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

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.

Automated summary

This study reviewed relevant literature to identify factors affecting substance use relapse based on the ecological approach. The findings showed that factors influencing substance use relapse exist at different levels of the ecological model, such as intrapersonal factors like unpleasant emotions, interpersonal factors like addicted friends and family disputes, organizational factors like poor follow up, community factors like society rejection, and environmental factors like drug availability and unhealthy environment.