Estimating relapse rates and understanding different related factors among heroin-dependent patients: A prospective study

Introduction: Craving, poor coping, peer pressure, lack of family and social support, and negative mood states are important psychosocial factors which are important to understand the complex psychodynamics among heroin-dependent patients on an individual basis. Aim: The aim of the study was to estimate the prevalence of relapse and understand different related factors among heroin-dependent patients admitted to a tertiary care hospital. Materials and Methods: It was a time-bound (January 2016–January 2017) prospective study conducted at a tertiary care hospital involving 200 consecutive heroin-dependent individuals. Participants were interviewed using a self-structured questionnaire covering sociodemographic profile and clinical domains. Follow-up visits were conducted on 10 th day and after 1, 3, 6, and 12 months of discharge. Urine for morphine was done using Instant-View opiates (300) urine-cassette test. We classified the individuals in each visit as: Lapse (L), Relapse (R), Droupout (DR*). In each visit, after selecting relapsed patients, a self-structured pro forma for related factors assessment was applied. Patients who dropped out and relapsed were not followed, lapsed, and abstinent patients were further assessed, and the above protocol was repeated at every visit until the last follow-up. Results: Out of 200 patients, 11 (32.4%) did not complete the initial detoxification period of 15 days and left the study. Hence, 189 (94.5%) were followed further of which 116 lapsed, 15-relapsed, 54 abstained, and 4 dropped -out at first visit. During sequential follow-ups, lapsed patients kept on decreasing with 84 lapses at the 2 nd , 32 at 3 rd , 6 at 4 th , and nil at 5 th visit while abstinent patients kept on increasing at each follow-up visit with 88 (44%) abstinent patients out of total 200 at last visit relapsed patients increased until 3 rd -visit and were maximum at this visit with 29 patients. In this study, the prevalence of relapse was 39.0%. The most important related factors among these heroin-dependent patients were high income (>Rs. 20,000/month) – 49 (62.8%), indulgence in heroin-dependent peer groups-48 (61.5%), and risk-taking behavior - 39 (50%). Thirty-three (42.3%) had craving 0.24 (30.8%) had stressful events, 30 (38.5%) had anger outbursts, and 0.6 (7.7%) faced legal issues. Conclusion: The related factors play a complex psychodynamic role in heroin dependence.