The goal of this research is to understand relapse to heroin use in methadone-maintenance patients. Intravenous heroin use is a high-risk behavior for transmission of the human immunodeficiency virus (HIV). Methadone maintenance, while effective in reducing intravenous drug use and needle-sharing, does not prevent some patients from lapsing to these behaviors. Variables that predict lapses to heroin use should be identified so that innovative interventions can be developed. The proposed study replicates and extends our earlier work on prediction of relapse. One previous study focused on treated alcoholics, cigarette smokers, and detoxified opiate users (N= 221). In a second project, we studied cocaine treatment patients (N= 104). Important contributions of the earlier work are both theoretical and methodological. They include (a) determination of the importance of commitment to abstinence, social support, and positive moods in predicting continued abstinence, independent of drug of abuse; and (b) design refinements that allow comparison of prospective and retrospective data in the prediction of relapse. These comparisons suggest that retrospective data about relapse may not be valid because a lapse distorts subsequent self-report. In the proposed study, more frequent assessments will allow fine-grained prospective prediction of drug use. Subjects will be 186 exheroin-users in methadone-maintenance treatment who, according to program data, have been abstinent from heroin for 60 days. During a baseline month, potential subjects' urines will be screened twice weekly for heroin and cocaine. Patients who maintain abstinence from these drugs will enter the study and be assessed twice weekly for three months. Predictors include commitment to abstinence, social support, psychiatric diagnosis, psychological symptoms, stress, positive and negative moods, withdrawal symptoms, optimism, coping with temptation, positively reinforcing nondrug activities, and cocaine use. The outcome variable is lapse to heroin use. Besides self-reports, subjects will provide urine specimens at each assessment for confirmation of abstinence. All subjects will be reassessed at six months. The study findings are expected to lead to more powerful interventions for preventing relapse to heroin use in methadone-maintenance patients. The findings will also contribute to a model of relapse applicable across the addictions.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
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Drug Abuse Clinical and Behavioral Research Review Committee (DACB)
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University of California San Francisco
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Wasserman, D A; Korcha, R; Havassy, B E et al. (1999) Detection of illicit opioid and cocaine use in methadone maintenance treatment. Am J Drug Alcohol Abuse 25:561-71
Wasserman, D A; Weinstein, M G; Havassy, B E et al. (1998) Factors associated with lapses to heroin use during methadone maintenance. Drug Alcohol Depend 52:183-92
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