Promoting Factors to Relapse among Drug Addicts: A Review

The problem of drug addiction in the community is not a new problem in our country, even in other countries. This statement is proven by statistics released by the National Anti-Drug Agency (AADK) which show inconsistent readings over the five years starting from 2015 to 2019 which is worrying if these cases continue to increase in the future. Therefore, this study was conducted with the aim of studying and finding out the main factors of relapse among former drug addicts. The research method used is the Schematic Review method which is by identifying 51 articles related to the study through electronic materials such as computers and then analyzing the title and abstract and using 24 articles to make article reviews. This study carried out a comprehensive review of past scientific articles and journals related to relapse published from 2017 to 2022. Through the results of reading past studies it can be seen that there are various factors that cause relapse to occur and the most dominant factors are identified after analysis is a personal factor that encourages relapse behavior. Therefore, through this study the researcher can state steps and methods to improve treatment and rehabilitation programs in agencies and communities in order to curb the issue of relapse in Malaysia.


Introduction
Drug addiction in the community is no longer a problem unique to our nation. In fact, this issue, which has an adverse effect on society, affects the entire nation. In response to the issue, the National Anti-Drug Agency (AADK), a division of the Ministry of Home Affairs, was established to address it. This organisation is in charge of creating regional and worldwide collaboration, conducting programmes for prevention, treatment, and rehabilitation, and assessing the program's effectiveness (Nurhazlina et al., 2019). Table 1 shows the statistical reading of relapse cases in Malaysia starting from 2015 to 2019. According to the statistical data that AADK has published for the period of 2015 to 2019 showing inconsistent readings over the five years due to numerous risk factors that lead to relapse. This demonstrates why the issue of ongoing addiction (relapse) needs to be highlighted.
Depending on the person's tolerance for drug withdrawal symptoms, relapse is the usage or re-addiction of drugs by a former drug addict after following a prevention and rehabilitation treatment programme. Relapse, according to Rasmussen (2000), is the resumption of drug use following a period of abstinence and depends on the user's tolerance for withdrawal symptoms. Regardless of the individual's age, rank, degree, level of education, race, or gender, the phenomenon around this topic has persisted throughout many societal strata. Drug addiction can be harmful to a person's physical, mental, emotional, spiritual, and spiritual well-being, among other things. Due to the drug's potent effects on the human body system, relapses will injure the patient and result in issues that may even be fatal. As a result, depending on this circumstance, the efficiency of the programmes and modules put in place by the agency to combat addicts may be noticed. For an addict to develop his identity and prevent relapse, the implementation of the treatment and rehabilitation programme of trainees is crucial.
By reducing the amount of pain and suffering that clients endure, the agency's services will be able to assist them enhance the quality of their lives. Therefore, it is important to emphasise the program's level of success in order to stop relapse among former addicts who have finished their treatment and recovery. In order to increase the efficiency of the agency's programmes and lessen the problem of relapse or repeated use of illicit substances, a study was done to identify the causes and variables that lead former drug addicts to relapse.

Methodology
The review of this article is carried out by using a systematic process by searching for material such as previous articles using electronic search that is a computer to access all journals and articles related to the study title which is about the factors of relapse or repetition of drug addiction in Malaysia published from 2017 to 2022 This study began by collecting information from the publication of valid and high-impact scientific materials by using searches on the internet such as Researchgate, Semantic Scholar as well as various searches through 'Google'. Searching for information on Google is by typing various words related to the study either separately or combined: relapse, relapse factors, drug relapse factors in Malaysia, illicit substance addiction, repeated addiction, relapse addicts, relapse prevention and Malaysian relapse. All research from various publications between 2017 and 2022, which studied the issue of relapse and repetition of illicit substance addiction in Malaysia using various research methods according to the researcher were included in the review. A total of 51 articles were successfully found and collected and then analyzed in more detail by looking at the title and abstract of the study. The final article selection review will be done based on the inclusion criteria and exclusion criteria as stated in the diagram below. A total of 24 studies were selected for a more detailed article review. The inclusion criteria are (1) all studies on the repetition of addiction or relapse in Malaysia, (2) Studies that explain the factors and reasons for relapse, (3) All research designs, (4) Publication of articles between the years 2017 to 2022 and (5) All studies are in Malay and English. Meanwhile, the exclusion criteria are (1) All unverified studies and (2) Studies that do not have items studied. The research strategy used in the review is illustrated in Figure 1.

Result and Discussion
The results of the publication of the selected articles have been reviewed and analyzed to show relapse factors in various studies that obtain different results for each article according to several researcher criteria such as the scope of the researcher's area, the number of respondents/trainees studied and the target group. Although most studies use a range of diverse research methodologies, research scopes, and geographical regions, they all share similar research methods and designs. There has been a lot of domestic and international study on relapse that focuses on the causes of the issue of persistent addiction (Relapse). Relapse is an act of taking or using drugs again after stopping using them for a period that depends on a person's resistance against drug withdrawal syndrome (Azizul et al., 2018).
Drug withdrawal syndrome affects the physical and mental health of an individual who stops taking a substance, especially a drug that causes the individual to return to addiction or relapse. According to Marlatt & Gardon (1985) states that relapse begins with a factor called "High Risk Situation". High-risk situations have a high influence on a former addict to return to drug addiction (Ibrahim et al., 2012). The study conducted by Idris et al (2020) in the title of the study entitled the factors to prevent relapse phenomenon among drug users says that the majority of respondents involved in the study This is in a condition called 'high risk situation' for relapses. Table 2 is a list of articles that obtained the highest dominant percentage that studied relapse factors from different studies based on different data structures and study goals. Among the main factors are negative emotional situations such as anger and anxiety, interpersonal conflict situations such as disagreements between families and communities, and social pressure.
Azizul (2018) 7 The importance of social support in strengthening social control of ex-drug users: A literature review.
The factors are the feeling of curiosity or wanting to try, the influence of peers or friends, wanting fun, there are drug suppliers, label problems, stimulation, resisting illness and body resistance, fun, not having a job, emotional or The factor that can be seen through this study is the personal factor. Jaidin (2020) mental stress , addiction, selfwill, withdrawal problems, wanting to experience different drugs, forgetting problems, disappointed in life, low drug prices, no motivation and encouragement to change, lack of parental education, lack of religious knowledge, choosing a free way of life, becoming a dealer, programs recovery is less effective. 8 Substance dependence issues and treatment in South Africa: voices of repeat voluntary service users.
The cause of relapse is due to lack of self-motivation, stigmatization and lack of reintegration, lack of postrehabilitation care programs, socioeconomic conditions, poor social support, addiction, psychological factors.

Self-factors External factors Psychological factors
Mkhize et al (2021) 9 The concept of selfcontrol and quality of life to prevent drug addiction relapse among prisoners.
Addiction symptoms are associated with poor selfcontrol factors and put themselves in a high-risk situation for relapse.

The addictive factor itself
Aziz et al (2021)   10 Profile and level of selfesteem of repeat addicts among people under supervision (OKP) in IPD Tangkak, Johor, Malaysia.
Relapse occurs because there is a crisis of self-esteem in the OKP person who experiences confusion and overreacts as a result of not being able to think clearly, not being able to manage feelings and emotions, having difficulty remembering things, feeling confused, not being able to control stress and getting angry easily.
Self-factor Hussin et al (2020) 11 High-risk situations of propensity to relapse among ex-addicts: a descriptive analysis. Based on Table 2, which includes some prior studies conducted between 2006 and 2021, the greatest proportion of study outcomes is shown to be 45.83%. According to the study's goals, the researcher used the right methodologies to perform this investigation on the problem of ongoing addiction or relapse in Malaysia. Re-Addiction Behavior Causes of Addiction and Spiritual Recovery is an article by (Mohamed, 2006). on relapse research. According to Islamic Perspective, people who lack a strong sense of identity and mental stamina are more likely to relapse. An ex-addict faces a high risk after leaving a Centre for treatment and recovery. Next, a study conducted by Baba et al (2018) in an article titled Factors Contributing to the Tendency to High-Risk Situations Among Repeated Drug Addicts in Malaysia states that negative emotions in former addicts. This statement is also supported by a study conducted by Razali et al (2021) who found that negative emotions cause individuals to relapse.
The results of the earlier study on relapse by Idris et al (2020), titled Factors to prevent the phenomena of relapse among drug users, indicated that the primary cause of recurrence is the drug users themselves. Likewise, with studies conducted by Azizul (2018) (2020) states that the main cause of relapse is personal factors. An absence of identity and a strong sense of self-will will cause the person to relapse. Next is a prior study by Amat et al (2020) titled Relapse Among Drug Addicts on the East Coast of Malaysia: A Qualitative Study of Risk Factors, the findings of which indicate that the primary risk factor for relapse is an internal factor, namely oneself. Additionally, a study by Mokhtar et al (2019) shown that the age factor has a role in the relapse factor. His study's findings showed that older people increase the likelihood of drug addicts relapsing. Table 3 shows the second highest relapse factor which recorded a percentage of 16.67%. This article is from several previous studies that have been conducted on the behavior of repeat addicts in the range of 2018 to 2022. The results of this study show that the dominant factor in the relapse of former drug addicts who have completed treatment and rehabilitation at the agency is environmental factors and peer factors which each recorded the same percentage. Recidivism factors and coping strategies among community surveillance cases.
Factors of relapse are the influence of peers as many as 25 people (29%) and self-attitude as many as 21 subjects (24%).
Peer factor Self-factors.

Shanmugam (2018)
A study conducted by Azmi et al (2018) states in his study entitled Drug Addicts: Psychosocial Factors Contributing to Relapse that the main factor in relapse is due to psychosocial factors. The objective of his study is to examine four psychosocial perspectives of relapsed individuals, namely in terms of self-efficacy, peer support, family support and community support.  Table 4 shows about the relapse factor article, which from 2016 to 2021 showed a percentage of 8.33%. According to the study's findings from the cited articles, family circumstances and a lack of appreciation for religion are the major factor or main cause of relapse. According to a prior study, Family Support and Relapse Addiction Tendency among Drug Addicts, conducted by Azmi et al (2016), the relapse factor is caused by the family's lack of support, which puts pressure on the individual ex-addict. The main factors that because relapse are weakness from the point of view of religious appreciation, the family is unable to help them and the felda environment is at a high risk of relapse.
Weakness of religious appreciation, family unable to help, high risk felda environment. Said et al (2021) 4 Religious well-being among former drug users (BPD) to reduce the risk of drug relapse.
The study found that the higher the influence of religious well-being (RWB), the lower the risk of drug relapse (KPD).
Weak religious influence factor.
Ariffin (2017) The results of this study are also supported by Azizul et al., (2018) in his study titled External Factors of Relapse among Adult Male Addicts at the Cure and Care Service Centre, Kuala Pilah which states that family factors cause relapse to occur. Next is an article that states the weak factor in religious appreciation that causes relapse, which is in a study conducted by Said et al (2021)  A study by Nasir et al (2020) titled Risk Factors for Drug Relapse Behavior among Female Trainees at Cure and Care Rehabilitation Center stated that the risk factor for relapse is because of work issues that lead to relapse to occur. Table 5 shows that the employment factor is the main factor for ex-drug addicts to relapse, which recorded the lowest percentage of 4.17%. They feel emotional stress as a result of the effects of their work challenges.  Nasir et al (2020) Referring to the results of discussion of previous articles and studies on the problem of relapse or repetition of illicit substance addiction, it can be seen that every former drug addict who has completed the treatment and rehabilitation process at the agency is at a high risk of relapse. This is due to various factors that can influence their behavior such as external and internal factors. The results of the reading and analysis of the article found that the most dominant factor of relapse is based on the personal factor which recorded the highest percentage of 45.83%. This situation can be seen that a strong identity is very important and needs to be applied from the beginning of the recovery process.
Next is the second highest percentage which is 16.67% which is environmental factors and peer factors because the result of stigma and labels by society and family members will have an impact of social pressure on their internal factors which is themselves. As for the lowest factor based on the results of the analysis of this article, it was found that the employment factor is the lowest which is 4.17%. Therefore, it can be known that all relapse factors are different according to individuals and geography and the target group of researchers (

Conclusion
The problem of collection is a problem that needs to be emphasized by all parties, whether government agencies or non-government agencies (NGOs) to ensure that the relapse collection statistics show a decrease from year to year. Therefore, the issue of postrehabilitation care needs to be given deep attention so that each individual ex-addict does not fall back into addiction. Through the results of the analysis of each article on relapse, it can be identified that the personal factor is the most dominant factor in the recurrence of addiction. Therefore, related parties, especially AADK, need to focus more and identify prevention programs that are more suitable based on the factors that have been identified. A more appropriate relapse prevention measure is to do Cognitive Behavioral Therapy which needs to be done in 7 steps for former drug addicts. (1) Identifying the level of individual motivation, (2) Identifying risky situations, (3) Changing lifestyle, (4) Identifying the client's relapse process, (5) Identifying the situation where the client makes irrelevant decisions, (6) Cognitive factors related to relapse and (7) Management of risky situations. All these stages of therapy will be able to help ex-addicts to strengthen their identity and internal motivation so as not to relapse.