Relapse

Cravings are the main reason for relapse, and cravings are activated as part of the fear-motivated behaviour circuits, which involves the amygdala. This part of the brain is activated when people relapse back to addictive behaviour to avoid withdrawal symptoms, which, as well s strongly subjective cravings, may be physical (such as shaking, or a drop in body temperature). Since the amygdala activated the stress response (hypothalamus, Pituitary, adrenal glands, and also the sympathetic nervous system), this is involved too. But during addiction the stress response is usually blunted, then gradually recovers during quitting. Then recovery of the stress response actually makes quitting easier, probably because it release endogenous opioids, which help with coping. People whose stress response recovers slowly are more likely to relapse.

Shawa– 45 Smokers interested in quitting were recruited, and their stress response was measured during a public speaking task. Four weeks later, the task was repeated. Smokers who relapsed during those four weeks had a weaker stress response and less endogenous opioids during the public speaking task. This suggests that addicts are more likely to relapse because they have a weaker stress response and are therefore not likely to cope with quitting.

Paris– Recreational and Pathological gamblers has corticosteroid stress hormone levels assessed in saliva before and after watching a video of a roller-coaster ride. Recreational gamblers demonstrated significantly increased salivary stress response after both videos, whereas pathological gamblers demonstrated no increase. This suggests that addicts have a blunted stress response and therefore are more likely to relapse because they are unable to cope with the stress of withdrawal symptoms.

Relapse is often caused by classically conditioned cues in the environments. The cues are the sights, sounds, smells and people associated with (smoking/gambling) and particular places may be a problem for many people. The problem arises because we start to associate cues in the environment with smoking/gambling and the two become linked by classical conditioning. The cues alone trigger withdrawal symptoms, and these may produce lapses and eventually a full relapse. Relapse sometimes occurs because of the spontaneous recovery of the addictive behaviour: it kicks in unexpectedly, when the person is off-guard. This shows that is was never truly extinguished: the brain circuits for addiction still exist, and may do so for a very long time. Relapse also occurs through operant conditioning because the addiction is repeated through negative reinforcement, to relieve severe withdrawal symptoms. It is obvious then, that removing as many cues as possible reduces relapse.

Yang– In a study of Chinese male smokers trying to quit, Yang used questionnaires to access reasons for relapse. He found that the commonest reason for elapse was being cued by particular social situations: 34% of relapses were caused by these social cues (e.g. lighting up whilst drinking with friends). This suggests that social cues in the environment create withdrawal symptoms and cravings because they are constantly reminded of their past addiction.

Crockford– He showed 10 male pathological gamblers and 10 match healthy control participants a gambling-cutes video alternating with a video of nature scenes. Pathological gambling participants reported a significant increase in mean cravings for gambling after the gambling-cues video, expectations of relapse and also showed a different pattern of brain activity for control participants when their brains were scanned. This suggests that classically conditioned cues in the environment create withdrawal symptoms and cravings because they are constantly being reminded of the behaviour.

Cognitive models of relapse that centre around the Theory of Planned Behaviour involve the role of ‘perceived control’, in permenantly quitting the addiction to smoking/gambling. Sometimes people who relapse have very black and white views of their control, they tell themselves that either they have it or they don’t. So one little lapse is perceived as a full-blown relapse, and they quickly give up bothering. People who relapse are less tolerant about few lapses, fail to analyse carefully what happened to cause the lapse, so they run into the same problems next time, or they may develop negative automatic thoughts that they will lose control and have deeply held core beliefs that they are not the kind of person who can control themselves.

Dijkstra– The influence of a smokers lack of belief in their ability to quit was the main factor that affected whether they would actually relapse. In a survey of TPB factors, unsuccessful quitters (who would later relapse) chose statements such as ‘I am not so sure anymore that I can quit’. Other statements related to variables in the TPB had a small influence on comparison. This suggests that addicts relapse because they don’t believe they have the control necessary to quit e.g. they think they can’t do it.

LeBlond– The effect of cognitive therapy to improve a sense of control over behaviour resulted in prevention of relapse into gambling by 88% of participants. In an untreated control group, only 20% avoided relapse. This suggests that if addicts have a stronger sense of control over believing they can quit, they are more likely to be successful and less likely to relapse.