Perhaps the most important finding from this study is that so few injection drug users were able to resolve their addiction. While 71 percent did experience some period of abstinence, most took up the practice of injecting drugs again. Only 19.6 percent succeeded in ceasing injection drug use completely during the study.
A younger age at enrollment, especially being younger than 30 years, was significantly associated with cessation of drug use or with cessation followed by relapse. Women were more likely than men to stop using injected drugs.
A total of 29 percent of the study population remained persistent drug users, the authors report. Fourteen percent relapsed once during the study period, and 37 percent relapsed at least twice.
The scientists say their data show that the average time to first relapse is 10–18 months. They suggest that intervention efforts should continue throughout this critical period to support injection drug users who try to overcome their addiction.
Study participants in all four groups—persistent drug users, those who ceased drug use completely, those who relapsed once and continued using drugs, and those who had multiple relapses—could not be differentiated by educational level, marital status, and the presence of dependent children, the authors report.
Only a history of incarceration differentiated people who successfully stopped using injection drugs from those who continued to use them. However, the scientists also report that daily use of alcohol was strongly associated with persistent injection drug use.
Participants who relapsed once were younger than persistent drug users. These male participants also were 4 times more likely to report engaging in homosexual sex.
The highest mortality rates were seen in the persistent drug users. The principal causes of death were overdose, violence, AIDS, and other infections.
Patterns noted in the study are consistent with the view of drug addiction as a chronic disease, the researchers say. The data presented emphasize the need to develop and make available effective cessation programs for people who use injection drugs to prevent adverse health and social outcomes.
The NIDA-funded study by Dr. Noya Galai and colleagues was published in the October 1, 2003 issue of the American Journal of Epidemiology.
