Five years after: The process of long-term abstinence from heroin use among ex-offenders.

摘要

The DSM-IV-TR reports that only 20-30% of individuals meeting criteria for heroin dependence are able to successfully maintain long-term abstinence. These high relapse rates are problematic because heroin use is inexorably linked to crime, and its intravenous use is associated with high rates of hepatitis, HIV and other infectious diseases. The process of long-term abstinence from heroin has not been studied in detail, especially among ex-offenders. Using an analytical approach grounded in the study data, this dissertation analyzes and describes the process of maintaining abstinence from heroin use and the connection between sustained abstinence and desistance from criminal behaviors. Alternate coping strategies employed by a sample of former heroin using ex-offenders to maintain their recovery efforts are examined. The study explores how heroin-seeking roles were modified or substituted during the recovery period and considers subsequent effects on desistance from criminal activities. A total of twenty-five individuals (15 males and 10 females) were interviewed for this study. They met the following eligibility criteria: they were former heroin users who when active, used the drug on an almost daily basis for at least a year, encountered some type of involvement with the criminal justice system (arrest or conviction) directly or indirectly related to their heroin use and have maintained abstinence from heroin use for a period of five years or longer. In-depth semi-structured conversational interviews were conducted eliciting information from various domains including drug use histories, criminal behaviors, employment, education and health status. Data analyses suggest that prior treatment experiences while helpful, may not be sufficient in addressing relapse triggers and maintaining prolonged abstinence. Key motivating factors in facilitating sustained long-term recovery efforts include a redefinition of self-identity and respect, religion/spirituality, familial interaction and a strong peer support network. In addition, the study reveals the process of agency and ownership the participants demonstrate to facilitate their successes. The findings suggest that re-entry programs and policies should help ex-offenders overcome the struggles associated with sustained long-term abstinence by supporting the various coping strategies that they themselves find to be particularly valuable. The theoretical, methodological and policy implications of this research are examined.