Context of relapse for substance-dependent adults with and without comorbid psychiatric disorders.

OBJECTIVE: This study examined the context of initial posttreatment substance use episodes and 1-year treatment outcomes among substance abusers in relation to Axis I psychiatric diagnoses.
METHOD: Of the 210 adults meeting DSM-III-R diagnostic criteria for a substance use disorder (SUD), 102 also met criteria for mood disorder, posttraumatic stress disorder (PTSD), or both (SUD-PSY). Quarterly face-to-face interviews and monthly telephone contacts were conducted following treatment to ascertain outcomes.
RESULTS: Antecedents of initial posttreatment substance use differed for SUD adults compared to SUD-PSY. Negative affective states preceded posttreatment use episodes more frequently among SUD-PSY participants. The majority of SUD-PSY adults reported intrapersonal/environmental antecedents whereas the majority of SUD adults reported interpersonal antecedents. Compared to SUD adults without an Axis I disorder, the SUD-PSY group was more likely to resume substance use when alone. Participants drank more than twice as much alcohol when relapsing alone compared to those who resumed use with others. Negative affective state prior to initial use was predictive of more subsequent using days for comorbid adults but not SUD adults.
CONCLUSIONS: These findings highlight differences in the process of resuming substance use for substance abusers with concomitant psychiatric disorders compared to SUD adults. Treatment implications are discussed.