Relapse

Understanding Relapse: A Journey Through Internal Medicine and Psychiatry

Imagine a river flowing smoothly, its waters representing health and recovery. But what happens when this river suddenly starts to flow backwards? In internal medicine, relapse is like the river reversing course, bringing back past conditions that seemed long gone. And in psychiatry, it’s akin to a person slipping back into old, harmful behaviors after they thought they had overcome them. So, how do we navigate these treacherous waters?

Risk Factors: The Hidden Currents

One of the key factors that can cause this reversal is the availability of dopamine D2 receptors in the brain. Think of these receptors as tiny locks; when drugs enter the system, they unlock these receptors, leading to a flood of pleasure. But once the drug use stops, these locks can become more available, making it easier for the river to flow backward.

Another factor is social hierarchy. Just like in nature where higher ranks have access to better resources and protection, those with higher status might be less likely to relapse due to their perceived security and stability. But for others, the pressure to maintain a certain position can push them towards risky behaviors that lead to relapse.

Triggers are like the rapids in our river analogy. Pharmacokinetics and neurochemistry can create powerful currents, while stress acts as a storm, pushing us off course. Re-exposure to drugs or drug-priming is like finding an old map leading back to familiar but dangerous waters. Environmental cues, such as places where one used to take drugs, are like landmarks that can trigger the urge to return.

Treatment Approaches: Building a Dam Against Relapse

To prevent this river from flowing backward, we need to build dams and levees. Pharmacotherapy is like using medication to reinforce the locks on our dopamine receptors, making it harder for drugs to unlock them. Cognitive behavioral techniques are akin to teaching someone new navigation skills, helping them avoid dangerous areas.

Contingency management is like setting up a reward system where good behavior is rewarded and bad behavior is punished. This can be as simple as giving a token for each day of abstinence or removing privileges if relapse occurs. By focusing on the immediate determinants and covert antecedents, we can anticipate and cope with various triggers.

Animal Models: Studying Relapse in a Controlled Environment

In the laboratory, researchers use animal models to study relapse prevention. These models are like mini-ecosystems where scientists can control variables and observe outcomes. Protocols for self-administration and extinction tasks are used to model relapse prevention. When an animal performs a task it has been trained to perform, it is no longer reinforced with an injection of the drug. The visual stimulus associated with the drug and completion of the task is also removed.

Extinction sessions continue until the animal ceases the drug-seeking behavior by pressing the lever. Once this behavior is extinguished, a stimulus is presented to promote reinstatement of that same drug-seeking behavior (e.g., receiving an injection of the drug). Neuroimaging techniques such as PET and SPECT have contributed to understanding neural components involved in drug reinstatement.

However, there are limitations to using these models. The validity of the model can be assessed by formal equivalence, correlational models, and functional equivalence. These methods help researchers understand how well their findings translate to human behavior.

The Role of Hormones: A Gender Perspective

In females, relapse is like a river that flows faster due to hormonal fluctuations in ovarian hormones such as estradiol and progesterone. The luteal phase, when these hormones peak, can increase symptoms like anxiety, irritability, and depression, making it easier for the river to flow backward.

Further research on other manipulations or reinforcements that could limit drug-taking in non-human primates would be beneficial. This could lead to new strategies for preventing relapse in humans, much like finding a better way to build our dams against the floodwaters of addiction.

Relapse is a complex journey, but with the right tools and strategies, we can navigate it successfully. By understanding risk factors, employing effective treatment approaches, and conducting thorough research, we can build stronger defenses against this river of relapse.