Risk factors associated with relapse of drug dependence after treatment and rehabilitation in areas under the influence of war on terror

Muhammad Abdullah, Muhammad Imran Khan, Faiza Mumtaz, Faridullah Shah, Rosana C Ximenes, Vahid Nikoui, Abdul Wahab


Background: People exposed to war on terror are more prone to neuropsychiatric disorders and drug addiction. The present study was aimed to investigate the risk factors associated with relapse of drug dependence after treatment and rehabilitation in areas under the influence of war and terrorism.

Methods: Total 57 individuals who had a relapse from the war affected area were included in current study. Retrospective data were collected from Drug Detoxification and Health Welfare Research Center, Bannu, KPK, Pakistan. Along with demographic characteristics, current study also focused on the prevalence of psychological problems due to war, in association with prevalence of relapse.

Results: A total of 93% of Individuals with relapse have concurrent stress. Similarly, depression was also common in 78.9% of relapsed individuals. Relapse was more common in Polydrug abusers (66.7%) as compared to single drug abusers. As far as abstinence duration is concerned, subjects having depression and stress due to war, relapsed in less time as compared to individuals with no psychological disorders.

Conclusion: Wars are related with mental and psychological problems like stress and depression and these factors significantly contribute to the relapse of drug dependence as suggested by results of current study.

Keywords: Drug addiction; Relapse; War on terror; Depression

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Koob GF, Ahmed SH, Boutrel B, Chen SA, Kenny PJ, et al. Neurobiological mechanisms in the transition from drug use to drug dependence. Neuroscience & Biobehavioral Reviews, (2004); 27(8): 739–749.

Wikler A. Dynamics of Drug Dependence: Implications of a Conditioning Theory for Research and Treatment. Archives Of General Psychiatry, (1973); 28(5): 611–616.

The drug problem and organized crime, illicit financial flows, corruption and terrorism in World Drug Report 2017, United Nations, (2017); 1–45.

UNODC and Ministry of Interior and Narcotic Control Govt of Pakistan, “Drug Use in Pakistan",(2013); 1–71.

NIDA, Abuse, “Drugs, Brains, and Behavior: The Science of Addiction.” [Online]. Available: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. [Accessed: 11-Mar-2018].

Sinha R. New Findings on Biological Factors Predicting Addiction Relapse Vulnerability. Current Psychiatry Reports, (2011); 13(5): 398–405.

Brandon TH, Vidrine JI, Litvin EB. Relapse and Relapse Prevention. Annual Review of Clinical Psychology, (2007); 3(1): 257–284.

See RE, Fuchs RA, Ledford CC, McLaughlin J. Drug Addiction, Relapse, and the Amygdala. Annals of the New York Academy of Sciences, (2003); 985(1): 294–307.

Martin-Soelch C, Leenders KL, Chevalley AF, Missimer J, Künig G, et al. Reward mechanisms in the brain and their role in dependence: evidence from neurophysiological and neuroimaging studies. Brain Research Reviews, (2001); 36(2–3): 139–149.

Nestler EJ. Is there a common molecular pathway for addiction? Nature Neuroscience, (2005); 8(11): 1445–1449.

1Self DW. Neural substrates of drug craving and relapse in drug addiction. Annals of Medicine, (1998); 30(4): 379–389.

Koob G. Drug Addiction, Dysregulation of Reward, and Allostasis. Neuropsychopharmacology, (2001); 24(2): 97–129.

Fox HC, Jackson ED, Sinha R. Elevated cortisol and learning and memory deficits in cocaine dependent individuals: Relationship to relapse outcomes. Psychoneuroendocrinology, (2009); 34(8): 1198–1207.

Sinha R. How does stress increase risk of drug abuse and relapse? Psychopharmacology, (2001); 158(4): 343–359.

Hasin D, Liu X, Nunes E. McCloud S, Samet S, Endicott J. Effects of Major Depression on Remission and Relapse of Substance Dependence. Archives of General Psychiatry, (2002); 59 (4): 375-380.

Jafari S, Movaghar AR, Craib K, Baharlou S, Mathias R. Socio-cultural Factors Associated with the Initiation of Opium Use in Darab, Iran. International Journal of Mental Health and Addiction, (2009); 7(2):376–388.

Mahfoud Y, Talih F, Streem D, Budur K. Sleep Disorders in Substance Abusers: How Common Are They? Psychiatry, (2009); 6(9): 38–42.

Batool S, Manzoor I, Hassnain S, Bajwa A, Abbas M, et al. Pattern of addiction and its relapse among habitual drug abusers in Lahore, Pakistan. Eastern Mediterranean Health Journal, (2017); 23(3): 168–172.

Domino KB, Hornbein TF, Polissar NL, Renner G, Johnson J, et al. Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders. JAMA, (2005); 293(12): 1453-1460.

Mohammadpoorasl A, Fakhari A, Akbari A. Addiction Relapse and Its Predictors: A Prospective Study. Journal of Addiction Research & Therapy, (2012); 3(1): 1-3.

Schiff M, Benbenishty R, McKay M, DeVoe E, Liu X, Hasin D. Exposure to Terrorism and Israeli Youths’ Psychological Distress and Alcohol Use: An Exploratory Study. American Journal on Addictions, (2006); 15(3): 220–226.

Khan MI, Sameem B, Nikoui V, Dehpour AR. Is the war on terror induced-post traumatic stress disorder; the cause of suicide attack? An approach from psycho-cognitive and neurobiological perspective. Advancements in Life Sciences, (2016); 3(4): 109–111.

Greenfield SF, Weiss RD, Muenz LR, Vagge LM, Kelly JF, et al. The Effect of Depression on Return to Drinking: A Prospective Study. Archives of General Psychiatry, (1998); 55(3): 259.

Sinha R. The role of stress in addiction relapse. Current Psychiatry Reports, (2007); 9(5): 388–395.

Sinha R, Garcia M, Paliwal P, Kreek MJ, Rounsaville BJ. Stress-Induced Cocaine Craving and Hypothalamic-Pituitary-Adrenal Responses Are Predictive of Cocaine Relapse Outcomes, Archives of General Psychiatry, (2006); 63(3): 324.

Pfefferbaum BJ, Devoe ER, Stuber J, Schiff M, Klein TP, Fairbrother G. Psychological Impact of Terrorism on Children and Families in the United States. Journal of Aggression, Maltreatment & Trauma, (2005); 9(3–4): 305–317.


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