title: Psychological and environmental determinants of relapse in crack cocaine smokers.
abstract: The paper reviews approaches to relapse in the treatment of cocaine abusers. Approaches reveal a common mechanism underlying relapse that involves drug craving, recall of euphoria, environmental cues, denial, myths of being able to sell or use drugs, and painful affect states necessitating use of a multifaceted clinical technique. Empirical validation of a common mechanism underlying relapse establishes a typology of psychological and environmental determinants of relapse for crack cocaine smokers (N = 35) who relapse after hospital detoxification and return a second time. Major findings are that relapse follows a painful emotional state (40%), failure to enter arranged aftercare treatment (37%), or encounters with conditioned environmental stimuli (34%), and involves narcissistic psychopathology and denial (28.5%) and interpersonal stress (24%); 85.7% involve multideterminants. Case examples illustrate the role of multideterminants in relapse. The paper educates clinicians to the integrated theory and multifaceted clinical technique necessary for efficacious treatment of cocaine patients, while the typology predicts probable relapse situations.
authors.affiliation: African-American Studies Department, John Jay College of Criminal Justice, City University of New York, New York 10019.
authors.forename: B C
authors.initials: BC
authors.lastname: Wallace
mesh_terms: D000328:Adult; D003042:Cocaine; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012931:Social Environment; D012934:Social Isolation; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology* / Q000534:rehabilitation
chemical_list: D003042:Cocaine