22 Nov Assessing Relapse Risks in People With Cannabis Use Disorder
Cannabis use disorder (CUD) is a mental health category used to identify people who abuse cannabis (marijuana or hashish) without experiencing chemical dependence or develop dependence symptoms. Like people with other substance use disorders, people recovering from cannabis use disorder can experience short- or long-term relapses and return to cannabis intake. In a study published in September 2013 in the journal Drug and Alcohol Dependence, a multinational research team assessed the likelihood that an individual with cannabis use disorder will experience a relapse. The members of this team also looked at some of the key factors that increase or diminish an affected person’s relapse risks.
Cannabis Use Disorder Basics
Cannabis use disorder was established as a diagnostic category by the American Psychiatric Association in 2013. Prior to the creation of this category, individuals affected by significant cannabis-related problems received a diagnosis for either cannabis abuse (which does not constitute a form of chemical dependence) or cannabis dependence (which does constitute a form of chemical dependence). Although dependence and addiction are separate issues, many of the people who received a cannabis dependence diagnosis also had the drug urges and behavioral changes that characterize cannabis addiction. CUD was created (along with a range of other forms of substance use disorder) because issues of abuse and addiction commonly overlap in the real world and doctors often can’t clearly distinguish the two conditions from each other.
Relapse is a fairly common problem for people recovering from substance abuse or addiction, the National Institute on Drug Abuse explains. Some people relapse while in the early stages of recovery, while others relapse after successfully avoiding substance use for extended periods of time and establishing a routine of substance abstinence. On a chemical level, recovering abusers and addicts have risks for returning to drug or alcohol use because their brains have either grown generally accustomed to a substance or become physically dependent on a substance to maintain a “normal” chemical environment. Addicted individuals, in particular, are typically affected by strong urges to return to substance use during the early stages of the recovery process. On a mental/emotional level, risks for relapse commonly arise when an affected individual experiences moments of normal or unusual stress that previously led to substance use, encounters physical environments or social situations where substance use took place in the past, or directly encounters someone actively engaged in substance use.
As a rule, abuse and addiction recovery programs look at the ability to avoid a relapse as a key indicator of a successful long-term break with substance use. For this reason, treatment commonly centers on medication-based and non-medication-based techniques designed to achieve and maintain substance use abstinence. Medication options for dealing with the effects of abuse and addiction vary according to the substance in question. Non-medication-based options typically involve some form psychotherapy, including such approaches as cognitive behavioral therapy and psychodynamic psychotherapy.
Assessing Relapse Risks
In the study published in Drug and Alcohol Dependence, American and Spanish researchers used data from a project called the National Epidemiological Survey of Alcohol and Related Conditions to determine how many people affected by cannabis use disorder go through a relapse. The researchers also used data from the same project to determine which specific risk factors make cannabis relapses more or less likely. All told, the study involved 2,350 individuals with CUD who had achieved full drug abstinence. The researchers tracked relapse events in these individuals over a period of three to four years.
At the study’s end, the researchers found that 6.6 percent of the participants experienced at least one relapse back into cannabis use. Two key factors increased the likelihood that any given individual would experience a relapse: a preexisting history of a childhood mental health condition called conduct disorder and the development of major depression at some point during the recovery process. On the other hand, relapse risks dropped over time as the study participants increased the length of their periods of cannabis use abstinence.
Significance and Considerations
According to the results of the study published in Drug and Alcohol Dependence, relapse occurs with uncommonly low frequency in people seeking treatment for cannabis use disorder. In fact, relapse in these individuals occurs so infrequently that the study’s authors view successful maintenance of abstinence during CUD recovery as the norm rather than the exception. The authors believe that appropriate modification of the treatments used in cannabis use disorder programs may substantially increase the abstinence rates in program participants affected by conduct disorder or major depression.
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