Substance use disorders (SUDs) are a group of mental illnesses characterized by impulsive behavior and a persistent, strong desire to ingest a given substance, associated with drug-seeking behavior, withdrawal symptoms, and tolerance.1
They can involve a wide variety of drugs, including stimulants, analgesics, hypnotics, and narcotics2, potential for mental and/or physical dependence depends in part on the substance’s mechanism of action. According to 2017 estimates, 2.3% of Japan’s population have used a drug of abuse at least once in their lives. Cannabis is the most commonly used substance, with an estimated lifetime prevalence of 1.4%.3 One 2014 study of SUD patients receiving inpatient treatment in Japan reported stimulants as the most common drug of abuse, followed by legal highs and prescription drugs, noting problems associated with the striking jump in the latter two.4
Two factors are expected to dramatically increase the number of people with SUDs supervised under probation: Japan’s extremely high recidivism rate among stimulant offenders (74.1%), and the 2016 introduction of a legal framework to partially suspend the execution of sentences for drug-related and other criminal offenses.5 However, some commentators have called for an urgent overhaul of Japan’s SUD treatment system, noting the paucity of facilities dedicated to drug rehabilitation, and the resulting low rates of treatment among those who need it.6
Studies have raised cognitive-behavioral therapy (CBT) and stage-transition models as effective interventions for drug dependence7, and demonstrated the importance of self-awareness and its association with drug cessation.8 Coping skills, recreational activities, and social support have been reported to effectively encourage continued abstinence.9
Drug dependence can be considered a chronic disease based on its pathology and symptoms, meaning SUD patients should be provided with continuous therapy and support even after they have stopped taking the offending substance. Moreover, since denial is a characteristic symptom of drug dependence10, it is imperative for patients to gain self-management skills by deeply understanding their disease and personally feeling the benefits of recovery. Participation in recovery group meetings held in self-help groups and treatment centers helps substance abusers to improve self-disclosure.11 This strengthens resilience, a crucial psychological trait for preventing relapse.
Self-help group participation can constitute a ‘spiritual’ experience, enhancing self-disclosure12 and allowing attendees to recognize their own experiences in the stories of others.13
Resilience is a concept that has attracted attention in recent years in discussions about recovery from substance dependence.14 Resilience is the ability to adapt to adverse conditions15–17, regarded in the field of psychiatry as a critical component of recovery. Resilience does not reflect personal weakness; it can be enhanced in any and everyone.18
Resilience can be subcategorized into innate resilience, a product of inherent, individual factors, and acquired resilience, which can be modified and strengthened by a variety of environment factors.19, 20 This trait is crucial to the concept of recovery as it relates to people with mental disorders. Recovery has been defined as “a process that allows people [with diseases or disabilities] to actively participate in their life, work, study, and community; affected individuals may conceptualize it as the ability to lead a rich and productive life despite their disability, while others may see it as a reduction or mitigation of those individuals’ symptoms.”21 While individual factors certainly play a role in SUD recovery, it is acquired resilience-related factors that are predicted to strongly drive recovery, helping people to grow and develop as they combat their disease.
This survey-based investigation aimed to shed light on relapse risk in SUD patients attending self-help groups, along with its association with resilience and related factors, in the hope of providing some insight into how to support SUD recovery efforts.