The DRAM, Vol. 4(8) – Falling off the recovery wagon: Drinking trajectories

October 1, 2008

Understanding the drinking behavior that can occur immediately after a lapse from abstinence can help individuals prepare for obstacles as they work their way toward a more stable recovery. Using data from the Relapse Replication and Extension Project (RREP), researchers examined the behavior of recovering individuals from an alcohol-related disorder following an initial post-treatment lapse (Witkiewitz & Masyn, 2008).

Participants

  • N (RREP sample) = 563 participants
  • All participants met RREP recruitment criteria, which included the following:
    • aged 18 or older;
    • satisfied criteria for having alcohol use or dependence within the past 6 months;
    • with no record of additional concurrent substance use disorder diagnoses, intravenous drug use, or other major comorbid diagnoses.

Measures/Instruments
Using the Structured Assessment Interview for Drinking and Related Behaviors, self-report data from RREP baseline assessments were obtained during admission and bimonthly assessments of drinking for one year after admission.

Results


Figure. Drinking trajectories: drinking frequency after first lapse (adapted from Witkiewitz and Masyn, 2008). Click image to enlarge.

  • 395 participants (70%) lapsed following treatment
  • The authors identified three primary post first lapse drinking patterns (see Figure):
    • Moderate drinking, Heavy drinking, and Prolapsing (i.e., frequent drinking following the first lapse and a return to less frequent drinking)
      • The majority of participants had a moderate drinking trajectory or a prolapsing trajectory
  • Years of drinking problems and family history of drinking problems did not negatively affect post-lapse drinking trajectories
  • An increase in coping ability over time led to less frequent drinking at the time of a first lapse and lighter drinking in the time following the first lapse

Limitations
Self-report data

Discussion
Witkiewitz & Masyn’s results suggest that lapses can lead to multiple drinking trajectories and that successful recovery is affected by coping skills. Further, a family history of addiction and many years of alcohol related problems do not affect individuals’ post lapse recovery. The three trajectories indicate that both lapse and lapse recovery have to be addressed early and comprehensively in an individual’s treatment so that any possible future relapse is offset by a plan for recovery.

—Ingrid R. Maurice

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References
Witkiewitz, K., & Masyn, K. (2008). Drinking Trajectories Following an Initial Lapse. Psychology of Addictive Behaviors, 22(2), 157-167.