Understanding Prolonged Cessation from Heroin Use: Findings from a Community-Based Sample

Background: 

There is abundant literature describing heroin initiation, co-morbidities, and treatment. Few studies focus on cessation, examining the factors that motivate and facilitate it.

Methods: 

The CHANGE study utilized mixed methods to investigate heroin cessation among low-income New York City participants. This paper describes findings from qualitative interviews with 20 former and 11 current heroin users. Interviews focused on background and current activities, supports, drug history, cessation attempts, and motivators and facilitators to cessation. 

Results: 

Participants found motivation for cessation in improved quality of life, relationships, and fear of illness, incarceration and/or death. Sustained cessation required some combination of treatment, strategic avoidance of triggers, and engagement in alternative activities, including support groups, exercise, and faith-based practice. Several reported that progress toward goals served as motivators that increased confidence and facilitated cessation. Ultimatums were key motivators for some participants. Beyond that, they could not articulate factors that distinguished successful from unsuccessful cessation attempts, although data suggest that those who were successful could describe more individualized and concrete—rather than general—motivators and strategies. 

Conclusions: 

Our findings indicate that cessation may be facilitated by multifaceted and individualized strategies, suggesting a need for personal and comprehensive approaches to treatment.

...Drug History

Participants generally began substance use with alcohol and marijuana, then started using cocaine, heroin, and other drugs. Many participants were raised in homes where drugs were readily available, giving them repeated opportunities to experiment. Timothy¹ explained that he became addicted to heroin inadvertently, from using cocaine that had been—unbeknownst to him—mixed with heroin by his aunt.

I first started on marijuana at the age of 12. Cocaine, sniffing, at the age of 14; heroin I started at the age of 25. Okay. And drinking, the age of 9. (Timothy, former heroin user)

The mean age at first heroin use was 23 (range: 12-37), with no significant differences between former and relapsed users (Table 2). Several participants reported that they used drugs as an escape. Bill, adopted into an upper-middle-class home, reported general mistreatment and sexual abuse.

Because I was looking for a way to cope. I was looking for a way to deal. You know - I was looking for a way out of that misery. (Bill, former heroin user)

Most participants, however, described their early drug experiences in more positive terms, noting, for example, significant pleasure, diminished anxiety, and an expanded social network...

Full article at:   http://goo.gl/rxqHHy

By:   Linda Weiss Ph.D.^a*, Jonathon Gass M.P.H.^b, James E. EganM.P.H.^c, Danielle C. Ompad Ph.D.^d, Claudia Trezza M.P.H.^e &David Vlahov R.N., Ph.D.^f

• ^a Director, Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY
• ^b Project Director, Center for Evaluation and Applied Research, The New York Academy of Medicine, New York, NY
• ^c Pre-Doctoral Fellow, Department of Behavioral and Community Health Sciences School of Public Health, University of Pittsburgh, Pittsburgh, PA
• ^d Research Associate Professor, New York University, Steinhardt School of Culture, Education, and Human Development and the Center for Health, Identity, Behavior and Prevention Studies, New York, NY
• ^e Senior Research Associate, George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC
• ^f Dean and Professor, School of Nursing, University of California, San Francisco, CA

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