With lifelong abstinence difficult to achieve, researchers urge incremental treatment goals
A 33-year study of heroin addicts by UCLA researchers details the severe personal and social consequences of dependence on the drug, and the heavy odds against permanent abstinence from heroin by long-term addicts. With lifelong abstinence difficult to achieve, the researchers urge a greater emphasis on incremental treatment goals for heroin addicts.
"For many heroin addicts, dependence on the drug has become a lifelong condition associated with severe health and social consequences," said Yih-Ing Hser, adjunct professor at UCLA's Neuropsychiatric Institute and the study's principal investigator. "These findings suggest that drug abuse treatment programs should focus more on incremental improvements in the lives of heroin addicts, a more realistic goal than lifelong abstinence. Treatment programs also need to consider the social and physical health needs of older adults with addictions."
The study, published in the May edition of the peer-reviewed Archives of General Psychiatry, is the third follow-up of a group of 581 male heroin addicts committed by the courts to the California Civil Addict Program between 1962 and 1964 at an average age of 25.4 years. At the time of the most recent follow-up, in 1996-97, 284 of the original group were dead, and 242 were interviewed. The mean age at interview was 57.4 years.
Of those interviewed, 20.7 percent tested positive for heroin (9.5 percent refused testing and 14 percent were incarcerated and unavailable for testing), 66.9 percent reported current tobacco use and 22.1 percent drank alcoholic beverages daily. Many also reported illegal drug use in the past year: 40.5 percent reported using heroin, 35.5 percent marijuana, 19.4 percent cocaine, 10.3 percent crack cocaine and 11.6 percent amphetamines.
The group also reported high rates of health problems, mental health problems and criminal activity. Long-term heroin abstinence - five consecutive years or longer - was achieved by 46.7 percent of the group, and was significantly associated with lower rates of criminal behavior, morbidity, and psychological distress, and with higher rates of employment.
The study was funded by a grant from the National Institute on Drug Abuse (NIDA). Dr. Alan I. Leshner, director of NIDA, noted the low level of participation in methadone maintenance among study subjects.
"Although assessing treatment effectiveness was not the intent of this study, it is worth noting that while methadone maintenance (MM) was effective in reducing heroin use in this population, fewer than 10 percent of the sample were in a MM program in any given year," Leshner said. "It would appear that greater access to such treatment could prevent much of the human suffering and economic losses associated with heroin addiction."
Among other findings:
¬∑ Overall, the group showed remarkably stable use patterns since the 1985-86 follow-up, demonstrating that reaching long-term abstinence from heroin use is a very slow process.
¬∑ A minimum of five years of heroin abstinence considerably reduced the likelihood of future relapse, but even after 15 years of abstinence a quarter still relapsed, suggesting that for some individuals heroin dependency becomes a lifelong affliction.
¬∑ The overall high mortality rate (48.9 percent) among study participants demonstrates the severe consequences of heroin use and, possibly, related factors such as heavy drinking and criminal lifestyle. The most common cause of death was overdose, 21.6 percent.
¬∑ Public policies that ensure more stable funding for methadone maintenance or other opiates substitution therapy may improve long-term results for heroin addicts who enter treatment.
In addition to Hser, researchers involved in the study include M. Douglas Anglin, Christine E. Grella, and Valerie Hoffman, all from UCLA's Neuropsychiatric Institute.
The UCLA Neuropsychiatric Institute and Hospital together provide world-renowned leadership in the treatment of neuropsychiatric and behavioral disorders, in research to expand our knowledge of these common problems, and in education in the field of mental health.
Part of the National Institutes of Health in Bethesda, Md., NIDA is dedicated to bringing the power of science to bear on drug abuse and addiction.