Coping strategy as a predictor of illicit drug use among persons who inject drugs

Persons engaging in illicit drug use, particularly injection drug use, are often overlooked in resilience literature. Understanding factors that foster resilience within this population can support cessation from, and prevent relapse to, illicit drug use. We examined whether coping strategies are associated with short-term cessation and relapse among persons who have injected drugs.

Data come from a community-recruited cohort of people who have a history of injection drug use from Baltimore, Maryland. We examined two subsamples of visit pairs conducted from 1988 to 2020: (1) where at the first visit, participants reported past-6-month illicit drug use (684 participants, 8,783 visits), and (2) at the first visit, participants reported no past-6-month illicit drug use (516 participants, 7,872 visits). Logistic regression with generalized estimating equations was used to estimate the associations of 14 self-reported lifetime coping strategies with (1) short-term cessation and (2) relapse to illicit drug use.

Among persons reporting recent illicit drug use, self-reported use of substances to cope, denial, and behavioral disengagement were associated with decreased odds of short-term cessation, whereas use of prayer or meditation and emotional support were associated with increased odds of short-term cessation. Among persons reporting no recent illicit drug use, lifetime use of substances to cope, denial, and self-blame were associated with increased odds of relapse, whereas lifetime use of active coping was associated with decreased odds of relapse.

Findings demonstrate coping strategies that may be similarly and uniquely associated with short-term cessation from, versus relapse to, illicit drug use. (PsycInfo Database Record (c) 2026 APA, all rights reserved).