Responding to location-based triggers of cravings to return to substance use: A qualitative study.

Introduction: Individuals with substance use disorders face many challenges in establishing and maintaining recovery, most notably from contextual factors such as people, locations, events, emotions, and other triggers of cravings that could spark return to use. We sought to understand how individuals experience and cope with locations as triggers.

Methods: We conducted 31 semi-structured in-depth interviews with individuals who had recently been in substance use treatment and reported problem levels of alcohol and opioid use according to screening instruments. Interviews were designed to explore how individuals experience location-based triggers. We coded these interviews according to concepts outlined in Marlatt and Gordon's cognitive behavioral model and used thematic analysis to generate themes in participant experiences.

Results: We found that participants described triggers as interrelated and associated with multiple people, locations, events, or emotions. Participants commonly identified 'home' as a trigger, one that is particularly difficult to cope with. Participants most commonly employed avoidance as a coping strategy. Finally, participants described an expectation that substance use was associated with more time spent outside of 'home' while recovery was associated with limited travel and more time spent at home.

Conclusions: Location-based triggers represent a particularly challenging barrier to sustained substance use disorder recovery, partly due to the amorphous and interrelated nature of such triggers. The identification of 'home' as a primary trigger and common use of avoidance as a coping strategy suggest the need for additional recovery support and interventions. We plan to use these findings to develop and test an intervention promoting coping strategies.