title: Mapping heroin careers: utilising a standardised history-taking method to assess the speed of escalation of heroin using careers in a treatment-seeking cohort.
abstract: OBJECTIVE
  Although there has been increasing research attention to the concept of addiction careers and treatment careers, there are few standardised measures for assessing illicit drug using careers. A new instrument for mapping lifetime drug use history (LDUH) was used to assess transitions in the initial stages of heroin use careers among illicit drug users.
  
  
  METHODS
  58 lifetime heroin users completed a one-off researcher-administered interview in treatment settings in two English cities, London and Birmingham, about their histories of drug use, drug treatment and other key life events.
  
  
  RESULTS
  The sample reported initiating heroin use at a mean age of 21 years and escalated to daily use by 23 years. On average, there was a gap of nearly 8 years before seeking treatment and at the time of interview the cohort averaged one-third of their heroin careers in treatment. However, there was marked variability across the group, with three discernible groups identified based on use patterns. While one group (n = 21) showed consistent escalation in total quantity of heroin used across the first year, the second group had an intermittent pattern of use and the third group reported an unchanging monthly heroin use pattern. These groups differed in the time taken to initiate treatment and in the proportion of their heroin careers in active use.
  
  
  CONCLUSIONS
  The instrument was acceptable to research participants and identified important variability in onset and escalation factors in heroin careers. The implications for therapeutic interventions and for clinical use of the instrument are discussed.
authors.affiliation: University of Birmingham Department of Psychiatry, Queen Elizabeth Psychiatric Hospital, Edgbaston, Birmingham, UK. d.w.best@bham.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Best
authors.forename: Ed
authors.initials: E
authors.lastname: Day
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cantillano
authors.forename: Romina Lopez
authors.initials: RL
authors.lastname: Gaston
authors.forename: Angela
authors.initials: A
authors.lastname: Nambamali
authors.forename: Ruth
authors.initials: R
authors.lastname: Sweeting
authors.forename: Francis
authors.initials: F
authors.lastname: Keaney
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006556:Heroin Dependence / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology