Family Support and Relapse Timing Among Adolescents Following Substance Use Rehabilitation: A Survival Analysis Approach

Abstract Adolescent relapse following substance-use rehabilitation remains a critical clinical challenge in low-resource settings such as Zimbabwe. Although family support is widely recognized as protective, its temporal influence on relapse has received limited empirical attention. This study investigates the association between family support and time to relapse among adolescents’ post-rehabilitation using Kaplan-Meier survival analysis and Cox proportional hazards modeling. A retrospective cohort design was applied to secondary data from two private rehabilitation hospitals, yielding a final analytic sample of 983 adolescents aged 13–19. Family support was assessed using an adapted Family Environment Scale (FES), and relapse was defined as the first readmission for substance use. I compared survival distributions using Kaplan–Meier estimates and log-rank tests, and we adjusted for gender with a Cox proportional hazards model. Adolescents with family support demonstrated significantly longer relapse-free survival than those without support (log-rank χ²(1) = 65.55, p < .001). I included gender to explore variation in relapse timing within the family-support context. The findings underscore family support as a time-structuring relational resource that extends recovery stability during the high-risk post-discharge period. These findings underscore the importance of embedding structured family assessments and family-inclusive interventions within adolescent rehabilitation pathways. For clinical social work practice, the results highlight the need to systematically evaluate family relational climate and tailor post-discharge support plans accordingly.