The process of relapse in severely dependent male problem drinkers

Aims. The aim of the study was to investigate factors hypothesized to influence the relapse process, with a focus on the role of self‐efficacy, alcohol dependence and cognitive functioning. Design. The study was conducted in the context of a controlled trial of a relapse prevention programme. Subjects were assessed prior to treatment, at immediate conclusion of treatment and at 6‐ and 12‐month follow‐up. Setting. The study was conducted in an Alcohol Treatment Unit (ATU) in Scotland. Participants: Subjects were 60 male problem drinkers who were patients at the ATU. They were heavy drinkers, with corresponding high levels of alcohol dependence and alcohol‐related harm. Measurements. The independent variables were posttreatment self‐efficacy, alcohol dependence, cognitive functioning, level of depression and alcohol consumption prior to admission to treatment. The dependent variables were post‐treatment drinking behaviour and functioning and time to lapse and relapse. Findings. Although the methodology does not allow identification of causality, support was found for the hypothesis that post‐treatment self‐efficacy was an intervening variable between treatment and outcome. Higher post‐treatment self‐efficacy predicted better outcome at 6‐month follow‐up and was associated with a reduced risk of lapse and relapse over the 12‐month follow‐up. Poorer cognitive functioning was significantly associated with being categorized as a problem drinker at 6‐month follow‐up and with higher risk of a lapse over the 12‐month follow‐up. Level of alcohol dependence did not predict outcome. Conclusions. It was concluded that post‐treatment self‐efficacy rating is a predictor of treatment outcome and time to lapse and relapse and that cognitive functioning is a predictor of treatment outcome and time to lapse.