title: Characterizing durations of heroin abstinence in the California Civil Addict Program: results from a 33-year observational cohort study.
abstract: In accordance with the chronic disease model of opioid dependence, cessation is often observed as a longitudinal process rather than a discrete endpoint. We aimed to characterize and identify predictors of periods of heroin abstinence in the natural history of recovery from opioid dependence. Data were collected on participants from California who were enrolled in the Civil Addict Program from 1962 onward by use of a natural history interview. Multivariate regression using proportional hazards frailty models was applied to identify independent predictors and correlates of repeated abstinence episode durations. Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year. Multivariate analysis revealed several important findings. First, demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. However, employment and lower drug use severity predicted longer episodes. Second, abstinence durations were longer following sustained treatment versus incarceration. Third, individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes. Finally, abstinence episodes initiated >10 and ≤20 years after first use lasted longer than others. Public policy facilitating engagement of opioid-dependent individuals in maintenance-oriented drug treatment and employment is recommended to achieve and sustain opioid abstinence.
authors: University of California, Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA 90025, USA.
authors: Bohdan
authors: B
authors: Nosyk
authors: M Douglas
authors: MD
authors: Anglin
authors: Mary-Lynn
authors: ML
authors: Brecht
authors: Viviane Dias
authors: VD
authors: Lima
authors: Yih-Ing
authors: YI
authors: Hser
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult