Predictors of relapse following institutional drug rehabilitation among male drug addicts in selected rehabilitation centres in Sri Lanka - A nested casecontrol study

Background. Relapse is defined as a return to drug use after a period of abstinence, often accompanied by reinstatement of dependence symptoms. After a successful rehabilitation program, drug addicts face many challenges in integration with society leading to relapse. This study aimed to identify possible predictors of relapse after drug rehabilitation among drug addicts managed in selected rehabilitation centres in Sri Lanka. Methods. A nested case-control study was conducted among 108 cases (drug addicts had a relapse within six months after discharge from the rehabilitation centre) and 74 controls. Data were collected using an interviewer-administered questionnaire and analysed using SPSS software. Results. Six factors were associated with relapse after rehabilitation among drug addicts, of which only two remained predictive of relapse after controlling for confounding. Use of alcohol and tobacco after discharge posed a high risk (OR=15.16, 95% CI=6.24-36.79, p<0.001), while having adverse consequences in social relationships due to drug use demonstrated a lower risk (OR=0.35, 95% CI=0.12-0.98, p<0.05) in multivariate analysis. Follow-up status after discharge from the rehabilitation centre, patient service satisfaction during rehabilitation and discharge from the rehabilitation centre and having a history of previous rehabilitation did not emerge as significant risk or protective factors in multivariate analysis. Conclusions. Use of alcohol and tobacco after discharge from rehabilitation centres increased the risk for relapse, while experiencing adverse consequences in social relationships emerged as a protective factor. The study recommends addressing the use of other psychoactive substances and social issues of drug addicts during rehabilitation.