Can opiate addicts tell us about their relapse risk? Subjective predictors of clinical prognosis.

Given the high relapse rate of opiate addicts following detoxification, it is pertinent to identify whether any subjective variables mediate outcome, since these may then be targets of treatment. The present study assessed personality, cue-elicited craving, outcome expectancies for drug use, and self-efficacy for resisting drug use, in 43 opiate addicts receiving inpatient detoxification in either a specialist drug-dependence unit or a behavioral/general psychiatric ward, within the context of a randomised, controlled-treatment trial. Subjects were followed-up at between 1 and 3 months and again at 6 months after discharge. Frequency of drug use was not predicted by any of the subjective variables at the first follow-up; but at 6 months, subjects with lower self-efficacy and higher positive outcome expectancies were found to be using less often. Latency to first lapse was greater in subjects with higher anxiety and neuroticism scores. Precipitants to the first lapse were identified, but none of the predicted relationships between subjective variables and circumstances of lapse emerged. It is suggested that greater awareness of personal vulnerability may promote effective coping strategies.