1. Personality, stress, and social support in cocaine relapse prediction
A Program Evaluation

2. This study identified prospective psychosocial predictors of relapse status and drug abuse severity in male subjects in the first year after
residential treatment for cocaine dependence.

3. Personality, stress, and social support measures from an intake assessment, and stress and
support measures reflecting status during the three-month period prior to the one in which relapse was identified were used as predictors.

4. An accumulating body of
research suggests that these three broad personality dimensions
have significant implications regarding stress vulnerability
and recovery from substance abuse

5. Detached Personalities
Those with prominent detached personality features are
assumed to be preoccupied by disturbing and conflictual
cognitions which interfere with social communication and
lead to dysphoric affect. Further, detached personalities are
hypothesized to be vulnerable to the negative effects of life
stressors because they have never learned complex coping
skills. Although they may desire social acceptance, they are
unable to tolerate close relationships and are expected to
show limited ability of profit from social support.

6. Dependent Personalities
Vulnerability to relapse in those with prominent dependent characteristics is thought to
be associated with their excessive reliance upon others for feelings of worth and adequacy.
They show little initiative, autonomy, or adult responsibility. Dependent types are
hypothesized to be vulnerable to a wide range of life stressors because they have limited coping resources and experience pervasive feelings of inadequacy

7. Dependent The predominant coping strategy
adopted by dependent types involves efforts to develop
secure relationships with caretakers perceived as more
competent than themselves. Thus, in contrast to detached
types, those with prominent dependent characteristics are
hypothesized to experience reduced relapse risk in a post-treatment environment that includes high levels of perceived social support.

8. Antisocial Personality
Those high on the Antisocial personality factor
factor tend to look to themselves as sources of need fulfillment either because of a deeply rooted confidence in
themselves and/or because of pervasive mistrust of others

9. Antisocial They are expected to perceive comparatively
few negative consequences associated with cocaine use and to resist social pressure for changes in attitude or behavior regarding substance use.
For these reasons, it was predicted that antisocial types are considered unlikely to make a serious commitment to treatment or recovery in the posttreatment
period. They were assumed likely to return to a
sensation-seeking, rather than a stress-coping, pattern of
substance abuse.

10. Participants Three hundred four program participants
provided written informed consent, were evaluated, and met
DSM III-R criteria for current cocaine dependence. The
initial evaluation was conducted after detoxification but
within two weeks after treatment admission. Follow-up
evaluations were conducted prior to treatment discharge
and at 3, 6, 9, and 12 months after treatment completion.

11. Evaluations Individually administered intake and follow-up evaluations
were conducted by trained Ph.D. students in counseling
psychology.
These evaluations were conducted
in a variety of settings (aftercare meetings at
treatment centers, project research office, or during prescheduled
telephone conferences).

12. Treatment Receipt
All subjects recruited had completed a minimum of three
weeks of residential treatment (see Table 1 for mean days of
treatment by Group). Urine samples were collected regularly
during residential treatment, and no positive tests were
found for study participants.

13. Demographics Almost half (46.7%) of subjects were African American,
another one-third (34.2%) were Caucasian, and most of the
rest (12.5%) were Hispanic. The mean age was 29.3 years
(SD = 6.5) and the average level of education was 12.2 years
(SD = 2.2). Relatively few (13.2%) were currently married
and living with a spouse prior to treatment entry.

14. Measures: Life Experience Survey
The LES lists 47 life events
that occur with reasonable frequency in clinical populations
and permits respondents to add and rate up to three
events not listed. It requires an evaluation of the perceived
desirability or undesirability, as well as of the
degree of impact, of identified events.

15. Perceived Support Network Inventory PSNI
The first element involves a sense that there is a satisfactory number of individuals who are available in times of need.
The second involves a perception of satisfaction with the
quality of available support.

16. PSNI Perceived support quality is gauged by
a composite index that reflects initiation of support
seeking behavior, support availability, satisfaction with
support received, support multidimensionality, support
reciprocity, and social network conflict.

18. Relapse In the current investigation, we classified
participants as having relapsed if they reported, during the
ASI drug interview, at least seven days of cocaine use
during any one of the four three-month follow-up periods
after treatment completion.

19. Results The final logistic regression model was significant
[c2(df = 10) = 54.22, p = ].
Detached personality [Wald(df = 1) = 5.85, p = 0.015], T1 social support (Wald(df = 1) = 4.87, p = 0.027], T2 stress (Wald(df = 1) = 5.02, p = 0.024], T2 social support [Wald(df = 1) = 9.77, p = 0.001], and T2 support network size (Wald(df = 1) = 6.38, p = 0.011], contributed significantly to prediction of relapse group membership.

20. Conclusions In general, current findings suggest that personality,
stress, and social support characteristics which have beenuseful in the prediction of relapse to alcohol, opiates, tobacco, and other drugs are also useful in predicting
cocaine relapse.

21. Implications Assessment of these characteristics may
assist in understanding the likelihood of relapse and in
planning effective treatments. Interventions designed to
address certain long-standing personality disturbances, as
well as those that assist patients in coping with cumulative
stress effects and in remedying social support deficiencies,
should continue to be planned and evaluated.

22. Implications