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Year : 2018  |  Volume : 62  |  Issue : 3  |  Page : 218-220  

Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital

1 Lecturer, Department of Psychiatric Nursing, Sri Venkateswara College of Nursing, Chittoor, Andhra Pradesh, India
2 Assistant Professor, Department of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3 Additional Professor, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Web Publication12-Sep-2018

Correspondence Address:
Padmavathi Nagarajan
Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Puducherry - 605 006
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.IJPH_57_17

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Alcoholism is one of the major health problems seen all over the world. The risk of relapse was estimated among 94 clients with alcohol dependence syndrome (ADS) who attended both in- and out-patient units of a tertiary care hospital. The tools used were the sociodemographic and clinical variables, Clinical Institute of Withdrawal Assessment Alcohol–revised (CIWA–Ar), Alcohol Use Disorder Identification Test (AUDIT), and Advanced Warning of Relapse (AWARE) scale. Out of the 94 clients, 63 (67.7%) were in the low-risk group for getting relapse, 26 (27.7%) were in the moderate-risk group, and 5 (5.3%) were in the high-risk group. Family history of alcohol use was significantly associated with the AWARE score (P < 0.05). Nicotine use was reported by 56 (59.6%) clients. Clients with a positive family history of alcohol use, disturbed sleep pattern, and higher total score (>20) of AUDIT scale were at higher risk of relapse.

Keywords: Alcoholism, Advanced Warning of Relapse score, alcohol dependence syndrome, relapse

How to cite this article:
Subash P, Nagarajan P, Kattimani S. Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital. Indian J Public Health 2018;62:218-20

How to cite this URL:
Subash P, Nagarajan P, Kattimani S. Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital. Indian J Public Health [serial online] 2018 [cited 2022 Dec 5];62:218-20. Available from:

Alcoholism is a significant health and social problem seen all over the world. Relapse refers to return to abusing the substance regularly after a period of abstinence. Research studies report that peer pressure and familial problems were the main factors for relapse. Individual and environmental factors also influence the relapse.[1],[2],[3]

Identifying those at risk for early relapse helps in taking adequate relapse prevention measures. The present study was aimed to categorize clients with alcohol dependence syndrome (ADS) currently abstinent for alcohol based on their risk of relapse and to identify the association between the risk of relapse and sociodemographic variables in such clients.

A cross-sectional descriptive study was conducted which included 94 clients through purposive sampling, diagnosed with ADS based on the International Classification of Diseases-10 criteria,[4] who attended the services of department of psychiatry at a tertiary care hospital, South India. Male patients aged 18 years and above, abstinent from alcohol for at least 1 week, were included in the study. Clients who scored more than 10 in CIWA–Ar scale and who used other substances except tobacco were excluded from the study. Data collection was carried out from July 2015 to September 2015 by face-to-face interview method. Severity of alcohol use in the past 1 year was collected using AUDIT scale.

AWARE scale [5] has 28 questions which include all the possible predictors for relapse. The score ranges from 28 to 196. The probability of relapse increases with score. The total score was divided into three categories. Category 1 refers to low risk (score range of 28–69), 2 refers to moderate risk (score range of 70–111), and 3 refers to high risk (score range of 112–196). Health education was given to the clients who had low risk. Relapse prevention techniques such as yoga and meditation were taught to the clients in the moderate risk. Clients who belonged to high-risk category were referred to the De-addiction clinic for further treatment.

Before commencing the study, approval was obtained from the Institute's Ethics Committee for human studies of the institute, where the study was conducted. Participants signed the written informed consent after being explained about the risks and benefits of the study. Privacy and confidentiality were maintained throughout the study.

Results showed that out of 94 clients, 44 belonged to the age group of 20–40 years. No one fell into the high-risk group, 26 were in the low-risk group, and 18 had moderate risk of getting relapse. In the age group of 41–60 years, only one was in high risk, 25 were in low risk, and 21 clients had moderate risk for getting relapse. Further, three clients were aged above 60 years and no one had high risk. Regarding educational status, 49 clients had secondary education (6th to 12th) and maximum clients 27 (55.1%) belonged to the low-risk group. Pertaining to occupation, out of 54 clients who were self-employed, 33 (61.1%) clients came under low-risk category. Based on marital status, it was found that 81 clients were married and majority, i.e., 45 (65.5%) were in the low-risk group. Further, among 51 (54.2%) clients who had the monthly income of < ₹5000, 26 (50.9%) were in the low-risk group and among the remaining 43 members who had the income of more than ₹5000, 27 (62.7%) clients belonged to low-risk group.

Distribution of the study participants based on their pattern of alcohol use is shown in [Table 1]. Out of 41 (43.6%) clients, who regularly used alcohol before the age of 25 years, 23 (56%) were in the low-risk group and out of 53 (56.6%) clients who used alcohol after 25 years of age, 30 (56.6%) were grouped under low-risk group. Positive family history was found in 41 (43.6%) clients, of which, 21 (51.2%) were reported to be at low risk, 19 (46.3%) at moderate risk, and 1 (2.4%) at high risk.
Table 1: Pattern of alcohol use (n=94)

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The association between clinical variables with AWARE score is summarized in [Table 2]. It was found that positive family history of alcohol use, sleep disturbance, and higher score on AUDIT scale were significantly associated with AWARE scores.
Table 2: Association between clinical variables and advanced warning of relapse score (n=94)

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The World Health Organization estimates the presence of 140 million alcoholics worldwide. Studies suggest that patients who received treatment within 30 days of completing detoxification were ten times less likely to relapse, while those completing detoxification alone are getting relapsed at the rate of 65%–80%.[3]

A study by D'souza and Veerabhadraswamy [6] concluded that monthly income and history of polysubstance use were significantly associated with relapse at P < 0.05. The present study found that monthly income was not associated with relapse, but the positive history of alcohol use predicts the relapse. Walter et al.[7] stated that marital status (living alone, i.e., separated/divorced/widow) was an important predictor of relapse, which is contradictory to the findings of the present study.

In contrast with the present study which found that age of onset is not associated with relapse, a study by Kuria [8] mentioned that age of onset was significantly associated with relapse.

The results of the present study revealed that family history of alcohol use was significantly associated with the AWARE score (P < 0.05). It implies that the positive family history of alcohol use will increase the risk for relapse. A significant association was found between sleep disturbance and AWARE score (P < 0.05). It suggests that the clients having disturbed sleep pattern have an increased risk for relapse. Another significant association was found between AUDIT score and AWARE score (P < 0.05). It indicates that the clients who scored more than 20 in the AUDIT score have higher chance to get relapse in the future. In the present study, the results revealed that sleep disturbance was significantly associated with relapse. Similar finding was reported by Brower et al.[9] Gulliver et al.[10] suggested that smoking is one of the important predictors of heavy drinking. However, the present study showed that smoking was not a predictor of relapse.

To conclude, it was found that out of 94 participants, 63 (67%) were in low-risk category of relapse, 26 (27.7%) clients were in moderate-risk category of relapse, and 5 (5.3%) clients were in high-risk category of relapse based on AWARE scores [Figure 1]. Clients with a positive family history of alcohol abuse, disturbed sleep pattern, and a high score on AUDIT scale were seen in the high risk of relapse category.
Figure 1: Distribution of level of risk for relapse among clients with alcohol dependence (n = 94).

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Few limitations in the study exist. Sample size was less. Due to purposive sampling, the study lacks generalizability. One-time assessment only was done. Study results were based on subjective reporting of patients.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Dutta R, Gnanasekaran S, Suchithra S, Srilalitha V, Sujitha R, Sivaranjani SS, et al. A population based study on alcoholism among adult males in a rural area, Tamil Nadu, India. J Clin Diagn Res 2014;8:JC01-3.  Back to cited text no. 1
Lyvers M, Hammerbacher M. Factors associated with relapse to problematic alcohol or illicit drug use. J Subst Use 2005;11:387-94.  Back to cited text no. 2
Moos RH, Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction 2006;101:212-22.  Back to cited text no. 3
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992. p. 75-7.  Back to cited text no. 4
Miller WR, Harris RJ. A simple scale of Gorski's warning signs for relapse. J Stud Alcohol 2000;61:759-65.  Back to cited text no. 5
D'souza AC, Veerabhadraswamy DS. Prevalence of alcohol relapse and its relation with emotional maturity among alcoholics. Asian Acad Res J Multidiscip 2014;1:294-300.  Back to cited text no. 6
Walter M, Gerhard U, Duersteler-MacFarland KM, Weijers HG, Boening J, Wiesbeck GA. Social factors but not stress-coping styles predict relapse in detoxified alcoholics. Neuropsychobiology 2006;54:100-6.  Back to cited text no. 7
Kuria MW. Factors associated with relapse and remission of alcohol dependent persons after community based treatment. Open J Psychiatry 2013;3:264-72.  Back to cited text no. 8
Brower KJ, Aldrich MS, Robinson EA, Zucker RA, Greden JF. Insomnia, self-medication, and relapse to alcoholism. Am J Psychiatry 2001;158:399-404.  Back to cited text no. 9
Gulliver SB, Rohsenow DJ, Colby SM, Dey AN, Abrams DB, Niaura RS, et al. Interrelationship of smoking and alcohol dependence, use and urges to use. J Stud Alcohol 1995;56:202-6.  Back to cited text no. 10


  [Figure 1]

  [Table 1], [Table 2]

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