Relapse into opiate and crack cocaine misuse: a scoping review

Abstract

Aims

International statistics show that relapse rates associated with opiate and crack cocaine (OCC) misuse remain high. This has led to an increased scientific interest in the topic of relapse. However, there are limited studies reflecting on the state of this field. This review provides an overview of the topic and directions for future research. Method: Guided by the overall question of how relapse into OCC misuse is understood, a scoping review was conducted using Arksey and O’Malley’s framework. A total of 126 studies between 1972 and 2019 were included. The literature was thematically grouped into relapse definitions, theories, associated factors and treatment approaches. Results: This review found that the majority of relapse understandings were derived from the USA and UK, and that these studies predominantly used quantitative research designs. Relapse definitions were controversial with the majority using biomedical concepts of disease. Theories on relapse were based on psychological theories and developed through clinical and neuroscientific research. Findings show that the majority of the literature focused on relapse risk factors with very few papers focusing on protective factors. Findings on treatment approaches indicate a steer toward harm-minimization strategies over relapse management strategies. Conclusions: This review demonstrates that drug relapse research needs to grow more diverse, inter-disciplinary and user-centred in perspective so as to respond to relevant challenges ahead.

Keywords:

• Relapse
• opiates
• crack cocaine
• scoping review

Acknowledgements

The author would like to thank Professors Matthew Hickman and Annmarie Nelson for providing motivation to conduct this research. Thanks to Dan Ranson for advice regarding the display of figures. Thanks also to Dr Jeremy Dixon and Dr Fergus Law for useful feedback regarding the interpretation of the data and efforts in reviewing an earlier version of this paper. This work was carried out at the University of Bath with the support of two PhD Studentships awarded to the author from the Society for the Study of Addiction as well as from the Economic and Social Research Council.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Stroop tasks assess for cognitive control, specifically, for attentional bias and salience attributed to the drug. Participants are shown words in coloured font. The task is to name the word, not the colour of the word, as quickly as possible (see Smith and Ersche 2014).

2 Attentional bias is the acute awareness of some things while simultaneously not being aware of others (Cherry 2019).

3 For a discussion around the causal effects of poly-drug use on relapse, please see Williamson et al. (2006).