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That is, the emotional vulnerability and the little internal instrumental to support them have triggered a frustration which has only been satisfied with the drug. Interpersonal relationships, like relationship problems with close people have been claimed as the main causes.

The following speech depicts this situation. Because this is something which disturbs a person’s inside and out of a sudden a certain grief you may feel, or a quarrel with someone you like, or something which goes wrong and we thought would be different, only crack to get rid of it, then the relapses happen.

F9 Unwilling to seek support after the treatment They believed that the ending of treatment was not promise of success and the positive treatment effect would not last for so long. The crack user is a fragile person and if this fragility is not watched there is a risk to return to the consumption.

There must be a continuity of the treatment somehow so he might feel a little bit more relieved towards the pressure he undergoes along his life. R34 They have recognized the necessity of continued treatment, specially for those who have had relapse more than once. However, this piece of advice has not always been followed. I don’t do it, generally for lack of mood, the head is not at the right place.

I don’t show up at the workshop, I don’t show up at the exams that we take during the appointments. This is the way it is. The lack of this learning has made them relapsed many times. However, they feel regretful for what happened, but that feeling is totally harmless. Because we forget the trauma and the tough situations which we have undergone. I didn’t take anyone into consideration, I went out, passed by a drug stand and there I stayed and bought some crack.

Then, I forgot it very fast. We have noticed the discourse became rigid when relapse was considered unconventional behavior and therefore, it would deserve a kind of judgement. Because it is the person’s weakness of not having strong determination. Without willpower we can’t do it. The anxiety for the drug comes back. While taking medication, we are abstinent. When the treatment ceases, anything can lead to relapse.

Environment Related Reasons The reasons, which have been put together, come from the context where the user lives. The concrete possibility of obtaining the drug due to the possession of resources may conduct to relapse.

I didn’t want to use anything, it had been some time since I didn’t use anything. But when I got some money, things changed. I threw my money about by changing it for crack rocks. G33 Environmental cues triggering conditioned responses To come back to the place where they used to take drugs, to find the drug consumption friends, to pass by drug stands, to walk across people who clearly used crack are strong incentives to return to drug consumption.

In addition to those reasons, there is also the lack of activities and life perspectives. I left this place the treatment unit , I came back to the same place I live and know everything. Where I could find money, buy drugs and there is also the reason that when I arrive at home, I don’t do anything and my mind gets empty. We try to do something to fill the time and the drug turns out to be an option. R38 Drug use that induces crack consumption There are some drugs that the users associate with crack to interfere with the effects produced by the drug, either to intensify the pleasure or to lessen the undesirable effects caused by the drug.

According to the respondents, taking those drugs during crack abstinence leads to a relapse. Alcohol seems to be the most harmful drug in this way. We must be very careful with alcohol. Alcohol is like a valveā€¦ Alcohol is a vehicle we take which lead us straight to crack. L27 Drug related reasons The reasons, which derive from crack, have been grouped in this category, due to the pleasure, craving, compulsion and addiction effects.

I really feel like smoking because the feeling crack gives you when you smoke it is a paradise feeling. But only at that very moment.

D5 In more extreme situations, the user has developed craving, a compulsive desire for the drug addiction effects. Associated to these symptoms are intense physical changes, related to the drug abstinence which led to relapse.

The compulsion came very fast, the heart beat quickly, I couldn’t stop trembling, I also had stomachache, diarrhea, I couldn’t control it. It looked like death was approaching, I wanted to smoke a rock as soon as possible to get rid of that situation.

S41 Unwilling to stop taking the drug There are respondents who stated they did not want, as a matter of fact, they never wanted to abandon the drug, so at the end of the treatment they restarted to use it. It is not exactly a relapse, but a decision to continue the drug consumption, mainly because there had never been the decision to stop it. They made clear they weren’t at that place of their own volition, but because somebody wanted to, which gave them the right to return to the drug consumption.

I don’t want to stop, I don’t have the true wish to stop. I’m here because of the cops, family quarrels, to save the marriage, anyhow, but not to treat myself.

I’m not here because I want to but because somebody did so. Having constant thoughts with crack The drug kept dominating the user’s thoughts, after concluding the treatment so recently. They start thinking about crack constantly, about its pleasure effects, forgetting the other effects that made them look for help.

This situation contributes to relapse. The thought is the main conductor. Keep imagining the pleasure it brings, we let it grow up in our minds, developing, it turns out to lead to crack. This verification make us believe that relapse is a very common process, almost inevitable and of difficult management, by both drug user and professional involved with their recovery, because the reasons which originate it are hard to control due to the fact they are very common 27 , The analysis of the sample characteristics illustrate it is similar to the one considered by Senad’s study 4 , only dissenting from the big presence of white respondents.

Among the relapse triggers pointed out by this sample, includes the respondent’s inability to handle with their feelings. Identified in this study as a user associated reason, it has risen as the most cited of all. This finding is impressive, even in an intentional sampling, when taking into account that the crack effects are defined as harmful and therefore, more probable to conduct to relapse 30 , 31 , given the reason that many authors attribute craving as the main reason for relapsing 32 , In this study, the desire for the drug, expressed by constant thoughts about its use or even by unpleasant effects the user develops in the absence of crack have also been considered as reasons why the user doesn’t carry on the abstinence, however it doesn’t feature as a relapse key process.

The knowledge the users have obtained about crack along almost 30 years of the drug in Brazil has allowed them to develop strategies to deal with some of the unpleasant drug effects, specially craving, as explained by other authors 15 , They have concluded that, although it is very simple, for example, replacing the crack compulsion for other compulsive situations physical exercise bring huge benefits to the user 15 , It could be a possible explanation to that fact.

On the other hand, the daily life challenges are perceived as exaggeration, especially when interpersonal relationships are involved, something that the participants from the study have pointed out. The incapability which the crack cocaine users have to stand frustration, the relapse can be understood as an answer to the fact they don’t confront those situations 6 , Rigotto and Gomes 27 have warned about this situation, which may cause a vicious circle, regarding the person’s inclination after relapse is to feel failed, frustrated, which contributes even more to the consumption maintenance.

Still according to the findings from this study, the interaction with drug user friends may affect the abstinence process. This result is similar to the ones found in other studies, which suggest the peers are considered an important factor of relapse triggering, just as the drug availability.

Both conditions might lead to pleasure experience memories along the drug interaction 35 , The external clues, as defined by some authors, conduct the user to crack consumption return.

Tiffany 37 considers the fact that the repetitive use of the drug makes the user develops clues connecting them to the consumption smell, pictures etc. Other authors state that when the users are exposed to these instigators related to drug use, a strong desire to take the drug is prompted.

Bruehl et al. Nevertheless, the answer for those instigators is difficult to be interrupted because it occurs regardless the user’s will. Yet, the respondents have related that keeping the same previous habits when they used to take the drug, for example: The ability abuse drugs have to disturb the behavior in order to search for another abuse drug is common This crossed reactivity among abuse drugs explains the crack craving provoked by alcohol, if it causes abstinence it may lead to relapse This scenario is explained by classical Pavlovian conditioning, widely accepted as having an important role in relapse These stimuli then increase motivation for drug-taking, elicit or occasion behavior making drug-taking and drug-seeking more probable As a way to reach a more stable abstinence, the adherence to social support programs after the treatment, like self-help resources seem to be of big relevance as raised by the participants.

Siegal et al. Still about this topic, but not clearly mentioned, family is an essential social nucleus, which may act in this abstinence process, having influence on either accelerating or blocking the relapse, according to the family atmosphere.

Families with more co-operating and friendly relationships, in which the members are aware of their roles, may develop a very conducive environment for the user’s rehabilitation 35 , The contrary, as identified throughout the speeches, family dispute problems are causes for relapse Another point that must be considered in this study – a possible research limitation – is the fact the participants had just finished the treatment, what can explain the rigidity in the relapse process evaluation.

There might possibly be a contamination in their speeches with the discourse repeated in some treatment places, especially those with a religious bias. Among the most important findings of this study is the fact that interpersonal relationship problems and the consequent frustration have been the most mentioned reasons as relapse triggers, causing a rupture in the paradigm in which the causes would be focused on the drug.

We still infer in this study that the possibility that the user gets to know and recognize their emotional vulnerabilities and weaknesses could be of great help in relapse prevention. Although the authors haven’t perceived any interference of the treatments in connection with the reasons which lead to relapse cited by the interviewees, we do not exclude the possibility that this interference may happen in studies of such kind. The sample is predominantly consisted of men fact which is in accordance with the profile of the Brazilian crack user which does not allow us to assert that the reasons of relapse, cited in the manuscript, would be the same for women.

Crack cocaine: Subst Use Misuse. Inciardi JA. Crack cocaine in the Americas. Brazil-United States. Binational Research. Pesquisa Nacional sobre o Uso de Crack.

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