Reasons for Relapse After In-Patient De-Addiction Treatment for Alcohol Dependence – a Qualitative Analysis From India

[摘要] Aims. To explore the reasons for relapse after receiving in-patientdetoxification and de-addiction treatment for alcohol dependencesyndrome, through in-depth interviews and thematic analysis.Methods. This study was conducted in a tertiary care teachinghospital in South India. After obtaining Institutional ethicscommittee approval, patients of 18 years and above, who wereadmitted for the management of alcohol withdrawal syndrome,were approached and informed consent was obtained. Patientswere screened with Clinical Institutes WithdrawalAssessment-Alcohol Revised (CIWA-Ar) and 15 patients whoscored less than 7, who did not have any severe medical or psychiatric illness, whose cognition was intact according to HindiMental Status Examination (HMSE) and those who had twode-addiction treatments in the past were recruited. In-depth interviews were conducted in Tamil, audio-recorded, and transcribed.A semi-structured guided interview format was used to gathertheir narratives. The transcripts were translated to English onthe same day and a step-by-step thematic analysis recommendedby Braun et al was followed. The interviews were conducted in asoundproof room ensuring privacy and confidentiality. Therecorded audios and the transcripts were firewall protected. Thetranscripts were read multiple times to familiarize the investigators. By using a general inductive method the data were retrieved,coded, and systematically organized according to patterns andthemes. Two investigators coded the transcripts separately andany conflict was resolved by discussion. Thematic saturationwas attained with the 14th transcript but the coding was completed for all 15 manuscripts. The mean age of the participantswas 26.4 years.Results. The analysis resulted in the identification of reasonsattributed by the patients for resuming drinking after receivingin-patient detoxification and de-addiction treatment for 21 days.This 21 days deaddiction program comprises of detoxification,motivation enhancement therapy, group therapy, and familyinterventions. The reasons for relapse included peer pressure,confidence that they will not become dependent again, craving,stressors, and health issues such as pain and insomnia and totest whether the treatment works or not. Reasons for the delayin help-seeking were lack of motivation, poor social support,financial constraints, lack of hope in medical treatment, did notfeel the necessity to take treatment, fear of whether the doctorswould be upset for relapsing again and, the guilt of lettingdown the treatment team. The reasons why they finally camefor treatment were having severe withdrawal symptoms, pressurefrom a family member or employee, guilt and a desire to change,and fear of dying.Conclusion. This research provides avenues to understand patients’perspectives on relapse of alcohol dependence. Understanding thesewould be beneficial in psychotherapy while managing relapses. Italso helps us to reflect on our practice and to address these issuesbefore discharging the patients to minimize the relapses.

[学科分类] 计算机科学（综合）