Content area
Background: Mental health care users (MHCUs) are usually admitted to mental health care facilities when they relapse. MHCUs who abuse illicit substances get admitted to a special ward in the hospital specifically for drug detoxification for six weeks. Despite thorough recovery programs, there is still rapid post-discharge relapse among MHCUs with high accessibility to substances. The study was conducted at a psychiatric hospital, in South Africa. It is suggested that MHCUs relapse due to the easy availability of substances and association with negative friends. Two themes emerged: MHCU related challenges and MHCU support system challenges. It is evident that MHCUs frequently relapse in the absence of support. Community Psychiatric nurses are to oversee, assist and follow up with MHCUs after rehabilitation. Further studies are needed to strengthen interprofessional community programs for aftercare treatment to monitor recovering MHCUs.The results demonstrate the influence of unfavourable social networks and substance accessibility affecting the therapy.
Abstract
Background: Mental health care users (MHCUs) are usually admitted to mental health care facilities when they relapse. MHCUs who abuse illicit substances get admitted to a special ward in the hospital specifically for drug detoxification for six weeks. Despite thorough recovery programs, there is still rapid post-discharge relapse among MHCUs with high accessibility to substances. The study was conducted at a psychiatric hospital, in South Africa. It is suggested that MHCUs relapse due to the easy availability of substances and association with negative friends. Two themes emerged: MHCU related challenges and MHCU support system challenges. It is evident that MHCUs frequently relapse in the absence of support. Community Psychiatric nurses are to oversee, assist and follow up with MHCUs after rehabilitation. Further studies are needed to strengthen interprofessional community programs for aftercare treatment to monitor recovering MHCUs.The results demonstrate the influence of unfavourable social networks and substance accessibility affecting the therapy.
Introduction
Individuals who have been diagnosed with a mental illness by a mental health care professional are known as MHCUs. These MHCUs are often diagnosed with mental health illnesses such as schizophrenia, anxiety disorders, mood disorders and addiction disorders. Individuals with addictive disorders mostly use illicit substances and they require admission to a rehabilitation centre for detoxification. In United Kingdom (Diaper et al., 2014) indicated that the duration of the detoxification program should range between 04 weeks and 12 weeks to ensure a full recovery. In Pretoria, South Africa (Mhlungu, 2018) concurred with the practices in the setting of this study that the detoxification program may vary and can take between 08 weeks to 12 weeks depending on the type of substance consumed. The process of detoxification assists the MHCUs in stopping the usage of substances. They go through various physical challenges during the detoxification process which include but are not limited to withdrawal manifestations where they experience feelings of discomfort such as stomach cramps, sweating, hypersalivation, dry and cracking skin, nausea, headaches and tremors. During detoxification, the other negative feeling that MHCUs experience is a strong desire to use the substances just to satisfy the craving. In some instances, some MHCUs discontinue or verbalize wanting to stop the treatment brought by the undesirable feelings they go through during the detoxification period.
The positive effect of completing the treatment of detoxification is that MHCUs no longer have the urge to consume or take substances. Substance misuse and addiction are curable conditions that can impair normal functioning, result in harm to oneself or others, create missed work or other financial difficulties, and strain families. Their impact can extend to emotional and physical well-being (National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services., 2016). MHCUs are expected to comply with their prescribed medication to prevent relapse. (Adebiyi et al., 2018) defines relapse as a step of regression from a particular level of stability that occurs when a MHCU develops mental health symptoms after recovery. Relapse and substance abuse contribute to the global burden of mental illness, creating barriers to effective and successful recovery and rehabilitation. Addressing these issues necessitates a multidimensional approach that includes integrated treatment programs, community assistance, and improved access to care. Through the relevant interventions, more individuals can recover. (Otlhapile et al., 2023) in Botswana suggested that the high rate of relapse is evident to less hope for complete recovery for those with substance use disorders. In addition, (Otlhapile et al., 2023) indicated that the most frequently used substances in Botswana are tobacco (58.4%), cannabis (42.6%), alcohol (34.7%), and cocaine (12.8%) among MHCUs. (Mokwena & Setshego, 2021) found that 47% of research participants in the Free State province of South Africa used substances, with alcohol consumption accounting for the largest percentage (87%) of substance users, followed by cigarette smoking (45%) and dagga smoking (24%). (Chughtai et al., 2020) indicated that 70% to 90% of substance abusers relapse within a year of post-rehabilitation treatment because they go back to their old habits of abusing substances. Mental and addictive disorders affect a significant portion of the global population with a high burden, in high- and upper-middle-income countries. These identical results from different countries suggest that substance misuse is on the rise, and effective measures must be implemented. More effective, comprehensive approaches to mental health and substance misuse treatment are necessary. The relapse has heightened in the past decades, due to stigma and lack of treatment (Rehm et al., 2019) In Africa about 6.7% of the adult population use drugs, while in Europe they are estimated at 5.7% (World Health Organisation, 2024). Approximately individuals under the age of 20 years in South Africa misused illicit substances such as cannabis, nyaope and heroin and alcohol (Ndou & Khosa, 2023). According to (World Health Organisation, 2024) an increasing number of children younger than 12 are being treated for drug addiction globally. Relapse rates for people with substance use disorders can indeed be considerable, and it is vital to note that recovery is a journey, not a destination. Some individuals achieve long-term recovery, generally after several attempts.
Treatment advances such as therapy, support groups, and medication have a favourable influence on MHCUs. Individual's experience is unique, and there is a great deal of optimism about discovering the correct support and remedies. Community support, empathy, and resilience can act an important contribution to the rehabilitation process. (Menon & Kandasamy, 2018) suggested that substance abusers can relapse in two distinct ways: (a) completely or relapse; and (b) partially or lapse (slip). Contrary to lapse or partially, MHCUs lapse temporarily and present isolated patterns of drug use, while relapse or complete is accompanied by a more severe and prolonged pattern of drug use. During the discharge of the MHCUs, families need to be educated on how to support the MHCUs to ensure continuity of treatment post-rehabilitation. Moreover, referral post-rehabilitation should be done to ensure the linkage between MHCUs, and the community psychiatric nurses at local clinics. MHCUs continue to relapse due to easy access to illicit substance abuse found in the communities (Kabisa et al., 2021). Furthermore, they relapse due to the lack of support from their families and inadequate care from community psychiatric nurses who are supposed to oversee, assist, and follow up with MHCUs after rehabilitation.
Purpose of the study
Therefore, this study's purpose is to examine the views of mental health nurses as to why do mental health care users relapse after completing a rehabilitation programme.
Research methods and design
Study Design
The study, which details mental health nurses' perspectives on mental health care users' relapses following a rehabilitation programme is descriptive, qualitative and exploratory
Study setting
A psychiatric hospital is located in the Tshwane district, Gauteng province, South Africa. It was established in 1892, and 1t has a bed capacity of 1 400. It employs nurses ranging from assistant nurses to specialized nurses with advanced psychiatric nursing science. It offers acute, chronic, adolescent, forensic and geriatric mental health care services.
Study population and sampling strategy
The population consisted of nurses employed for the inpatient mental health units where MHCUs with substance addiction diagnoses are admitted. A purposive participant selection was employed. The participants were selected by the researcher according to the inclusion and exclusion criteria (Gray & Grove, 2021). Purposive sampling bias was reduced as the rescarcher selected only individuals who met the inclusion requirements. The rescarchers also reduced their bias by withholding their own opinions and knowledge that may influence the data provided by participants at any phase of the interviews and data processing.
Inclusion criteria
* Nurses working in substance addiction units
* Nurses with working experience of two years or more, whether on the day or night shift were eligible to participate in the study.
* Nurses who agree to participate and signed the consent form
Exclusion Criteria
* Nurses with less than two years of working experience
* Nurses not working in substance abuse units and.
* Had not signed the consent form.
Data collection
Following ethical clearance from Sefako Makgatho Health Science University Research and Ethics Committee. Approval from the gatekeeper of the hospital was obtained. The researcher sought the operational management for permission to speak with the mental health care nurses. The researcher then approached the participants, scheduling the day and time of the interviews which was suitable for the participants. Interviews were conducted in a private office which was provided by the operational manager of the psychiatric unit. Semi-structured interviews were performed in English where individuals were asked questions and probing where necessary. The interviews were recorded using a tape recorder, to ensure all information is captured correctly. The participants were asked an open-ended essential question: "What are your experiences caring for relapsed mental health care users diagnosed with substance use disorder in the unit?". The researcher then probed further by asking follow-up questions to gather further information (Gray & Grove, 2021). The interview guide was utilized as a data collection tool to ensure its authenticity.
Data analysis
The data collected was analyzed thematically to identify and interpret themes and subthemes (Hackett & Strickland, 2019). Each interview was transcribed verbatim. The lead investigator read and re-read the transcripts to become comfortable with the data and identify developing patterns. Codes were created to record how these patterns happened. The codes were integrated into themes and analyzed to determine their relevance to the data. Themes which considerably enhanced the understanding of the results of the data were highlighted. Subsequently, the data were evaluated to verify that the participant narratives were presented correctly and to minimize the likelihood of errors. Themes that emerged were discussed with an independent coder and consensus was reached between the researcher and the coder. To minimize bias, the author observed three transcripts of their own before getting together to compare the results.
Trustworthiness
The researcher adhered to trustworthiness criteria throughout the study, including credibility, transferability, dependability, confirmability and authenticity. Credibility was established through the active participation of mental health nurses' interviews lasting for 45min - 60min. Triangulation was accomplished using observations, field notes and audio recordings. Purposive sampling of mental health nurses ensured transferability. Dependability was maintained by providing a full description of the research process and an examination of mental health nurses' perspectives. The researcher guaranteed confirmability by obtaining thorough explanations and participant statements that illustrated how she arrived at her conclusions. The coded data was confirmed by the supervisor and an independent co-coder. Transcripts, audio recordings, field notes and observations were all kept in a secure location that was locked to preserve authenticity. These would serve as proof that the study was carried out in a real-world setting.
Ethical considerations
The Sefako Makgatho Health Sciences University's Research and Ethical Committee presented a clearance certificate (Refno: SMUREC/H/186/2015:PG) prior to the implementation of the research. Permission was obtained from the CEO of the mental health facility where data were to be collected. In this study, the principle of justice relates to the right to fair treatment of participants in the selection process as well as their right to participation, privacy and anonymity were all upheld. After receiving consent from each nursing staff member, the researcher used purposive sampling to apply the concept of justice. The participants were advised of their ability to withdraw from the study without having to give reasons. The consent forms were stored separately from the voice recordings of participants' interviews, which were protected with locks. The field notes were electronically saved, and a password was created to safeguard the participant's electronic data. The interviews were conducted in a space free from distractions so that no one could overhear them.
Results
The section below presents the demographic characteristics and key findings.
Demographic characteristics
Table 1 provides an overview of the demographic characteristics of the participants. Of the nine participants interviewed, three were 2-4 years, three had 5-10 years, and three had more than 10 years working with MHCU diagnosed with substance abuse. Of the nine participants, one professional nurse had a Master's Degree in Nursing, one had a Bachelor's Degree in Nursing, and six had a Diploma in Nursing. One Nursing Assistant held a certificate. Participants had working experience in a mental health hospital ranging between 03 years and 14 years.
Two overarching themes emerged from the analysis: namely, (1) MHCU-related challenges and (2) MHCU support system challenges.
Theme 1: MHCU-related challenges
MHCU challenges were a significant encounter for mental health nurses. Without a supportive structure from the families of mental health users and the community mental health services, the continuity of care post-rehabilitation would not be a success:
Subtheme 1: MHCUs' craving for substances
The nurses verbalized their frustrations regarding the availability and circulation of illicit substances in the communities. The availability of these substances makes it tough for the MHCUs to resist the temptations and as such they give in to the habit. The participants mentioned that it is disheartening to watch MHCUs go through the withdrawal symptoms again and again:
P1: 'We cannot do it alone; everyone must lend a hand".
P4: "It's sad to watch them go through the withdrawal symptoms, unfortunately, that is something that they must experience themselves in order to get through it".
Subtheme 2: MHCUs' easy access to substances
The trade of illicit substances in the communities by the drug lords appears to be a norm in other communities looking at the way that it is conducted. It becomes more complicated when the drug lords are residents of the neighbourhood whose illegal activities are hushed up by the authorities. The presence of drug lords in the communities may result in increased violence, crime, and instability, lowering people's general quality of life. If local officials turn a blind eye or are participating in these activities, it weakens trust in law enforcement and may discourage locals from seeking assistance or reporting problems:
P8: They are dangerous, and they are friends with police so reporting them will be a waste of time, People are helpless regarding police aid with substances and snitching is risky. They are sold all over , even at schools.
Subtheme 3: MHCU association of friends
During the recovery period, the kind of friends that mental health users associate with are important. Previous companions may be linked to old habits and environments that can trigger cravings or temptations. MHCUS need to recognize these triggers and actively avoid them. To ensure that the recovering MHCU is free from temptations that could lead to a setback, it is imperative that he quit associating with his previous companions:
P3: 'I think they should stop hanging out with their bad friends because they do drugs and fortunately for them, it does not affect their mental status'.
P5: You will find them hanging around with bad crowd at the street corners, sometimes playing cards or rolling a dice. They have too much time on their hands idling".
Subtheme 4: MHCU personal stressors
A few participants mentioned that MHCUs have poor backgrounds and that some of them are impoverished. Poverty presents unique challenges and has a significant influence on the healing process of mental health care users (MHCUs). Some MHCUs turn to crime to put food on the table because of their poverty, and as a result, they find themselves behind bars:
P5: "Most of them are unemployed and they live in poverty. In some households the situation is so bad that they go to bed hungry, and they sleep on empty stomachs which is something that was not happening while they were admitted here. Some of them will tell you that people are always suspicious of them and therefore they are not hiring them".
Employers may perceive MHCUs to be dangerous or unreliable due to misconceptions about mental illness and substance abuse which restricts MHCUs' access to job opportunities.
P5. 'People are scared to offer them jobs because they think that they are dangerous".
Theme 2: MHCU support system challenges
Several participants felt that the support of families in conquering addiction disorders is very important. Understanding and involvement from families can improve the emotional support that MHCUs require, making 1t simpler for them to reintegrate into regular life. There is a need to educate families about the user's condition so that they can be able to support the user and make informed decisions regarding their care:
Pl: "The families must be brought in because families tend to move away from patients'
P2: 'Maybe if they can be included in the management of their loved ones' conditions then they will change their attitudes".
Subtheme 1: Family challenges during recovery
Some MHCUs believed that their family members did not understand them or their illnesses, thus they did not provide adequate assistance. When family members do not understand mental health illness, they may struggle to provide the necessary assistance. Open communication and education can help to close this gap, allowing for greater empathy and better aid. It is important that MHCUs voice their needs, and that families seek understanding and resources to properly support their loved ones:
P2: The patients need support for a successful recovery so by bringing them together and having family therapy together then there 's a good turnaround'.
Subtheme 2: Healthcare services
According to the participants, people in recovery from mental health disorders should get assistance with all facets of daily life. In order to keep the recovering MHCUs off the streets, they underlined the importance of community-based leisure activities and the creation of support groups. They hinted that in order for caregivers of people receiving mental health services to make well-informed decisions about the care of their loved ones, they too require help. Rehabilitation requires easily accessible services that offer information, counselling, and continuous support. These services can help close the gap between practical problems and clinical care.
P5: You will find them hanging around with bad crowds at the street corners, sometimes playing cards or rolling a dice. They have too much time on their hands idling.
P1: The caregivers are not knowledgeable about how to help their loved ones through the recovery Journey. Most of them see substance abuse as a lack of discipline associated with irresponsibility. We need to educate them and inform them about other forms of support systems that they can utilise.
Discussions
This study explored the perceptions of mental health nurses regarding the relapse of MHCUs after the successful completion of a rehabilitation program. It produced several significant findings. The discussions focused on the personal issues that MHCUs experience following rehabilitation:
MHCUs' craving for substances
Cravings can be severe and difficult to manage, but there are healthy coping strategies. Talking with a friend, or therapist, or joining a support group can make a significant difference. The participants mentioned that they feel sorry for the MHCUs who experience withdrawal symptoms because they are suffering. They sighted, among other withdrawal symptoms, cramps, headache and tremors. Individuals who experience severe signs of withdrawal are those with concurrent conditions like anxiety, depression, alcohol abuse and psychotic disorders.(Chen et al., 2020)
MHCUs' easy access to substances
In some interviews, the participants blamed the corrupt members of the South African Police services for the growing sales of illicit substances in the communities. They alleged that the police were more often in cahoots with the drug lords and therefore not arrest them for dealing and selling drugs (Nzaumvila et al., 2023), also discovered that the communities experienced despair, disarray, and helplessness regarding police intervention with substance usage. The participants felt unsafe working with the police and often used the phrase "switching is dangerous" [meaning you can be victimized for exposing drug lords] . In United States of America (Boateng et al., 2022) indicated that female police officers on duty committed much more drug-related and economically motivated offences than their off-duty counterparts. These unethical police practices are in line with what the participants narrated during the interviews. On the other hand, female police officers on duty had much lower rates of violent and alcohol-related crimes than their counterparts who were not on duty. The community appears to have lost faith in the justice system, since corruption has taken hold, and the findings indicated that the police are cooperating with the dealers and accepting bribes from them (Singh, 2022), resulting in dealers being released back onto the streets. This tendency is consistent as (Masombuka & Qalinge, 2020) stated that police collude with drug lords who sell illicit substances.
MHCUSs' association of friends
The participants suggested that MHCUs should surround themselves with supportive friends and family who promote their rehabilitation. Recovering MHCUs should avoid individuals who use substance that may cause cravings or undesirable behaviours. They should discover hobbies or activities that they enjoy and to reduce idleness and boredom. However, in a study conducted in Iran on lapse and relapse rates, it was discovered that recovering drug addicts require support from familiar companions like family and friends so that the recovery process can be effective and not prolonged. Further education or work training can boost self-esteem and improve life skills. Maintaining these relationships can help strengthen their commitment to recovery and provide essential support as they navigate life after rehabilitation.
MHCU's personal stressors
The negative effects of relapse according to the MHCUs were cravings, personal stressors, bad company of friends and the lack of supportive resources in the community. These findings are consistent with previous research by (Bearnot et al., 2019) and (Chughtai et al., 2020)). This revealed that recovering mental healthcare users are more prone to relapse into substance use due to their social backgrounds and living settings. The participants also stated that some of these MHCUs have had horrific childhood experiences, such as abusing alcohol and being raped and that after the rehabilitation program, they must return to the same environments which might trigger the addictive behaviour. Some MHCUs found it difficult to resist the urge to repurpose drugs when they get reintegrated into their communities because of inadequate support systems in place at that community.
Life following treatment for substance addiction can be a significant transitional period for those who completed their treatment. Another concern raised by mental health nurses was unemployment as a challenge for MHCUs following rehabilitation. It is vital to develop a health-promoting daily routine. This may involve getting adequate sleep, eating well, exercising regularly and engaging in useful activities that benefit both physical and mental health. (Robertson et al., 2018) reiterated that recovering addicts are at increased risk of relapsing into their old habits of abusing substances after being discharged. However, they recommended that mental health providers use relapse prevention therapy to lower this risk. Mental health nurses underlined the need to establish opportunities for employment for recovering MHCUs. (Ahmad et al., 2021) concurred that hiring ex-drug addicts minimizes MHCUs relapses. Improved discharge procedures are urgently needed to improve information and communication during the discharge process. Nurses and doctors should communicate at a set time to improve patient governance. In addition, the discharge process should be more personalized and focused on the special needs. Improvements are needed in both accessibility and continuity of care post rehabilitation as well as appropriate for the patient's level of understanding (Krook et al., 2020).
Family challenges during recovery.
The relatives expressed mixed feelings of anxiety and compassion as they attempted to provide a supportive environment for their loved ones. Family support is essential in the recovery and treatment of substance misuse. The majority of respondents said that the challenges include insufficient family involvement and poor family contact, which impede the delivery of mental health care services. This finding concurs with the study of (Huang et al., 2020) who discovered that engaging relatives of those diagnosed with mental illness is critical. Many issues may be avoided if MHCU's families were involved in their care and management. Even though caring for a loved one suffering from addiction can be emotionally exhausting, mental health nurses advised that families explore interventions such as therapy and ongoing support groups after rehabilitation. The nurses also recommend that family members volunteer to assist the recovering MHCUs by researching treatment choices and attending appointments with them if they accept.
Family members should seek help for MHCUs from counsellors and support organizations. This concurs with a Namibian study by (Makki et al, 2018) that showed that involving family members in mental health care helped families understand the nature of social support and the significance of family relationships. Family participation may lower recurrence rates and psychiatric symptoms in the most prevalent mental illnesses (Camacho-Gomez & Castellvi, 2020). Participating in these sessions can help to strengthen communication, rebuild trust and aid the MHCU's rehabilitation process. Some of the interviews with participants revealed that family members did not come to collect their loved ones from rehabilitation centres after discharge, which meant that the mental health nurses had to arrange transportation to take the MHCUs home. Family members were upset when their loved one returned home following rehabilitation. According to (Subu et al, 2021) family members have a negative attitude when mental health nurses visit them. Previous research by (Eichstadt et al., 2023a) has proven that nurses play a critical role in improving communication between patients and their families. To lessen the barrier to high-quality mental health treatments, nurses must be competent and have access to the necessary resources. (Haavisto et al., 2021). The interviews revealed how important it is to have family therapy and other activities that could strengthen and connect families before being released from the rehabilitation centre.
Healthcare services
Second, the study examined the support systems available to MHCUs from both the state and the local community. In this study, the nurses were adversely affected by the number of relapse cases taking place shortly after discharge. Although South Africa made the effort to adopt the Mental Health Care Act 17 of 2002 to extend its mental health care services. The Act further urges that following discharge, MHCUs be down-referred to communities and residential homes, a process known as deinstitutionalization of mental health care services. The Mental Health Care Act 17 of 2002 recommends community-based care, treatment and rehabilitation. This provision is supported by Section 8, which states that mental health care should be offered in the communities. Individuals with mental health illnesses benefit greatly from community-based care, treatment, and rehabilitation, according to this Act. This method incorporates mental health interventions into primary care, making treatment more accessible and lowering stigma. The Mental Health Care Act also suggests that once MHCUs are stable, they should be discharged to the care of their families. In order for this change to succeed, there should be sufficient resources in the communities such as support groups offered at primary health care centres. These findings align with (Eichstadt et al., 2023b)who reported that the unavailability or inadequate social support affects the success or failure of the recovery process.
Study recommendations
Further studies are required on the reasons why mental health care users relapse after completing a rehabilitation programme. There are measures which mental health care nurses recommended that they could use to encourage mental health care users to avoid relapsing after completing a rehabilitation programme. These measures include educating family members on their loved one's conditions and management and establishing aftercare programs to occupy the recovering mental health care users.
Limitations of the study
The generalisation of this research findings cannot be applied to employees working in mental health institutions as the study was conducted in one hospital within one province in the Republic of South Africa. These are the views of mental health nurses and exclude other participants who work at the same hospital.
Conclusion
The study offers actionable insights for designing comprehensive post-rehabilitation support programs, emphasizing the importance of structured follow-up interventions, community-based monitoring, and tailored support systems to reduce relapse risk. By identifying serious shortcomings in current care models, the study lays the groundwork for developing more successful, holistic approaches to mental health and substance misuse rehabilitation. According to the participants' views, several societal and personal factors contribute to the relapse in MHCUs. There are still many areas that the Mental Health Care Act 17 of 2002 does not cover, even though South African psychiatric facilities are adopting it to provide mental health care services. Another resource shortfall that could assist in preventing relapse, is to ensure that adequate community psychiatric nurses are employed and available to do home visits to recovering MHCUs. When MHCUs have completed their rehabilitation program they are discharged back to their communities, However, they tend to relapse shortly after being discharged from mental health facilities. The participants also mentioned that it is challenging to work with recovering MHCUs when there is limited or no support network. Other participants reported that some family members are not supportive of their loved one's therapy. While others indicated that they have lost faith in the MHCU because of his or her long-term use of illicit substances and multiple admissions. This study could contribute towards the expansion of effective community mental health facilities for rehabilitation and additional patient assistance would also help to encourage treatment compliance. This would enable continuous follow-up, proactive management of issues, and prompt referral to specialized services as needed. Further studies are needed to strengthen interprofessional community programs for aftercare treatment to monitor recovering MHCUs.
Acknowledgements
This paper is based on the researcher's Master of Advanced Psychiatric Nursing Science degree in Nursing at Sefako Makgatho Health Sciences University in South Africa, which was completed under the supervision of D.C.
Competing interest
The authors have stated that no competing interests exist.
Author's contributions
E.D.M is the project's principal investigator from the perspective of her Master's in Advanced Psychiatric Nursing Science, and D.C was the supervisor.
Funding Information
This work's research, writing, and publication were all done without financial assistance.
Data availability
The corresponding author can provide the data supporting the study's conclusions upon reasonable request.
Disclaimer
The thoughts and opinions mentioned in this article are those of the writers and are based on professional research. It does not necessarily represent the official policy or viewpoint of any linked institution, funder, or agency, including the publisher. The authors are responsible for the article's results, findings, and content.
References
Adebiyi, M. O., Mosaku, S. K., Irinoye, O. O., & Oyelade, O. O. (2018). Socio-demographic and clinical factors associated with relapse in mental illness. International Journal of Africa Nursing Sciences, 8, 149-153. https://doi.org/10.1016/j.ijans.2018.05.007
Ahmad, J., Taib, F. Md., & Jan, A. (2021). Employment of Ex-Drug Addicts as a Corporate Social Responsibility Initiative: The Malaysian Employer's Perspective. Journal of Entrepreneurship and Business Innovation, 8(2), 1. https://doi.org/10.5296/jebi.v8i2.18956
Bearnot, B., Mitton, J. A., Hayden, M., & Park, E. R. (2019). Experiences of care among individuals with opioid use disorder-associated endocarditis and their healthcare providers: Results from a qualitative study. Journal of Substance Abuse Treatment, 102, 16-22. https://doi.org/10.1016/j.jsat.2019.04.008
Boateng, A. B., Opoku, D. A., Ayisi-Boateng, N. K., Sulemana, A., Mohammed, A., Osarfo, J., & Hogarh, J. N. (2022). Factors Influencing Turnover Intention among Nurses and Midwives in Ghana. Nursing Research and Practice, 2022, 1-8. https://doi.org/10.1155/2022/4299702
Camacho-Gomez, M., & Castellvi, P. (2020). Effectiveness of Family Intervention for Preventing Relapse in First- Episode Psychosis Until 24 Months of Follow-up: A Systematic Review With Meta-analysis of Randomized Controlled Trials. Schizophrenia Bulletin, 46(1), 98-109. https://doi.org/10.1093/schbul/sbz038
Chen, L., Chen, C., Chen, C., Chang, H., Huang, M., & Xu, K. (2020). Association of Craving and Depressive Symptoms in Ketamine‐Dependent Patients Undergoing Withdrawal Treatment. The American Journal on Addictions, 29(1), 43-50. https://doi.org/10.1111/ajad.12978
Chughtai, K., Javed, S., & Kiani, S. (2020). Substance Abuse: From Abstinence to Relapse. Life and Science, 1(2), 4. https://doi.org/10.37185/lns.1.1.94
Diaper, A. M., Law, F. D., & Melichar, J. K. (2014). Pharmacological strategies for detoxification. British Journal of Clinical Pharmacology, 77(2), 302-314. https://doi.org/10.1111/bcp.12245
Eichstadt, S. A., Chetty, S., Magagula, T. G., & Swart, X. (2023a). Factors affecting readmission of adolescent mental healthcare users to a psychiatric hospital. South African Journal of Psychiatry, 29. https://doi.org/10.4102/sajpsychiatry.v29i0.2110
Eichstadt, S. A., Chetty, S., Magagula, T. G., & Swart, X. (2023b). Factors affecting readmission of adolescent mental healthcare users to a psychiatric hospital. South African Journal of Psychiatry, 29. https://doi.org/10.4102/sajpsychiatry.v29i0.2110
Gray, J. R., & Grove, S. K. (2021). Burns and Grove's The Practice of Nursing Research (9th ed.).
Haavisto, E., Soikkeli-Jalonen, A., Tonteri, M., & Hupli, M. (2021). Nurses' required end-of-life care competence in health centres inpatient ward - a qualitative descriptive study. Scandinavian Journal of Caring Sciences, 35(2), 577-585. https://doi.org/10.1111/scs.12874
Hackett, A., & Strickland, K. (2019). Using the framework approach to analyse qualitative data: a worked example. Nurse Researcher, 26(2), 8-13. https://doi.org/10.7748/nr.2018.e1580
Huang, C., Plummer, V., Lam, L., & Cross, W. (2020). Perceptions of shared decision‐making in severe mental illness: An integrative review. Journal of Psychiatric and Mental Health Nursing, 27(2), 103-127. https://doi.org/10.1111/jpm.12558
Kabisa, E., Biracyaza, E., Habagusenga, J. d'Amour, & Umubyeyi, A. (2021). Determinants and prevalence of relapse among patients with substance use disorders: case of Icyizere Psychotherapeutic Centre. Substance Abuse: Treatment, Prevention, and Policy, 16(1). https://doi.org/10.1186/s13011-021-00347-0
Krook, M., Iwarzon, M., & Siouta, E. (2020). The Discharge Process-From a Patient's Perspective. SAGE Open Nursing, 6, 237796081990070. https://doi.org/10.1177/2377960819900707
Makki, M., Hill, J. F., Bounds, D. T., McCammon, S., Mc Fall-Johnsen, M., & Delaney, K. R. (2018). Implementation of an ACT Curriculum on an Adolescent Inpatient Psychiatric Unit: A Quality Improvement Project. Journal of Child and Family Studies, 27(9), 2918-2924. https://doi.org/10.1007/s10826-018-1132-2
Masombuka, J., & Qalinge, L. (2020). Outcry and call for relief: Experiences and support needs of parents with nyaope users. Social Work, 56(1). https://doi.org/10.15270/56-1-789
Menon, J., & Kandasamy, A. (2018). Relapse prevention. In Indian Journal of Psychiatry (Vol. 60, Issue 8, pp. S473- S478). Medknow Publications. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_36_18
Mhlungu, S. A. (2018). Exploring the perceived effectiveness of cognitive behavioural therapy as a treatment model for substance use disorders with co-occuring disorders at substance abuse rehabilitation centres. University of South Africa.
Mokwena, K. E., & Setshego, N. J. (2021). Substance abuse among high school learners in a rural education district in the Free state province, South Africa. South African Family Practice, 63(1). https://doi.org/10.4102/safp.v63i1.5302
National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2016). PRINCIPLES OF SUBSTANCE ABUSE PREVENTION FOR EARLY CHILDHOOD: A RESEARCH-BASED GUIDE.
Ndou, N., & Khosa, P. (2023). FACTORS INFLUENCING RELAPSE IN INDIVIDUALS WITH SUBSTANCE USE DISORDERS: AN ECOLOGICAL PERSPECTIVE. Social Work (South Africa), 59(1), 1-23. https://doi.org/10.15270/59-1-1089
Nzaumvila, D. K., Mash, R., & Helliwell, T. (2023). Exploring the perspectives of community members on use of Nyaope in Tshwane, South Africa. South African Family Practice, 65(1). https://doi.org/10.4102/safp.v65i1.5715
Otlhapile, O. E., Gitau, C. W., & Kuria, M. W. (2023). The prevalence of substance use disorders and associated characteristics among patients admitted to a psychiatric hospital in Botswana. The International Journal of Psychiatry in Medicine, 58(4), 339-357. https://doi.org/10.1177/00912174231156027
Rehm, J., Hasan, O. S. M., Black, S. E., Shield, K. D., & Schwarzinger, M. (2019). Alcohol use and dementia: a systematic scoping review. Alzheimer's Research & Therapy, 11(1), 1. https://doi.org/10.1186/s13195-018- 0453-0
Robertson, A. G., Easter, M. M., Lin, H., Frisman, L. K., Swanson, J. W., & Swartz, M. S. (2018). Medication-Assisted Treatment for Alcohol-Dependent Adults With Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes. American Journal of Psychiatry, 175(7), 665-673. https://doi.org/10.1176/appi.ajp.2018.17060688
Singh, D. (2022). The Causes of Police Corruption and Working towards Prevention in Conflict-Stricken States. Laws, 11(5), 69. https://doi.org/10.3390/laws11050069
Subu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., Slewa-Younan, S., & Al-Yateem, N. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. International Journal of Mental Health Systems, 15(1). https://doi.org/10.1186/s13033-021-00502-x
World Health Organisation. (2024). World Drug Report. https://www.unodc.org/unodc/en/data-and-analysis/worlddrug- report-2024.html
Copyright IFE Centre for Psychological Studies 2025