Heroin Addiction and Predictors of Relapse

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: Dennis Lee, MD

TV shows sometimes spark strong public interest in medical topics. The popular ABC drama series "Lost" has millions of viewers speculating about the character Charlie Pace, a recovered heroin addict. When tempted with a stash of the drug hidden in porcelain statues, will he relapse or won't he? Is there any way to tell which addicts are at greatest risk for relapse?

Heroin (diacetylmorphine) is a derivative of the painkiller morphine and is the most commonly abused of the so-called opiate drugs. Heroin abuse peaked during the 1960s and gradually declined in the U.S. during the following two decades as the dangers of this drug became more apparent and the use of other drugs, especially cocaine, was on the rise. The 1990s, however, ushered in another period of increased heroin use. A survey conducted in 1998 (the National Household Survey on Drug Abuse) revealed that an estimated 2.4 million people in the U.S. had used heroin at some point in their lives.

Heroin and other opiates act on specific molecules in the brain (receptors) which lead to the sedative, euphoric, and analgesic effects of the drugs. After a dose of heroin, its action lasts for about four to five hours. A person can develop tolerance to the effects of opiate drugs and therefore requires greater and greater doses of the drug to achieve an effect. Physical dependence upon the drug can occur after one to two weeks of daily use. Heroin addicts are always at risk for overdose leading to death, and severe withdrawal symptoms occur when use of the drug is discontinued.

Despite the availability of treatment programs (using pharmacological agents as well as psychotherapy and hospitalization) for heroin addicts, relapse is a dangerous possibility for anyone who has ever been dependent upon the drug. Studies of addicts in the early 1970s showed dismal outcomes, with over half of addicts relapsing within three months after treatment ended, and a majority relapsing within the first six months after treatment. Although relapse prevention programs were strengthened as a result of these outcomes, relapse remains a constant risk.

Experts note that certain life situations and psychosocial factors can be associated with an increased risk for relapse in heroin addicts. These include:

  • Psychological stress - Many doctors feel that stress is the number one predictor of relapse in drug addicts. In a study of opiate addicts, high levels of stress were strongly predictive of continued drug use. Studies with animals have also confirmed that stress can lead to relapse of drug-seeking behavior.
  • Negative emotional states, including depression
  • Interpersonal problems
  • Lack of social support
  • Poor coping efforts
  • Decreased commitment to abstinence

How likely is it that an individual addict will relapse? There's no formula that will definitively tell, but experiencing one or more of the above states increases relapse risk. Likewise, after a relapse, the prognosis (outcome) for a given individual varies, dependent upon their levels of social support along with the availability of, and willingness to participate in, addiction treatment programs.

For more information, please see the following information:

Reference: Stress and Substance Abuse: A Special Report, U.S. NIDA (National Institute on Drug Abuse), accessed 2/10/2006.


Last Editorial Review: 2/13/2006



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