title: From Abstinence to Relapse: A Preliminary Qualitative Study of Drug Users in a Compulsory Drug Rehabilitation Center in Changsha, China.
abstract: BACKGROUND
  Relapse among abstinent drug users is normal. Several factors are related to relapse, but it remains unclear what individuals' actual life circumstances are during periods of abstinence, and how these circumstances facilitate or prevent relapse.
  
  
  OBJECTIVE
  To illuminate drug users' experiences during abstinence periods and explore the real-life catalysts and inhibitors contributing to drug use relapse.
  
  
  METHODS
  Qualitative in-depth interviews were conducted with 20 drug users recruited from a compulsory isolated drug rehabilitation center in Changsha. The interviews were guided by open-ended questions on individuals' experiences in drug use initiation, getting addicted, treatment history, social environment, abstinence, and relapse. Participants were also encouraged to share their own stories. Interviews were digitally recorded and fully transcribed. The data of 18 participants who reported abstinence experiences before admission were included in the analyses. The data were analyzed using a thematic analysis with inductive hand coding to derive themes.
  
  
  RESULTS
  Most drug users were able to successfully abstain from drugs. During abstinence, their lives were congested with challenges, such as adverse socioeconomic conditions, poor family/social support, interpersonal conflicts, and stigma and discrimination, all of which kept them excluded from mainstream society. Furthermore, the police's system of ID card registration, which identifies individuals as drug users, worsened already grave situations. Relapse triggers reported by the participants focused mainly on negative feelings, interpersonal conflicts, and stressful events. Craving was experienced but not perceived as a relapse trigger by most participants.
  
  
  CONCLUSIONS
  This study of in-depth interview with drug users found evidence of situations and environments they live during abstinence appear rather disadvantaged, making it extremely difficult for them to remain abstinent. Comprehensive programs on relapse prevention that acknowledge these disadvantages are implicated.
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China; Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China.
authors.forename: Jules
authors.initials: J
authors.lastname: Mamy
authors.affiliation: Hunan Judicial Police Vocational College, Changsha, China.
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Gao
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China.
authors.forename: Shuiyuan
authors.initials: S
authors.lastname: Xiao
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D003220:Conflict, Psychological; D055030:Drug Users / Q000523:psychology*; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012008:Recurrence; D057545:Social Stigma; D012944:Social Support; D013315:Stress, Psychological / Q000503:physiopathology*; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000503:physiopathology / Q000523:psychology*; D011795:Surveys and Questionnaires