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Predictors of relapse in the early stages of the treatment among inpatients with opioid use disorder: A single-center, prospective cohort study

Objective: Relapse rates in patients with opioid use disorder (OUD) seem to be higher compared with relapse rates in other substance use disorders. In this regard, it is important to deal with the treatment process after discharge and to determine the factors affecting relapse in the early stages of the treatment of the disease. The aim of the present study was to investigate the factors that may be related to relapse in the first 3 months of treatment such as sociodemographics, substance use characteristics, attention-deficit and hyperactivity symptomatology, and cognitive functions in detail. 
Method: A total of 100 inpatients with OUD who consented to participation were included in the research. CANTAB Rapid Visual Information Processing (RVP), CANTAB Emotion Recognition Task (ERT), the CANTAB Cambridge Gambling Test (CGT), Addiction Profile Index (API), Barratt Impulsiveness Scale (BIS), and Adult Attention-Deficit and Hyperactivity Disorder Self-Reporting Scale (ASRS) were administered to the patients. After discharge, the patients were followed up by phone calls, polyclinic follow-ups, and urine analysis for 2 months. Relapse was evaluated both in the interview and the results of the urine analysis. 
Results: Two months after discharge, there were 16 (16%) patients who reported no substance use. The patients were divided into three groups; 1) those who could not complete hospitalization, 2) those who experienced a shift on the first day after discharge; and 3) those who experienced a shift after discharge or those in remission. When the sociodemographic data, substance use characteristics, API, ASRS scores, and cognitive functions of the three groups were compared, only the mean RVP - ability to determine target scores and RVP - total correct rejection scores in patients who were in remission or experienced relapse in the later stages of discharge were significantly higher than the mean score of patients who were discharged before completing the hospitalization protocol (p= 0.011 and p=0.008, respectively). Age, education level, ASRS attention-deficit and impulsivity scores, recognition of happiness scores, and ability to determine to target scores had a significant effect on relapse. After the patients were divided into two groups according to the RVP median value, the abstinence probabilities of the patients were examined using Kaplan-Meier survival analysis. 
Conclusion: Interrogating and treating patients with attention-deficit and hyperactivity disease and symptomatology, as well as interventions with new treatment methods (such as computerized cognitive training and cognitive rehabilitation programs) for patients with sustained attention and social cognition impairment are needed to prevent relapse in the early stages of the treatment in patients with OUD.