Strategies for avoiding relapse to heroin use: A qualitative investigation

Objectives: Extensive studies have examined relapse occurrences among heroin users. Fewer reports have looked at the patterns of successful heroin cessation. Our aim was to document how former heroin users have sustained cessation. Methods: In-depth interviews, focused on drug use history and heroin cessation, were conducted with 15 former and 7 current heroin users. Interviews were audiotaped, transcribed, and coded using pre-identified and emerging themes and then analyzed using standard qualitative methods. Results: Participants were primarily male (59%), Black or Latino (96%) with a mean age of 39. Half the sample did not have a HS diploma/GED; and 33% were homeless. To avoid relapse most participants sought support from non-drug using friends and family, group meetings, and drug treatment counselors. Many participants spent more time with their children and almost all reported purposely avoiding heroin users. To resist cravings individuals employed a range of constructive and recreational activities, including exercise, school, and job training. Some participants used other drugs including cocaine, marijuana and cigarettes to deal with cravings, and over half the sample was on methadone. The harsh memories of the difficulties associated with life while using heroin helped several participants refrain from relapse. Wanting to be a role model for their children and acceptance by family was a strong motivator to stay clean. Discussion: Strengthening relations with social networks, especially family, and engagement in socially productive and physically intense activities were recurrent motivators for sustained cessation. Emphasizing these factors in drug treatment programs could promote heroin cessation among users.