Journal of Addiction & Addictive Disorders Category: Clinical Type: Review Article

Developing Illness Awareness and Self-Agency of Addicted Patients to Predict Risk Situations and Reduce Relapse

Nelson Valdés-Sánchez1*
1 Escuela de psicologia, Facultad de Ciencias Sociales y Comunicación, Universidad Santo Tomás, Millennium Institute for the Research of Depression and Personality (MIDAP), Santiago, Chile

*Corresponding Author(s):
Nelson Valdés-Sánchez
Escuela De Psicologia, Facultad De Ciencias Sociales Y Comunicación, Universidad Santo Tomás, Millennium Institute For The Research Of Depression And Personality (MIDAP), Santiago, Chile
Tel:+56 956694072, /

Received Date: Feb 26, 2020
Accepted Date: Mar 10, 2020
Published Date: Mar 20, 2020


Addiction is a physiological and psychological and social disorder that is considered a major health problem in many societies. This disorder is associated with difficulties in the ability of addicted patients to resist and prevent self-destructive and risk situations. This has led to numerous studies that have managed to demonstrate that there is a relationship between the self-efficacy and motivation of these patients aimed at changing addictive habits, even being considered as predictors and/or mediators of the effects of treatment. This article proposes to understand self-efficacy in a broader way (self-agency) that goes beyond the cognitive and behavioural aspects necessary, which also includes an adequate level of self-regulation, commitment and lifestyle changes, all of which are necessary to obtain successful and stable therapeutic results over time.


Addiction; Illness awareness; Self-agency


The prevalence of alcohol consumption is high worldwide and this risk behavior has been shown to lead to numerous physical and social consequences [1]. Furthermore, it is considered one of the main causes and/or risk factors for chronic diseases [2]. According to the World Alcohol and Health Situation Report presented by the World Health Organization [3], Chile is the Latin American country with the highest average consumption of pure alcohol per year, causing approximately 10% of deaths at the national level. According to statistics reported by the Eleventh National Study on Drugs in the General Population of Chile [4], the prevalence of alcohol consumption increased significantly from 69.1% in 2012 to 79.1% in 2014. This increase was seen in both sexes and in all age groups, except for young people, who showed no significant change from 2012. The highest prevalence of consumption was observed at the high socio-economic level (52.5%), compared to the medium and low level (46.1% and 46.5%, respectively). A systematic increase has also been observed in marijuana use since 2010. Lifetime prevalence of marijuana use increased from 23.0% in 2012 to 31.5% in 2014, regardless of gender, socioeconomic status and age range and has even doubled in people over 35 years of age. 

According to the results of the national study on the burden of disease and the burden attributable to risk factors in Chile [5], alcohol consumption is the leading cause of Healthy Life Years Lost, since it ends up affecting a person's psychological well-being and functioning in different areas of their life, producing a considerable deterioration in physical health and social functioning [6,7]. According to the World Health Organization [8], quality of life is defined as the way a person perceives his or her life situation, cultural context and the values in which he or she lives, in relation to his or her own goals, expectations, values and interests. Although quality of life can be measured in various ways, the minimum dimensions to consider are the physical, psychological and social Brewer aims [9-11], so that the greater the severity in any of these domains, the lower the level of self-perceived Quality of Life will be [12,13]. 

Numerous studies have demonstrated the relationship between improved quality of life for addicted patients and staying abstinent [14,15], as well as the inverse relationship with deterioration during relapse [16,17]. Bottlender & Soyka [18], found an association between a low level of awareness and a higher probability of relapse during their first year of abstinence, so the degree of motivation of the patient before starting treatment seems to be a key element for change, especially if they have managed to stay in abstinence before. 

Relapse of a patient after a period of abstinence may be the result of maladaptive ways of coping with stressful situations of everyday life, which are characterized by an imbalance between the demands on the environment and the skills or resources of the patient [19,20]. Therefore, it is necessary to train social skills, coping skills and behavioural changes to cope with such situations [21]. In this sense, Monti, Rohsenow, Colby and Abrams [22], proposed that the patient should develop the following 4 social skills to be able to adequately cope with such situations:

a) Interpersonal skills to establish better social relationships;
b) Cognitive-emotional coping skills to achieve that of mood regulation;
c) Skills that allow for improved quality of life;
d) Skills for the identification of signs related to consumption.

Shand, Gates, Fawcett and Mattick [23], showed that the development of these skills is often more effective in intensive treatment programs, while de Sá and Prette [24], propose that the ability to anticipate is the most important coping strategy for maintaining abstinence. 

Donovan [25], describes a coping strategy called the anticipatory strategy, which allows the individual to consciously and assertively identify his or her consumption desires. By using this strategy appropriately, the person's thoughts and behaviors are focused on building environments that are less susceptible to risk situations, on the one hand and on quickly and effectively resolving the danger before relapse occurs, on the other. However, people with chemical dependency are often highly impulsive, preferring small and immediate rewards, rather than larger and later ones, without necessarily assessing the pros and cons of the various options [26]. 

One of the main consequences of the consumption of illicit drugs and alcohol is cognitive dysfunction resulting from the deterioration of the person's awareness of the disease. This deteriorated or altered perception must be considered as a kind of continuum, ranging from a total denial of the disease, underestimating the multiple consequences in daily life due to consumption [27,28], through a deficit in autobiographical memory [29], to the total and conscious recognition of suffering from a chronic disease [30]. 

In fact, although it has been possible to identify different brain structures that are susceptible to the effects of chemical consumption [31-33], clinically the lack of awareness of illness has been associated with problems at the motivational level and with denial [34]. Thus, substance abuse appears to be incompatible with a person's thought processes, especially those related to the ability to pay full attention, voluntarily and consciously, as a result of the lived experience, in the moment itself and without attributing any value to them or connecting them to past memories, emotions or thoughts [35,36]. Consciousness, like full attention, has as its distinctive features to be thorough, efficient, but above all to remain oriented to the accomplishment of certain tasks [37]. In that sense, it has been observed that the ability to act with conscious attention is negatively associated with excessive alcohol use [38] and even more so when the person has consumed more than one substance [39]. Deficits in these executive functions predispose individuals to alcohol abuse [40], under the assumption that poor inhibitory control coupled with poor decision making ends up making the difference between a person choosing decisions that lead to advantageous outcomes, or choosing options that lead to unfavorable consequences [26,41]. Evidence of this is that relapses are generally characterized by a suppression of thought [42,43]. 

Most of these studies agree on the need to identify protective factors to prevent risk behaviour and possible relapses. Another factor that has been studied recently is the attention to the trait mindfulness [44-47], which has been analyzed together with other variables that could influence this relationship (e.g., phases of full attention, type of substance and characteristics of the sample and severity of consumption, among others). Baer and colleagues [48], propose the following 5 dimensions for understanding attention to the trait:

a) The person must be able to observe and attend to one's own internal and external experiences;
b) One must be able to describe and express them verbally;
c) One must act with awareness present in one's activities;
d) One needs to assume a non-judgmental posture of one's thoughts and feelings;
e) One must allow those thoughts and feelings to come and go without attachment (non-reactivity).

Some studies have shown that not acting reactively, but rather acting consciously and without judging oneself, are the dimensions most frequently related to the decrease in consumer behavior [38,49-51], since, in order to do so, the person requires higher order cognitive processes [52]. Therefore, impulsivity is one of the dimensions that could be explaining the relationship between the level of attention to the trait and the consumption behaviors [53,54], biases in attention [55] or stress tolerance [56]. However, a negative relationship between trait attention and substance use may be reciprocal, meaning that increased attention to the trait is associated with increased protection from substance use [57], while increased substance use may be associated with decreased attention to the trait [52,58]. 

Studies have shown that people with a high level of attention to the trait tend to be less likely to use substances because they tend to perceive aversive experiences as passing situations, rather than as a way of coping [59-61]. People who are less aware of situations that could mean high risk, or of the consequences of these, are associated with an increased susceptibility to automatic drug-seeking processes and with a lower propensity to search for appropriate and effective coping strategies that allow them to pay conscious attention to their own desires to use [62]. In this sense, an individual's thoughts about his or her illness play an important role in how he or she will respond to risk situations. A person who is able to perceive that his or her behavior leads to outcomes that are valued as negative will generally tend to make changes; however, when he or she is unable to avoid or resist risk situations despite wanting to do so, the result will be a cognitive dissonance characterized by much dissatisfaction, which over time ends up changing healthy beliefs, rather than risk behaviors. Along the same lines, Bitarello do Amaral, Lourenço and Ronzani [63], propose 2 main types of beliefs that characterize addict patients: risk-minimizing beliefs and functional beliefs (The first has to do with perceiving less possibilities of experiencing negative effects, or, downplaying the negative or undesirable consequences of a behavior (e.g., "I have not had and would not have negative consequences on my work performance due to my consumption"), while functional beliefs are those that relate to the perception of benefits from engaging in certain behaviors, which are valued as positive (e.g., “I use alcohol because it helps me reduce stress”) [64]. 

The recovery of patients with chemical dependency will be greater to the extent that they can develop a higher level of awareness of their illness, which translates into a greater subjective sense of happiness, a decrease in symptoms and a positive change in their interpersonal relationships [65-69]. However, this recovery also implies the realization of a series of lifestyle changes, which basically have to do with achieving a transformation of identity, understanding the latter as a multidimensional, fluid and context-dependent construct [70], implies that the person, on the one hand, is able to leave aside the identity of the 'drinker', while at the same time managing to develop and internalize a new 'non-consumption' identity that is stable and of which he or she is fully aware [71-75]. This change in lifestyle is directly associated with changes in the person's quality of life, which is why it has become one of the most studied indicators of therapeutic intervention in drug dependence in recent years [11]. 

These lifestyle changes are associated with increased self-agency by the patient, that is, a greater degree of self-efficacy in predicting risk situations and decreasing the likelihood of relapse, on the basis that people with greater awareness of illness would tend to repeat certain behaviours when they gain confidence in their ability to make correct decisions [76]. This is in complete contrast to what Bottlender [18], calls short-sightedness of the future, to refer precisely to a person's inability to foresee situations and learn from mistakes. In this sense, it is to be expected that patients with high positive expectations regarding their consumption behaviour (e.g., “Getting clean doesn't mean staying abstinent for the rest of my life”) will have unsuccessful therapeutic results, unlike those who have high negative expectations (e.g., “The urge to consume alcohol can lead to isolation from family and friends"), precisely because they will be able to anticipate the negative consequences of their decision to consume [77,78]. 

On the other hand, a positive relationship has been observed between the use of adaptive strategies as a form of self-agency and improved treatment adherence [79,80] and a negative relationship with relapse rate [81-83]. These results should be taken into consideration as an essential element when designing and implementing interventions to ensure the successful recovery of these patients, including relapse prevention [20]. 

This entire theoretical and empirical framework was used by Valdés, Quevedo, Arriagada, Borzutzky and Schilkrut [78], to develop a questionnaire to estimate the degree of disease awareness of addicted patients receiving outpatient treatment. It was observed that the disease awareness of abstinent addicted patients gradually increased, especially after the sixth month of treatment, when they were able to improve their self-esteem and reduce their emotional pain, allowing them to develop a new lifestyle. This increased disease awareness (self-agency) was significantly maintained between the sixth and twelfth month of treatment. These results are too coincidental with those found by Marquez-Arrico, Benaiges and Adan [84], regarding the need to develop the capacity of emotional expression during risk situations (i.e., "Working on my emotions has allowed me to understand the seriousness of my addiction") and also strategies to modify the meaning of the stressful situation in an attempt to make it less stressful (i.e., "Protective measures are part of my daily behaviour"). However, it is also important to emphasize the importance of the need for patient commitment as a condition for keeping their recovery stable (i.e., "I feel responsible for my rehabilitation process"). All of these capabilities, coupled with the implementation of more adaptive behaviors (i.e., "I can anticipate risk situations or exposures to avoid the urge to consume") and the recognition of the need for positive social relationships (i.e., "My family or closest attachments are important in keeping me abstinent", "I need help learning to live with an addiction problem") [85-87]. 

Finally, although it is true that there are numerous studies that have shown that the recovery of addicted patients can be predicted by their level of self-efficacy, there are also studies that consider it a mediating variable. However, more research is still needed in this regard, in order to reach more consistent conclusions. This article proposes to understand self-efficacy in a broader way (self-agency) that goes beyond the cognitive and behavioural aspects necessary, which also includes an adequate level of self-regulation, commitment and lifestyle changes, all of which are necessary to obtain successful and stable therapeutic results over time.


We would like to express our gratitude for the support from the Millennium for Research in Depression and Personality Institute (Instituto Milenio para la Investigación en Depresión y Personalidad, MIDAP), Project IS130005 and the Psychotherapy Research Center (Cenrto de Investigación en Psicoterapia, CIPSI).


Author state no conflict of interest.


The writing of this article did not involve any studies with human participants or animals performed by the author.


  1. Kleinjan M, van den Eijnden RJJM, Engels RCM (2009) Adolescents’ rationalizations to continue smoking: The role of disengagement beliefs and nicotine dependence in smoking cessation. Addictive Behaviors 34: 440-445.
  2. Margozzini P, Sapag J (2015) El consumo riesgoso de alcohol en Chile: Tareas pendientes y oportunidades para las políticas públicas. Centro de Políticas Públicas UC, Temas de la Agenda Pública, USA. Pg no: 1-18.
  3. WHO (2014) Global strategy to reduce harmful use of alcohol. WHO, Geneva, Switzerland.
  4. Senda (2014) Chilean alcohol and drug observatory. Tenth study on drugs in the school population.
  5. Chile Ministerio de Salud (2008) Informe final: Estudio de carga de enfermedad y carga atribuible. Departamento de Epidemiología, Independencia, Chile.
  6. Fischer JA, Conrad S, Clavarino AM, Kemp R, Najman JM (2013) Quality of life of people who inject drugs: characteristics and comparisons with other population samples. Qual Life Res 22: 2113-2121.
  7. Laudet AB (2011) The case for considering quality of life in addiction research and clinical practice. Addict Sci Clin Pract 6: 44-55.
  8. Skevington SM, O’Connell KA (2004) Can we identify the poorest quality of life? Assessing the importance of quality of life using the WHOQOL-100. Qual Life Res 13: 23-24.
  9. Katschning H, Freeman H, Sartorius N (2000) Usefulness of the quality of life concept in psychiatry. In H Katsehning, Freemati H, Sartorius N (Ed.), Quality of life in mental disorders. Barcelona: Masson.
  10. Wiessma D (2000) Role performance as a component of quality of life in mental disorders. In: Katschning H, Freeman H, Sartorius N (eds.). Quality of life in mental disorders, Barcelona, Spain. Pg no: 43-52.
  11. Morales-Manrique CC, Castellano-Gómez M, Valderrama-Zurián JC, Aleixandre-Be-navent R (2006) Medición de la calidad de vida e importancia de la atención a las necesidades autopercibidas en pacientes drogodependientes. Trastornos adictivos 8: 212-221.
  12. Martínez JM, Grana JL, Trujillo H (2010) La calidad de vida en pacientes con trastorno por dependencia al alcohol con trastornos de la personalidad: Relación con el ajuste psicológico y craving. Psicothema 22: 562-567.
  13. Smith K, Larson M (2003) Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts. American Journal Alcohol Abuse 29: 323-335.
  14. Azbel L, Rozanova J, Michels I, Altice FL, Stöver H (2017) A qualitative assessment of an abstinence oriented therapeutic community for prisoners with substance use disorders in Kyrgyzstan. Harm Reduct J 14: 43.
  15. Kraemer KL, Maisto SA, Conigliaro J, McNeil M, Gordon AJ, et al. (2002) Decreased alcohol consumption in outpatient drinkers is associated with improved quality of life and fewer alcohol-related consequences. J Gen Intern Med 17: 382-386.
  16. Picci RL, Oliva F, Zuffranieri M, Vizzuso P, Ostacoli L, et al. (2014) Quality of life, alcohol detoxification and relapse: Is quality of life a predictor of relapse or only a secondary outcome measure? Quality of Life Research 23: 2757-2767.
  17. Vederhus JK, Birkeland B, Clausen T (2016) Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor? Quality of Life Research 25: 2315-2322.
  18. Bottlender M, Soyka M (2005) Impact of different personality dimensions (NEO Five-Factor Inventory) on the outcome of alcohol-dependent patients 6 and 12 months after treatment. Psychiatry Res 136: 61-67.
  19. Hassanbeigi A, Askari J, Hassanbeigi J, Pourmovahed Z (2013) The Relationship be-tween Stress and Addiction. Procedia - Social and Behavioral Sciences 84: 1333-1340.
  20. Adan A, Antúnez JM, Navarro JF (2017) Coping strategies related to treatment in substance use disorder patients with and without comorbid depression. Psychiatry Res 251: 325-332.
  21. Parks GA, Anderson BK, Marlatt GA (2004) Relapse prevention therapy. In: Heather N, Stockwell T (eds.). The Essential Handbook of Treatment and Prevention of Alcohol Problems. Wiley, Chichester, New Jersey, United States. Pg no: 87-104.
  22. Monti PM, Rohsenow DJ, Colby SM, Abrams DB (1995) Coping and social skills training. In: Hester RK, Miller WR (eds.). Handbook of alcoholism treatment approaches: Effective alternatives, (2nd edn). Allyn and Bacon, Needham Heights, USA. Pg no: 221-241.
  23. Shand F, Gates J, Fawcett J, Mattick R (2003) The Treatment of Alcohol Problems: A Review of the Evidence. Canberra: Commonwealth Department of Health and Ageing.
  24. Sá LGC, del Prette ZAP (2016) Habilidades de enfrentamento antecipatório para abstinência de substâncias: Construção de um novo instrumento de medida. Avances en Psicología Latinoamericana 34: 351-363.
  25. Donovan DM (2009) Assessment of dependent behaviour in relapse prevention. In Donovan, Marlatt (Ed.), Assessment of dependent behaviou, (pp. 1-50). Roca, Municipality of Gavà, Spain.
  26. Byrnes JP (2002) The development of decision-making. J Adolesc Health 31: 208-215.
  27. David AS, Bedford N, Wiffen B, Gilleen J (2012) Failures of metacognition and lack of insight in neuropsychiatric disorders. Philos Trans R Soc Lond B Biol Sci 367: 1379-1390.
  28. Lincoln R, Rosenthal CF, Malte CA, Simpson T (2011) A pilot study of memory impairment associated with discrepancies between retrospective and daily recall of alcohol consumption. American Journal on Addictions 20: 568-574.
  29. Poncin M, Neumann A, Luminet O, van de Weghe N, Philippot P, et al. (2015) Disease recognition is related to specific autobiographical memory deficits in alcohol-dependence. Psychiatry Res 230: 157-164.
  30. Volkow N, Li TK (2005) The neuroscience of addiction. Nature Neuroscience 8: 1429-1430.
  31. Moeller SJ, Goldstein RZ (2014) Impaired self-awareness in human addiction: Deficient attribution of personal relevance. Trends in Cognitive Sciences 18: 635-641.
  32. Prigatano G, Johnson SC (2003) The three vectors of consciousness and their disturbances after brain injury. Neuropsychological Rehabilitation 13: 13-29.
  33. Sullivan EV, Pfefferbaum A (2005) Neurocircuitry in alcoholism: A substrate of disruption and repair. Psychopharmacology 180: 583-594.
  34. Rinn W, Desai N, Rosenblatt H, Gastfriend DR (2002) Addiction denial and cognitive dysfunction. Journal of Neuropsychiatry and Clinical Neurosciences 14: 52-57.
  35. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, et al. (2004) Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice 11: 230-241.
  36. Brown KW, Ryan RM, Creswell JD (2007) Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry 18: 211-237.
  37. Giluk TL (2009) Mindfulness, Big Five personality and affect: A meta-analysis. Personality & Individual Differences 47: 805-811.
  38. Fernandez AC, Wood MD, Stein LR, Rossi JS (2010) Measuring mindfulness and examining its relationship with alcohol use and negative consequences. Psychol Addict Behav 24: 608-616.
  39. Dakwar E, Mariani JP, Levin FR (2011) Mindfulness impairments in individuals seeking treatment for substance use disorders. Am J Drug Alcohol Abuse 37: 165-169.
  40. López-Caneda E, Rodríguez S, Cadaveira F, Corral M, Doallo S (2014) Impact of alcohol use on inhibitory control (and vice versa) during adolescence and young adulthood: A review. Alcohol 49: 173-181.
  41. Körner N, Schmidt P, Soyka M (2015) Decision making and impulsiveness in abstinent alcohol-dependent people and healthy individuals: a neuropsychological examination. Substance Abuse Treatment, Prevention and Policy 10: 24.
  42. Garland EL, Boettiger CA, Gaylord SA, Chanon VW, Howard MO (2012) Mindfulness is inversely associated with alcohol attentional bias among recovering alcohol-dependent adults. Cognit Ther Res 36: 441-450.
  43. Levin ME, Dalrymple K, Zimmerman M (2014) Which facets of mindfulness predict the presence of substance use disorders in an outpatient psychiatric sample? Psychology of Addictive Behaviors 28: 498-506.
  44. Black DS, Sussman S, Johnson CA, Milam J (2012) Trait mindfulness helps shield decision-making from translating into health-risk behavior. Journal of Adolescent Health 51: 588-592.
  45. Bramm SM, Cohn AM, Hagman BT (2013) Can Preoccupation with alcohol override the protective properties of mindful awareness on problematic drinking? Addictive Disorders & Their Treatment 12: 19-27.
  46. Garland EL (2011) Trait mindfulness predicts attentional and autonomic regulation of alcohol cue-reactivity. J Psychophysiol 25: 180-189.
  47. Rogojanski J, Vettese LC, Antony MM (2011) Coping with cigarette cravings: Comparison of suppression versus mindfulness-based strategies. Mindfulness 2: 14-26.
  48. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13: 27-45.
  49. Bodenlos JS, Noonan M, Wells SY (2013) Mindfulness and alcohol problems in college students: The mediating effects of stress. Journal of American College Health 61: 371-378.
  50. Leigh J, Neighbors C (2009) Enhancement motives mediate the positive association between mind/body awareness and college student drinking. J Soc Clin Psychol 28: 650-669.
  51. Murphy C, MacKillop J (2012) Living in the here and now: Interrelationships between impulsivity, mindfulness, and alcohol misuse. Psychopharmacology 219: 527-536.
  52. Ives-Deliperi VL, Solms M, Meintjes EM (2011) The neural substrates of mindfulness: An fMRI investigation. Soc Neurosci 6: 231-242.
  53. Christopher M, Ramsey M, Antick J (2013) The role of dispositional mindfulness in mitigating the impact of stress and impulsivity on alcohol-related problems. Addiction Research & Theory 21: 429-434.
  54. LePera N (2011) Relationships between boredom proneness, mindfulness, anxiety, depression, and substance use. The New School of Psychology Bulletin 8: 15-23.
  55. Chambers R, Lo BCY, Allen NB (2008) The impact of intensive mindfulness training on attentional control, cognitive style and affect. Cognitive Therapy Research 32: 303-322.
  56. Linehan MM, Bohus M, Lynch TR (2007) Dialectical behavior therapy for pervasive emotion dysregulation: Theoretical and practical underpinnings. In: Gross J (Ed.s). Handbook of Emotion Regulation. Guilford Press, New York. Pg no: 581-605.
  57. Marlatt GA, Witkiewitz K (2005) Relapse prevention for alcohol and drug problems. In: Marlatt GA, Donovan DM (eds.). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd edn). Guilford Press, New York, USA. Pg no: 1-44.
  58. Dom G, Sabbe BGCC, Hulstijn W, Van Den Brink W (2005) Substance use disorders and the orbitofrontal cortex: Systematic review of behavioural decision-making and neuroimaging studies. Br J Psychiatry 187: 209-220.
  59. Brewer JA, Bowen S, Smith JT, Marlatt GA, Potenza MN (2010) Mindfulness-based treatments for co-occurring depression and substance use disorders: What can we learn from the brain? Addiction 105: 1698-1706.
  60. De Dios MA, Herman DS, Britton WB, Hagerty CE, Anderson BJ, et al. (2012) Motivational and mindfulness intervention for young adult female marijuana users. J Subst Abuse Treat 42: 56-64.
  61. Karyadi KA, VanderVeen JD, Cyders MA (2014) A meta-analysis of the relationship between trait mindfulness and substance use behaviors. Drug Alcohol Depend 143: 1-10.
  62. Garland EL, Gaylord SA, Boettiger CA, Howard MO (2010) Mindfulness train-ing modifies cognitive, affective and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial. Journal of Psychoactive Drugs 42: 177-192.
  63. Bitarello do Amaral M, Lourenço LM, Ronzani TM (2006) Beliefs about alcohol use among university students. Journal of Substance Abuse Treatment 31: 181-185.
  64. Borland R, Yong HH, Balmford J, Fong GT, Zanna MP, et al. (2009) Do risk-minimizing beliefs about smoking inhibit quitting? Findings from the International Tobacco Control (ITC) four-country survey. Prev Med 49: 219-223.
  65. Carter AD (2015) The effects of mindfulness on affect and substance use. University Honors Program Theses, Ohio, USA.
  66. Copello A, Orford J (2002) Addiction and the family: Is it time for services to take no-tice of the evidence? Addiction 97: 1361-1363.
  67. Lee K, Bowen S (2014) Relation between personality traits and mindfulness following mindfulness-based training: a study of incarcerated individuals with drug abuse disor-ders in Taiwan. International Journal of Mental Health and Addiction, 13: 413-421.
  68. Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, et al. (2014) Psychosocial difficulties in alcohol dependence: A systematic review of activity limitations and participation restrictions. Disability and Rehabilitation 36: 1227-1239.
  69. Longabaugh R (2002) Involvement of Support Networks in Treatment. Recent Developments in Alcoholism 16: 133-147.
  70. Tracy SJ, Trethewey A (2005) Fracturing the real?self↔fake?self dichotomy: Moving toward “crystallized” organizational discourses and identities. Communication Theory 15: 168-195.
  71. Best D, Beckwith M, Haslam C, Haslam SA, Jetten J, et al. (2015) Overcoming alcohol and other drug addiction as a process of social identity transition: The Social Identity Model of Recovery (SIMOR). Addiction Research and The-ory 24: 1-13.
  72. Buckingham SA, Frings D, Albery IP (2013) Group membership and social identity in addiction recovery. Psychol Addict Behav 27: 1132-1140.
  73. Chambers SE, Canvin K, Baldwin DS, Sinclair JAM (2017) Identity in recovery from problematic alcohol use: a qualitative study of online mutual aid. Drug Alcohol Depend 174: 17-22.
  74. Hill JV, Leeming D (2014) Reconstructing ‘the Alcoholic’: Recovering from alcohol ad-diction and the stigma this entails. International Journal of Mental Health and Addic-tion 12: 759-771.
  75. Laudet AB (2007) What does recovery mean to you? Lessons from the recovery experi-ence for research and practice. J Subst Abuse Treat 33: 243-256.
  76. Sakiyama HMT, Ribeiro M, Padin MFR (2012) Relapse prevention and social skills. In: Ribeiro M, Laranjeira R (eds.). The crack user's treatment. Artmed, Porto Alegre, Brazil. Pg no: 337-350.
  77. Sawayama T, Yoneda J, Tanaka K, Shirakawa N, Sawayama E, et al. (2012) The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment. Substance Abuse Treatment, Prevention, and Policy 7: 17.
  78. Valdés N, Díaz R, Quevedo Y, Arriagada L, Borzutzky A, et al. (2019) Construction and validation of the Inventory of Addiction Awareness (ICE-A). International Journal of Mental Health and Addiction 11.
  79. Forys K, McKellar J, Moos R (2007) Participation in specific treatment components predicts alcohol-specific and general coping skills. Addictive Behaviors 32: 1669-1680.
  80. Hasking P, Lyvers M, Carlopio C (2011) The relationship between coping strategies, alcohol expectancies, drinking motives and drinking behaviour. Addictive behav-iors 36: 479-487.
  81. Anderson KG, Ramo DE, Brown SA (2006) Life stress, coping and comorbid youth: An examination of the stress-vulnerability model for substance relapse. J Psychoactive Drugs 38: 255-262.
  82. Hruska B, Fallon W, Spoonster E, Sledjeski EM, Delahanty DL (2011) Alcohol use disorder history moderates the relationship between avoidance coping and posttraumatic stress symptoms. Psychol Addict Behav 25: 405-414.
  83. Kiluk BD, Nich C, Carroll KM (2011) Relationship of cognitive function and the acquisition of coping skills in computer assisted treatment for substance use disorders. Drug Alcohol Depend 114: 169-176.
  84. Marquez-Arrico JE, Benaiges I, Adan A (2015) Strategies to cope with treatment in substance use disorder male patients with and without schizophrenia. Psychiatry Research 228: 752-759.
  85. Little RJA (1988) A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association 83: 1198-1202.
  86. Muthén B, Kaplan D (1985) A comparison of some methodologies for the factor analysis of non?normal Likert variables. British Journal of Mathematical and Statistical Psy-chology 38: 171-189.
  87. Muthén B, Kaplan D (1992) A comparison of some methodologies for the factor analysis of non?normal likert variables: A note on the size of the model. British Journal of Mathematical and Statistical Psychology 45: 19-30.

Citation: Valdés-Sánchez N (2020) Developing Illness Awareness and Self-Agency of Addicted Patients to Predict Risk Situations and Reduce Relapse. J Addict Addictv Disord 7: 37.

Copyright: © 2020  Nelson Valdés-Sánchez, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Herald Scholarly Open Access is a leading, internationally publishing house in the fields of Sciences. Our mission is to provide an access to knowledge globally.

© 2023, Copyrights Herald Scholarly Open Access. All Rights Reserved!