists 47 life events that occur with reasonable frequency in clinical populations and permits respondents to add and rate up to three events not listed. It requires an evaluation of the perceived desirability or undesirability, as well as of the degree of impact, of identified events.

Perceived Support Network Inventory PSNI The first element involves a sense that there is a satisfactory number of individuals who are available in times of need. The second involves a perception of satisfaction with the quality of available support.

PSNI Perceived support quality is gauged by a composite index that reflects initiation of support seeking behavior, support availability, satisfaction with support received, support multidimensionality, support reciprocity, and social network conflict.

Relapse In the current investigation, we classified participants as having relapsed if they reported, during the ASI drug interview, at least seven days of cocaine use during any one of the four three-month follow-up periods after treatment completion.

Results The final logistic regression model was significant [c2(df = 10) = 54.22, p = 0.0001]. Detached personality [Wald(df = 1) = 5.85, p = 0.015], T1 social support (Wald(df = 1) = 4.87, p = 0.027], T2 stress (Wald(df = 1) = 5.02, p = 0.024], T2 social support [Wald(df = 1) = 9.77, p = 0.001], and T2 support network size (Wald(df = 1) = 6.38, p = 0.011], contributed significantly to prediction of relapse group membership.

Conclusions In general, current findings suggest that personality, stress, and social support characteristics which have beenuseful in the prediction of relapse to alcohol, opiates, tobacco, and other drugs are also useful in predicting cocaine relapse.

Implications Assessment of these characteristics may assist in understanding the likelihood of relapse and in planning effective treatments. Interventions designed to address certain long-standing personality disturbances, as well as those that assist patients in coping with cumulative stress effects and in remedying social support deficiencies, should continue to be planned and evaluated.

Implications