Toward a model of drug relapse: an assessment of the validity of the reinstatement procedure

Abstract

Background and rationale: The reinstatement model is widely used to study relapse to drug addiction. However, the model's validity is open to question.

Objective: We assess the reinstatement model in terms of criterion and construct validity.

Research highlights and conclusions: We find that the reinstatement model has adequate criterion validity in the broad sense of the term, as evidenced by the fact that reinstatement in laboratory animals is induced by conditions reported to provoke relapse in humans. The model's criterion validity in the narrower sense, as a medication screen, seems promising for relapse to heroin, nicotine, and alcohol. For relapse to cocaine, criterion validity has not yet been established primarily because clinical studies have examined medication's effects on reductions in cocaine intake rather than relapse during abstinence. The model's construct validity faces more substantial challenges and is yet to be established, but we argue that some of the criticisms of the model in this regard may have been overstated.

Figures

Figure 1. Hypothetical depiction of the contribution of relapse and abstinence factors to an observed relapse survival curve

(A) Time course of strength of three factors hypothesized to influence relapse: physiological withdrawal (dashed line; early onset and offset), cue reactivity (dotted line; gradual onset and offset), and an abstinence protective factor (dotted-dashed line; gradual increase over time). (B) Relapse survival curve (percent abstinent): relapse due to each of two factors (physiological withdrawal, dashed line; cue reactivity, dotted line) was calculated for each time point by subtracting a constant proportion of the factor’s strength (shown above in A) from 100. The Observed Relapse Survival Curve (solid black line) was then calculated by adding relapse due to physiological withdrawal and cue reactivity, subtracting the abstinence protective factor (dotted-dashed line) and subtracting the result from 100.