Prevalence and Determinants of Relapse Among Individuals with Substance Use Disorders in Iran: A Multi-Center Study
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Objective: Robust, context-specific data on relapse magnitude and its determinants are essential for designing effective prevention and recovery strategies.
Methods and Materials: In a multi-center cross-sectional study, 412 adults with DSM-5 SUD were recruited from eight outpatient addiction treatment centers in three Iranian provinces. Eligible participants had completed at least one structured treatment episode and achieved a minimum of one month of abstinence. Data were collected using a structured questionnaire assessing socio-demographic and clinical characteristics, relapse history, self-reported reasons for relapse, perceived social support, abstinence self-efficacy, family conflict, craving, psychological distress, and environmental factors (drug-using network, drug availability). Relapse was defined as a return to regular problematic use after at least one month of abstinence. Bivariate tests and multivariable logistic regression were used to identify independent predictors of relapse.
Findings: Overall, 61.9% of participants (n = 255) reported relapse after their most recent treatment episode; the median time to relapse was four months. In multivariable analysis, younger age, unemployment, primary opioid use, longer duration of use, more previous treatment episodes, and psychiatric comorbidity predicted higher relapse odds. Lower social support and abstinence self-efficacy, higher family conflict, greater craving, having at least one drug-using close contact, and perceiving drugs as easily available were also independently associated with relapse.
Conclusion: Relapse is highly prevalent among treatment-seeking individuals with SUD in Iran and is shaped by interacting individual, interpersonal, and environmental factors. Comprehensive relapse prevention requires integrated clinical, family-based, and structural interventions tailored to these determinants.
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Amin-Esmaeili, M., Rahimi-Movaghar, A., Sharifi, V., Hajebi, A., Radgoodarzi, R., Mojtabai, R., & Motevalian, A. (2016). Epidemiology of illicit drug use disorders in Iran: Prevalence, correlates, comorbidity and service utilization results from the Iranian Mental Health Survey. Addiction, 111(10), 1836–1847.
Araban, M., Ezati, E., Karimy, M., & Baghcheghi, N. (2026). An exploration into the factors contributing to addiction relapse: A qualitative study. Heliyon, 12, eXXXXX.
Asadi, A., et al. (2025). Illicit drug use derived from wastewater-based epidemiology in Iran. Heliyon, 11, eXXXXX.
Barati, M., Bashirian, S., Mohammadi, Y., Moeini, B., Mousali, A. A., & Afshari, M. (2021). An ecological approach to exploring factors affecting substance use relapse: A systematic review. Journal of Public Health, 29(1), 1–12.
Ezati, E., Baghcheghi, N., Araban, M., & Karimy, M. (2023). Assessing drug use relapse rate and its associated factors among Iranian users. Journal of Substance Use, 28(6), 945–951.
Hay, S. I., et al. (2025). Burden of 375 diseases and injuries and risk-attributable DALYs for 204 countries and territories, 1990–2023. The Lancet, 405, 1–22.
Mao, S., Chou, T., & D’Orsogna, M. (2024). A probabilistic model of relapse in drug addiction. Journal of Theoretical Biology, 576, 111–125.
Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed.). Guilford Press.
Mirzaei, S., et al. (2024). Exploring substance use disorder treatment policies in Iran: Achievements, challenges and future directions. Harm Reduction Journal, 21, 1–14.
Moazami Goudarzi, S., Azemoudeh, M., & Hoseini Nasab, S. D. (2025). Family Cohesion, Religious Values, and Spiritual Intelligence as Predictors of Youth Addiction: The Mediating Role of Social and Psychological Well-being. International Journal of Body, Mind and Culture, 12(3), 98–104. DOI: 10.61838/ijbmc.v12i3.880
Moeeni, M., Razaghi, E. M., Ponnet, K., Torabi, F., Shafiee, S. A., & Pashaei, T. (2016). Predictors of time to relapse in amphetamine-type substance users in the matrix treatment program in Iran: A Cox proportional hazard model application. BMC Psychiatry, 16, 265.
Moradinazar, M., et al. (2020). Prevalence of drug use, alcohol consumption, cigarette smoking and socioeconomic-related inequalities in Iran: Findings from a national survey. Substance Abuse Treatment, Prevention, and Policy, 15, 39.
Mousali, A. A., Barati, M., Mohammadi, Y., Bashirian, S., Moeini, B., & Afshari, M. (2021). Factors affecting substance use relapse among Iranian addicts. Journal of Education and Health Promotion, 10, 129.
Pashaei, T., Shojaeizadeh, D., Rahimi Foroushani, A., Ghazitabatabae, M., Moeeni, M., Rajati, F., & Moradi, A. (2013). Effectiveness of relapse prevention cognitive-behavioral model in opioid-dependent patients participating in the methadone maintenance treatment in Iran. Iranian Journal of Public Health, 42(8), 896–902.
Pirzadeh, S., & Parsakia, K. (2023). A Comparative Study of Family Structure (Cohesion and Flexibility) and Functioning in People with and without Drug Abuse: Family structure and drug abuse. International Journal of Body, Mind and Culture, 10(1), 82–89. DOI: 10.22122/ijbmc.v10i1.278
Rastegari, A., Baneshi, M. R., Hajebi, A., et al. (2023). Population size estimation of people who use illicit drugs and alcohol in Iran, 2015–2016. International Journal of Health Policy and Management, 12, 1–11.
Shaker, A. F., & Kadhim, A. A. (2024). Psychological and Social Risk Factors Contributing to Substance Use at Babylon Governorate, Iraq. International Journal of Body, Mind and Culture, 11(5). DOI: 10.22122/ijbmc.v11i5.766
Seyedfatemi, N., Peyrovi, H., & Jalali, A. (2014). Relapse experience in Iranian opiate users: A qualitative study. International Journal of Community Based Nursing and Midwifery, 2(2), 85–93.
Shid Anbarani, B., et al. (2023). Factors affecting substance use relapse in women: A systematic review. Scientific Journal of Forensic Medicine, 29(3), 1–12.
Sohrabpour, M., Kamyab, A., Yari, A., Afzali Harsini, P., & Khani Jeihooni, A. (2024). The factors affecting substance abuse relapse based on the Theory of Planned Behavior in male addicts covered by addiction treatment centers in Southern Iran. BMC Public Health, 24, 1265.
United Nations Office on Drugs and Crime. (2024). World Drug Report 2024. UNODC.
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