Chased by the dragon : the experience of relapse in cocaine and heroin users

Abstract

The purpose of this study is to describe the subjective psychological experience of relapse in cocaine/crack and heroin users with the aim of identifying the significant cognitive, emotional and social themes involved in relapse. A better understanding of relapse may aid in providing more effective treatment for substance users. Both the intra- and interpsychic factors involved in relapse that emerge from the study are viewed from within a broad systems theory approach. In this study, not only the whole system is of relevance, but also the subsystems. Various sub systems are also identified to allow for the recognition of patterns, functions and recursive feedback loops that maintain substance-using behaviour. Due to the qualitative nature of the study, the context surrounding substance abuse and the substance users assumes vital importance. The interrelationships between the various intrapsychic structures, the family unit, the social contexts, the drugs themselves and the physiological aspects of substance abuse are identified. A qualitative research design was applied. In-depth semi-structured interviews were used to gather data from the eight participants, who were crack and heroin users who attended the in-patient rehabilitation programme at Phoenix House. Seven of the participants were still in the in-patient rehabilitation programme at the time of the interview, while one participant was in the aftercare programme. All have been through a rehabilitation process before and were at Phoenix House due to a relapse. A thematic analysis was conducted and the process of analysis settled on eight overall themes. Extensive descriptions of these themes are provided. The discussion highlights the role of relapse in the cycle of self-destruction that constitutes substance abuse, in addition to the role relapse plays in the process of recovery. Connection seems to be the key to breaking the cycle of alienation that users experience. Falling into the trap of rejecting users without looking beyond their behaviour allows them to continue functioning in a way that confirms their view of themselves as unlovable, which, in turn, maintains their behaviour. Although systems theory is an independent approach in its own right, the nature of its view allows for the incorporation of other approaches. Where possible and relevant, other theories are incorporated into the discussion of the results, with the aim of gaining an integrated understanding of the findings of the study within the broader field of substance abuse.