A 33-year follow-up of narcotics addicts

Background: This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. Methods: The sample was composed of 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin-dependent criminal o ffenders. This 33-year follow-up study updates information previously obtai ned from admission records and 2 face-to-face interviews conducted in 1974- 1975 and 1985-1986; in 1996-1997, at the latest follow-up, 284 were dead an d 242 were interviewed. Results: In 1996-1997, the mean age of the 242 interviewed subjects was 57. 4 years. Age, disability, years since first heroin use, and heavy alcohol u se were significant correlates of mortality. Of the 242 interviewed subject s, 20.7% tested positive for heroin (with additional 9.5%;, urine refusal a nd 14.0% incarceration, for whom urinalyses were unavailable), 66.9% report ed tobacco use, 22.1% were daily alcohol drinkers, and many reported illici t drug use (eg, past-year heroin use was 40.5%; marijuana, 35.5%; cocaine, 19.4%, crack, 10.3%; amphetamine, 11.6%). The group also reported high rate s of health problems, mental health problems, and criminal justice system i nvolvement. Long-term heroin abstinence was associated with less criminalit y, morbidity, psychological distress, and higher employment. Conclusions: While the number of deaths increased steadily over time, heroi n use patterns were remarkably stable for the group as a whole. For some, h eroin addiction has been a lifelong condition associated with severe health and social consequences.