Long-Term Study Gives Grim Picture of Heroin Addiction

In a rare, long-term study of heroin addiction that spans nearly a quarter of a century, UCLA researchers have found that the average age of death for frequent users of the drug is 40, and that those who do not quit by their late 30s are unlikely ever to stop.

The 24-year-long study, reported in today’s issue of the Archives of General Psychiatry, is one of the few extended examinations of the cycle of heroin addiction. It found that active heroin users consistently reported higher rates of unemployment, arrest, incarceration and cigarette smoking than those who no longer use the drug.

Although such findings are not particularly surprising, experts say they provide important insight for those who are trying to develop treatment programs for addicts--most of whom refuse to get help voluntarily.

“One of the things that has been very badly missing in this field has been long-term follow-ups, and this study helps fill that gap,” said Herbert Kleber, executive vice president of Columbia University’s Center on Addiction and Substance Abuse. “This study highlights the need to improve our treatment methods and our ability to get into treatment those who are resistant to it.”

The UCLA study followed 581 male heroin addicts who between 1962 and 1964 were committed by court order to the California Civil Addict Program, a compulsory drug treatment program. The average age at the time of admission was 25; more than 80% of those admitted had been arrested by the age of 18. Nearly half of those arrests were attributed to drug-related charges.

The study was conducted against the backdrop of three very different decades of drug policy in the United States. During the 1960s, the standard approach was through the criminal justice system and efforts such as the Civil Addict Program. During the 1970s, that gave way to community-based drug treatment programs, many of which were dismantled during the 1980s.

The researchers analyzed death certificates, incarceration records and urine test results, and also interviewed study subjects twice, once in the mid-1970s and again in the mid-1980s. Another follow-up set of interviews is planned for 1995 and 1996, according to Douglas Anglin, the UCLA psychiatry professor who was the principal investigator for the study.

The researchers have found that:

* In 1986, when the second round of interviews concluded and the average age of study participants was 47.5 years, 28% of the original study subjects were dead; 11% were incarcerated; 7% said they were still using heroin on a daily basis; 6% were in methadone treatment programs; 10% used the drug occasionally; 22% were abstinent, and the rest could not be tracked down.

* One hundred sixty-one addicts died during the study period. Of those deaths, 32% were attributed to drug overdose, quite often involving drugs other than heroin or combinations of drugs. Twenty-nine percent were due to homicide, suicide or accidents, typically involving violence. The remainder, 39%, were linked to alcohol, smoking or other causes.

* Addicts were more likely to die if they were disabled, were frequently involved in crime, or used alcohol and tobacco excessively over a long period of time.

* Although those addicts interviewed during the 1980s were concerned about exposure to the AIDS virus, which can be transmitted through the sharing of unclean needles, they nonetheless told investigators that they were sharing needles more frequently than in the past.

Anglin said the findings suggest that although treatment works, most addicts have psychological and social problems beyond their addiction that make it difficult for them to seek treatment or stop using the drug on their own. He said treatment programs must include housing, medical care, job training and education if they are to be successful.

“It is not like the clap, where you can get 10 days of penicillin and cure 98% of the cases,” Anglin said. “You’re talking about people who come from disadvantaged backgrounds, families with alcoholism, criminal behavior.

“You’re talking about people who started getting involved with drugs in their adolescence. It interrupted their education, their socialization. So when these people come into treatment, it’s not just a drug use problem, it’s a whole person problem.”

Kleber said heroin use in the United State peaked in the mid-1970s, began to drop after that and then rose again in the late 1980s. Current estimates are that 600,000 to 750,000 Americans--less than three-tenths of 1% of the total population--use heroin frequently.