4. Have predictors of drug addiction relapse changed during the COVID-19 pandemic? A prospective study of recovery pathways in the Netherlands, Belgium and UK

Little data are available regarding the impact of the COVID-19 outbreak and related lockdown measures on populations in drug addiction recovery, particularly outside treatment settings. The pandemic may have had an impact on risk factors for relapse. Extending an existing European cohort of people in drug addiction recovery (REC-PATH), we examined (changing) risk factors for relapse before and during the COVID-19 pandemic.

In 2018, we recruited a convenience sample (N=367) of adults in recovery for at least three months, from the Netherlands, UK, and Belgium). 16% of participants were in early recovery (<1 year), 40% in sustained recovery (1-5 years), and 44% in stable recovery (>5 years). A baseline assessment with two follow-ups (T1, 2019, 92% of baseline cohort; T2, 2020, 67% of baseline cohort) measured key markers related to addiction recovery and two types of relapse measures (subjective relapse, according to the participant’s definition; and past 12 month problematic drug or alcohol use). We performed repeated multilevel logistic analyses to assess changes in predictors of relapse.

At T1 (before the pandemic) 22% of participants reported subjective relapse and 19% reported past 12 months problematic drug or alcohol use. At T2 (during the pandemic) 21% reported subjective relapse and 14% reported problematic drug or alcohol use. Overall, lower commitment to sobriety and past 12 months negative life events predicted higher odds of relapse. Before the pandemic less social support and professional support, and past 12 months negative life events predicted relapse. During the pandemic, less professional support, recovery capital, and commitment to sobriety predicted relapse.

Our findings provide new insights into the impact of the corona-pandemic on addiction recovery pathways in Europe. Lacking access to social and professional support during the pandemic, people in recovery may have been more dependent on their own commitment to sobriety and recovery capital.