Table 2 Summary of themes, categories, and their alignment with research questions.

1. How do adults in Ethiopia experience relapse?

Peer exposure and indifference

Exposure to peers using substances and lack of personal accountability facilitate initial and repeated substance use.

Substance use and reuse as a leisure time activity

Using substances to occupy unstructured time or as recreational activity.

2. What factors influence relapse among adults in Ethiopia?

Individual level: Negative emotions

Emotional distress, cravings, and regret trigger relapse.

Individual level: Loneliness

Feelings of isolation increase vulnerability to substance use.

Individual level: Lack of self-confidence

Low self-efficacy and fear of social judgment lead to relapse.

Environmental level: Social environment

Peer influence, family interactions, and social gatherings affect relapse risk.

Environmental level: Physical environment

Accessibility of substances and exposure to previous substance-use locations trigger relapse.

Periodic unemployment

Job loss or economic instability increases stress and relapse risk.

3. What coping strategies are effective for adults experiencing relapse in Ethiopia?

Self-motivation and fighting negative emotions

Intrinsic motivation and cognitive strategies help maintain abstinence.

Modifying the physical environment

Avoiding high-risk locations reduces relapse risk.

Establishing supportive social systems

Family, peers, and professional support aid recovery.

Obtaining mental strength and planning for future living

Psychological resilience and structured life planning mitigate relapse.

Spiritual healings and learning

Engagement in religious or spiritual practices provides cognitive diversion and emotional support.