Alkin Yılmaz, Yeşim Can, Müge Bozkurt, Cüneyt Evren

Alkol ve Madde Bağımlılığında Remisyon ve Depreşme

Alkol ve madde bağımlılığı kronik bir hastalık olup alkol madde bağımlılığı geliştikten sonra yaşam boyunca devam etmektedir. Bu yüzden doğal gidişi remisyon ve depreşmeler belirler. Alkol madde bağımlılarında zaman zaman remisyon dönemleri arkasından depreşme dönemleri ortaya çıkabil-mekte ve bu depreşme dönemleri de kişileri alkol maddenin tüm olumsuz etkileri ile karşı karşıya bırakabilmektedir. Depreşme riskini belirleyen günümüze kadar pek çok faktörden söz edilmiştir. Bu faktörler bireysel, durumsal olabildiği gibi fizyolojik temelleri de olan faktörlerdir. Bunların birbirleri ile karşılıklı etkileşimi depreşme açısından oldukça önemlidir. Depreşme bağımlılık gelişmiş kişilerin tekrar alkol madde kullanmaya başlamalarını önlemek için üzerinde oldukça fazla çalışılmış bir alandır. Bağımlı hastaların remisyon dönemlerinde yaşadıkları zorlukların veya tekrarlayan depreşme süreçlerinin ayrıntılı olarak tanımlanabilmesi alkol madde bağımlılığında tedavi stratejilerinin belirlenmesi ve sonraki depreşme süreçlerinin önlenmesi konusunda bağımlılık alanında çalışan klinisyenlere yol gösterici olacaktır.

Anahtar Kelimeler:

Alkol ve Madde Bağımlılığı, Remisyon, Depreşme

Remission and Relapse in Alcohol and Substance Addiction

Alcohol and substance addiction is a chronic disease and continues throughout individual's life once after addiction develops. Therefore its natural course is characterized by remissions and relapses. In addiction, relapse periods can be followed by remission periods and individuals encounter with negative effects of alcohol and substances in these relapse periods. Many factors have been defined to determine the risk of relapse up to the date. These factors can be situational or personal and they also have physiological bases. Interaction of these factors with each other is critical in terms of relapse. Relapse is a quite well studied area in the literature, in order to prevent the individuals from restarting alcohol and substance use again. Defining the challenges of addicted patients in remission periods and recurrent periods of relapse in detail will guide clinicians to determine treatment strategies in addiction and to prevent subsequent relapse periods.

Keywords:

Alcohol and Substance Addiction, Remission, Relapse,

PDF

___

Farren CK, Tipton KF. Trait markers for alcoholism: clinical utility. Alcohol Alcohol 1999; 34:649-665.
Davidson C. Identification and treatment of psychiatric comorbidity associated with alcoholism. Schweiz Rundsch Med Prax 1999; 88:1720-1725.
Gordon AJ, Zrull M. Social networks and recovery: one year after inpatient treatment. J Subst Abuse Treat 1991; 8:143-152. Walton MA, Castro FG, Barrington EH. The role of attributions in abstinence, lapse, and relapse following substance abuse treatment. Addict Behav 1994; 19:319-331.
Irvin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: a meta-analytic review. J Consult Clin Psychol 1999; 67:563-570.
Schuckit MA. Goals of Treatment. In Textbook of Substance Abuse Treatment. (Eds M Galanter, HD Kleber):3-10. Washington D.C., American Psychiatric Press, 1994.
Ceylan ME, Türkcan A. Araştırma ve Klinik Uygulamada Biyolojik Psikiyatri 2. Cilt, 1. Kitap: Alkol ve Madde Kullanım Bozuklukları, Genişletilmiş 2. Baskı. İstanbul, Küre Yayıncılık, 2003.
Evren C, Durkaya M, Dalbudak E, Çelik S, Çetin R, Çakmak D. Erkek alkol bağımlılarında depreşme ile ilişkili etkenler: 12 aylık takip çalışması. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi. 2010; 23:92-99.
Connors GJ, Maisto SA, Zywiak WH. Understanding relapse in the broader context of post-treatment functioning. Addiction 1996; 91(suppl):S173-S189.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders–Text Revision, 4th ed. Washington D.C., 10. American Psychiatric Association, 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington D.C., American Psychiatric Association, 2013.
Donovan DM. Assesment issues and domains in the prediction of relapse. Addiction 1996; 91(suppl):S29-S36.
Marlatt GA. Taxonomy of high-risk situations for alcohol relapse: evolution and development of a cognitive–behavioral model. Addiction 1996; 91(suppl):S37-S49.
Brownell KD, Marlatt GA, Lichtenstein E, Wilson GT. Understanding and preventing relapse. Am Psychol 1986; 41:765-782. Marlatt GA, George WH. Relapse prevention: introduction and overview of the model. Br J Addict 1984; 79:261-273.
Connors GJ, Maisto SA, Donovan DM. Conceptualizations of relapse: a summary of psychological and psychobiological models. Addiction 1996; 91(suppl):S5-S13.
Dodge R, Sindelar J, Sinha R. The role of depression symptoms in predicting drug abstinence in outpatient substance abuse treatment. J Subst Abuse Treat 2005; 28:189-196.
Sinha R, Li CS. Imaging stress-and cue-induced drug and alcohol craving: association with relapse and clinical implications. Drug Alcohol Rev 2007; 26:25-31.
Sinha R. The role of stress in addiction relapse. Curr Psychiatry Rep 2007; 9:388-395.
Wrase J, Grüsser SM, Heinz A. Cue-induced alcohol craving: neurobiological correlates and clinical relevance. Nervenarzt 2006; 77:1051-1052.
Heinz A, Löber S, Georgi A, Wrase J, Hermann D, Rey ER et al. Reward craving and withdrawal relief craving: assessment of different motivational pathways to alcohol intake. Alcohol Alcohol 2003; 38:35-39.
Hutcheson DM, Everitt BJ, Robbins TW, Dickinson A. The role of withdrawal in heroin addiction: enhances reward or promotes avoidance? Nat Neurosci 2001; 4:943-947.
Beck AT, Wright FD, Newman CF, Liese BS. Cognitive Therapy of Substance Abuse. New York, Guilford Press, 1993.
Tiffany ST. A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychol Rev 1990; 97:147-168.
Wong MM, Nigg JT, Zucker RA, Puttler LI, Fitzgerald HE, Jester JM et al. Behavioral control and resiliency in the onset of alcohol and illicit drug use: a prospective study from preschool to adolescence. Child Dev 2006; 77:1016-1033.
Stinson DS, Smith WG, Amidjaya I, Kaplan JM: Systems of care and treatment outcomes for alcoholic patients. Arch Gen Psychiatry 1979; 36: 535-539.
Marlatt GA, Gordon JR. Relapse Prevention: maintenance strategies in the treatment of addictive behaviors. New York, Guilford Press, 1985.
Uğurlu GK, Uğurlu M, Turhan L, Türkçapar MH. Alkol bağımlılarında işlevsel olmayan inançlar: karşılaştırmalı bir çalışma. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi. 2012; 1:113-120.
Marlat GA, Barrett K. Relapse Prevention. In Textbook of Substance Abuse Treatment. (Eds M Galanter, HD Kleber):2852 Washington D.C., American Psychiatric Press, 1994.
Shiffman S. Conceptual issues in the study of relapse. In Relapse and Addictive Behaviour, 1st. ed. (Ed M Gossop): 249-277. London, Routledge, 1989.
Strowig AB. Relapse determinants reported by men treated for alcohol addiction the prominence of depressed mood. J Subst Abuse Treat 2000; 19:319-331.
Miller WR, Westerberg VS, Harris RJ, Tonigan JS. What predicts relapse? prospective testing of antecedent models. Addiction 1996; 91(suppl):S155-S171.
Ito JR, Donovan DM. Predicting drinking outcome: demography, chronicity, coping, and aftercare. Addict Behav 1990; 15:53-59.
Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United States: results of the national longitudinal alcohol epidemiolo¬gic survey. J Stud Alcohol 1997; 58:464-473.
Ortaer N. Alkol bağımlılarının yaşam modaliteleri ve kendilik değerleri üzerine retrospektif tanımlayıcı bir çalışma (Uzmanlık tezi). Ankara, Ankara Üniversitesi Tıp Fakültesi Psikiyatri Bölümü, 1997.
İlhan İÖ, Demirbaş H, Yarpuz AY, Doğan YB. Alkol bağımlılığında remisyon süresi üzerinde etkili olan değişkenler. Bağımlılık Dergisi 2003; 4:57-61.
Sutton S. Is wearing clothes a high risk situation for relapse? The base rate problem in relapse research. Addiction 1993; 88:725-727.
Mc Kay JR, Maisto SA, O’ Farrel JJ. End of treatment self-efficacy, aftercare, and drinking outcomes of alcoholic men. Alcohol Clin Exp Res 1993; 17:1078-1083.
Birke SA, Edelmann RJ, Davis PE. An analysis of the abstinence violation effect in a sample of illicit drug users. Br J Addict 1990; 85:1299-1307.
Vaillant GE. A long-term follow-up male alcohol abuse. Arch Gen Psychiatry 1996; 53:243-249.
Saunders B, Allsop S. Relapse: a psychological perspective. Br J Addict 1987; 82:417-429.
Sandahl C. Determinants of relapse among alcoholics: a cross-cultural replication study. Int J Addict 1984; 19:833-848.
Janowsky DS, Fawcett J, Meszaros K, Verheul R. Core heritable personality characteristics and relapse in alcoholics. Alcohol Clin Exp Res 2001; 25(suppl):S94-S98.
Noone M, Dua J, Markham R. Stress cognitive factors, and coping resources as predictors of relapse in alcoholics. Addict Behav 1999; 24:687-693.
Kendall PC, Hollon SD. Cognitive-Behavioral Interventions: Theory, Research and Procedures. New York, Academic Press, 19 Cumming C, Gordon JR, Marlatt GA. Relapse: strategies of prevention and prediction. In The Addictive Behaviors: Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity (Ed WR Miller):100-125. London, Pergamon, 1980.
McLellan AT, Luborsky L, Woody GE, O’Brien CP, Druley KA. Predicting response to alcohol and drug abuse treatments: role of psychiatric severity. Arch Gen Psychiatry 1983; 40:620-625.
Litman GK, Stapleton J, Oppenheim AN, Peleg M, Jackson P. The relationship between coping behaviours, their effectiveness and alcoholism relapse and survival. Br J Addict 1984; 79:283-291.
Ögel K. Koruyucu psikiyatri açısından madde bağımlılığı/kötüye kullanımı. Türkiye Klinikleri Psikiyatri Özel Dergisi 2011; 4:76O’Malley SS, Jaffe AJ, Chang G, Schottenfeld RS, Meyer RE, Rounsaville B. Naltrexone and coping skills therapy for alcohol dependence. Arch Gen Psychiatry 1992; 49:881-887.
Kranzler HR, Burleson JA, Del Boca FK, Babor TF, Korner P, Brown J et al. Buspirone treatment of anxious alcoholics: a placebo-controlled trial. Arch Gen Psychiatry 1994; 51:720-731.
Uğurlu TT, Şengül CB, Şengül C. Bağımlılık psikofarmakolojisi. Psikiyatride Güncel Yaklaşımlar 2012; 4:37-50.
Kent S, Yellowlees P. Psychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatry 1994; 45:347-350.
Varcarolis EM. Foundations of Mental Health Nursing, 3rd ed. Philadelphia, W.B. Saunders, 1998.
Hillman SL. Predictors of rapid psychiatric readmission (Doctor of philosophy thesis). Houston, University of Houston, 2000. Solukçu ÜR. Alkol bağımlılığı tedavisinde nüks ve nüksü belirleyen etkenler (Tıpta uzmanlık tezi). İstanbul. Bakırköy Ruh ve Sinir Hastalıkları Hastanesi, 1997.
Gorski TT, Miller M. Staying Sober: A Guide for Relapse Prevention. Missouri, Herald House/Independence Press, 1986.
McKay JR, Alterman AI, Cacciola JS, Rutherford MJ, O’Brien CP, Koppenhaver J. Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results. J Consult Clin Psychol 1997; 65:778-788.
Demirbaş H, Doğan YB, İlhan İÖ. Yatarak tedavi gören alkol bağımlısı hastalarda iyileştirici grup faktörleri ile nüks arasındaki ilişki. Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi 2012; 25:119-124.
Chopra KS, Preston DA, Gerson LW. The effect of constructive coercion on the rehabilitative process. A study of the employed alcoholics in an alcoholism treatment program. J Occup Med 1979; 21: 749-752.
Moberg DP, Krause WK, Klein PE. Posttreatment drinking behavior among inpatients from an industrial alcoholism program. Int J Addict 1982; 17:549-567.
Smart RG, Gray G. Multiple predictors of dropout from alcoholism treatment. Arch Gen Psychiatry, 1978; 35:363-367.
Karadağ F. Madde kullanım bozukluklarında ektanı. Psikiyatride Güncel 2011; 1:171-186.
Rae JB. The influence of the wives on the treatment outcome of alcoholics: a follow-up study at two years. Br J Psychiatry 1972; 120:601-613.
Finney JW, Moos RH, Chan DA. Length of stay and program component effects in the treatment of alcoholism: a comparison of two techniques for process analyses. J Consult Clin Psychol 1981; 49:120-131.
McLellan AT, Luborsky L, O’Brien CP, Woody GE, Druley KA. Is treatment for substance abuse effective? JAMA 1982; 247:1423-1428.
Hester RK. Outcome Research: Alcoholism. In Textbook of Substance Abuse Treatment. (Eds M Galanter, HD Kleber):35-43. Washington D.C., American Psychiatric Press, 1994.
Cronkite RC, Moos RH. Evaluating alcoholism treatment programs: an integrated approach. J Consult Clin Psychol 1978; 46:1105-1119.
Daley DC, Marlatt GA. Relapse prevention. In Substance Abuse–A Comprehensive Textbook, 3rd ed (Eds JH Lowinson, P Ruiz, RB Millman, JG Langrod):458-467. New York, Williams and Wilkins, 1997. Alkin Yılmaz,.Uzm.Dr., Iğdır Devlet Hastanesi,Iğdır; Yeşim Can, Uzm.Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Hastanesi, İstanbul; Müge Bozkurt, Uzm.Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Hastanesi, İstanbul; Cüneyt Evren, Doç.Dr., Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Hastanesi, İstanbul. Yazışma Adresi/Correspondence: Alkin Yılmaz, Iğdır Devlet Hastanesi, Iğdır, Turkey. E-mail: alkinyilmaz@gmail.com Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no3/ Çevrimiçi yayım / Published online 14 Kasım/November 14, 2013; doi: 10.5455/cap.20131114113549