Rates and Patterns of Relapse among Patient with Substance Use Disorder with and without Psychiatric Co-Morbidity During 1 Year Period Following Inpatient De-Addiction Treatment at Tertiary Care Hospital, Kolenchery, Kerala, India

Introduction: Relapse is an inevitable phenomenon that arises in the course of substance use disorder that can be a frustrating experience for patients, caregivers and therapists. Co morbid psychiatric illness makes the individual more vulnerable to relapse. This study analyzed the rates, patterns of relapse and survival time before relapse among subjects with and without co-morbid psychiatric illness over a period of 1year after inpatient de-addiction treatment.

Subjects  and Methods: Prospective cohort, comparative design  in which 104 subjects admitted for 31days treatment programme  for substance use disorder from January to June 2014 at tertiary care hospital in Kerala  were  studied for 1year post treatment period. Subjects were classified into co morbid SUD (n=56) and Non co morbid SUD (n=48) based on the presence of psychiatric illness diagnosed by the treating psychiatrist based on ICD 10 DCR. Relapse status were assessed during monthly follow up meetings, irregular follow-ups were tracked from the OPD record and followed up telephonically.

Results: Present study findings revealed that 53.8% SUD subjects had co morbid Psychiatric illness. More than one third of subjects (39.4%) relapsed within 1year period. At 1year, 43% percentage of subjects in the co-morbid group relapsed their substance use whereas only (29%) in the non co morbid SUD group relapsed their substance use (p=0.04*). Among co morbid subjects 37 % of subjects with bipolar mania, 46%with Depression relapsed at 1year follow up. Kaplan Meir survival analysis revealed that non co morbid SUD had longer survival time compared to co morbid SUD before relapse (p=0.02*).

Conclusion: Strong therapeutic alliance, close monitoring and regular follow up of these subjects with substance use disorder especially with co morbid mental disorders will lower the rates of relapse.