Attempted cessation of heroin use among men approaching mid-life

Aims: To analyse the reasons for ceasing or continuing heroin use in mid-life and examine the contribution of drug treatment and social factors to this process. Methods: A semi-structured qualitative interview discussing drug-using history was conducted with Glasgow men who had previously received treatment for drug problems. Findings: Successful cessation occurred after repeated attempts and repeated treatments, often in the context of major life changes. Relapse occurred because of quitting without adequate mental preparation; returning to old haunts and life circumstances, life difficulties, the tedium of a life without heroin, and inability to cope with normal emotions previously blocked by heroin use. Men's lives could be understood as a set of tensions between the deviant subculture of heroin injecting and the conventional neighbourhood. The balance of these tensions affected men's behaviour and generally there needed to be both a push away from the subculture and a pull towards the neighbourhood for long-term cessation to occur. Conclusions: Treatment of heroin dependence may be better regarded as the management of a chronic problem, rather than as a single intervention with a quantifiable outcome. Treatment needs to consider both the benefits and problems of heroin use and the benefits and problems of conventional living.