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An ecological approach to exploring factors affecting substance use relapse: a systematic review

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Abstract

Background

Substance use is a serious public health problem in the world, and the relapse rate among abstinent substance users is very high. The purpose of this study was to clarify the factors affecting substance use relapse based on the ecological approach by reviewing the relevant literature.

Methods

Applying different search strategies, we searched electronic databases, including Scopus, PubMed, Web of Science, Psychinfo, Embase, Science Direct as well as Magiran, Iran Medex, and SID up to June 2018. The Joanna Briggs Institute Critical Appraisal Checklist was employed for critical appraisal. All searches were limited to studies published in English and Persian.

Results

The literature search identified 3481 articles. After screening titles, abstracts, and full texts, 39 studies met the inclusion criteria. The findings were classified based on ecological model (intrapersonal, interpersonal, organizational, environment, community, public policy). The most frequent factors affecting substance use relapse at any level of the ecological model included unpleasant emotion (at the intrapersonal level), addicted friends and family disputes (at the interpersonal level), poor follow up (at the organizational level), society rejection (at the community level), drug availability and unhealthy environment (at the environmental level).

Conclusion

According to the findings of the present study, it is indicated that designing interventions approaches based on the ecological model to prevent relapse of substance use seems to be useful.

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Notes

  1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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Acknowledgements

This project has been approved by the Research and Technology deputy of Hamadan University of Medical Sciences. The authors wish to thank all the interviewers who worked on this study.

Authorship contribution

The authors have contributed sufficiently to the scientific work and share collective responsibility and accountability for the results.

Funding

This study was supported by Hamadan University of Medical Sciences.

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Correspondence to Amirabbas Mousali.

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Appendix 1: Search strategy for all databases

Appendix 1: Search strategy for all databases

Addictive substances

addiction* OR narcotics* OR “morphine dependence” OR “heroin dependence” OR “opium dependence” OR “substance abuse” OR “substance use” OR drugs* OR opium* OR opioid* OR “opiate dependency” OR “drug use” OR “drug abuse” OR “opioid addiction” OR codeine* OR heroin* OR morphine* OR Ritalin* OR “synthetic marijuana” OR cocaine* OR crack* OR methamphetamine* OR ecstasy* OR caffeine* OR hashish* OR cannabis* OR LSD* OR methadone* OR opiate* OR addictive*

Determinants

Factors* OR “risk factors” OR determinants* OR forecast* OR forecasting* OR anticipation* OR predictive* OR prediction*

Recurrence of substance use

Recurrence* OR relapse* OR “relapse to addiction” OR “return to substance abuse” OR “return to substance use”

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Barati, M., Bashirian, S., Mohammadi, Y. et al. An ecological approach to exploring factors affecting substance use relapse: a systematic review. J Public Health (Berl.) 31, 135–148 (2023). https://doi.org/10.1007/s10389-020-01412-x

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