Understanding Heroin Addiction from the Life Course Perspective

Heroin and other opiate dependence is a disease that affects the user, interpersonal relationships, and the surrounding community. Due to societal stigmatization of heroin addiction, it can be difficult to help the wider community see the need for more effective intervention and prevention efforts. The purpose of this study was to better understand risk factors of dependency by examining the life courses of individuals who have been through addiction, treatment, and are currently in recovery. Early childhood experiences, specifically parental abuse and social rejection, combined with substance abuse as a model for coping, were found to be influential in the development of addiction. Social support and self-awareness during and post-treatment were effective components of sustaining recovery. HEROIN ADDICTION FROM THE LIFE COURSE PERSPECTIVE 3 From an outsider’s perspective, heroin addiction is an evil that harms not only the user, but society as a whole. Generally speaking, individuals have an impact on their community. Each person’s ability to find and maintain employment, buy goods and services, and obey the laws of one’s community dictate whether or not that individual is helping or harming the local economy and community as a whole (Mark, Woody, Juday, & Kleber, 2001). When an individual’s choices harm the community overall, there are resources in place that deal directly with the outcomes of behaviors. Law enforcement, treatment services, and DHS (Department of Human Services) are typically reactive programs that interact with the individual once the negative behavior has already occurred. Others in that person’s community may not see specific behaviors as symptoms of a disease—which is, in this case, addiction—but rather as a series of choices that are completely within the individual’s control. As a result of this, addicts are stigmatized as junkies or dopers and are spurned by their communities more often than they are helped. The goal of this study is to illuminate the disease of addiction by highlighting the personal stories of those who have been completely immersed in heroin or other opiate dependence, and are now in recovery. It will mainly examine the risk factors identified in early childhood that influenced later addiction, as well as common factors in successfully completing treatment and maintaining recovery. Within the medical community, heroin addiction is viewed as a disease. Taking a mindaltering substance changes the individual’s metabolic state, which after multiple uses will require continued and increased dosage to avoid withdrawal (Van Zyl, 2009). Once a drug user has reached the addiction stage, control over one’s use is lost. This leads to increased spending and drug-seeking behavior that can have negative personal and interpersonal consequences (Cheng, Lu, Han, Gonzalez-Vallejo, & Sui, 2012; Higgs, Jordens, Maher, & Dunlop, 2009; Simmons & HEROIN ADDICTION FROM THE LIFE COURSE PERSPECTIVE 4 Singer, 2006). Heroin is especially dangerous, due to its addictive potential and destructive nature (Cheng et al., 2012; Vaillant, 1988; Van Zyl, 2007) Although heroin and other opiates are certainly not the most commonly used substances, their individual and overall impact are what makes them of concern. In a 2011 assessment of national drug use, the National Survey of Drug Use and Health (NSDUH) determined that the rate of individuals who had used heroin in their lifetime over the age of twelve was 1.6%, and individuals aged twelve and older who had used in the past month was just over 0.1%. It is estimated that the total number of heroin users per year in the United States is 560,000 and the number of frequent users is about 338,000. A major limitation in heroin statistical data is that estimates are based on self-reporting by the surveyed populace, as well as heroin-related hospital and treatment facility admittances. Therefore, it is difficult to determine how accurate these estimates are, and many researchers agree that the number is likely higher than professional estimates (Mark, Woody, Juday, & Kleber, 2001). Finding longitudinal data for long-term success of opiate and heroin recovery is difficult. However, one study from Australia suggested that, depending on the form of addiction intervention, long-term success rates can range from 5263% (Ross et al., 2004). The life course perspective provides a framework for understanding the development of the individual, family unit, and their community over time. It is a comprehensive theory that takes into account the historical, cultural, and societal context in which the unit changes, and lends insight into the unique changes in relation to those contexts (Connidis, 2011). Specifically, the life course perspective focuses on pathways through the life-span, and age-related roles, transitions, and trajectories over time (Hser, Longshore, & Anglin, 2007). Certain life events, in general, relate directly to age (i.e. education, marriage, work, etc.). Adaptation to particularly HEROIN ADDICTION FROM THE LIFE COURSE PERSPECTIVE 5 stressful life events dictates an individual’s trajectory (Hser, Longshore, & Anglin, 2007). Additionally, the life course perspective provides an understanding of how the individual, family unit, and community changes interact and influence one another. Van Gundy and Rebellon (2010) used a life course approach to the “gateway hypothesis,” regarding the role marijuana plays in adolescent drug use and subsequent drug abuse in young adulthood. The authors proposed that certain components such as age-linked stressors and social roles are potential factors in adolescent marijuana use, and the prolonged exacerbation of these factors may influence an escalation to the use of other drugs and subsequent addiction in later life (Van Gundy & Rebellon, 2010). For example, exposure to trauma such as emotional or physical abuse may condition an adolescent to use substances as a means of coping, which in turn teaches the individual to use the same strategies in response to stress later. Therefore, “teens embedded in high stress environments may be particularly susceptible to ‘gateway’ risks” (Van Gundy & Rebellon, 2010, p. 245). Their study tested whether there was a causal link between marijuana use in high school and other drug abuse in later adolescence or whether the link can be explained by life course events and circumstances such as education, work, and youth stressors. They found that the “gateway effect” of marijuana use is more complex than simply getting hooked on one drug and progressing to another. Early marijuana use was not the dominant factor in laterlife substance abuse. Instead, other variables, specifically age-linked experiences like teen stress, mediate their propensity for escalation into abusing more potentially dangerous drugs as they develop. For this study, the life course perspective provided the theoretical lens for understanding heroin addiction. Investigators theorize that many turn to drug use as a result of a variety of stresses and anxieties of their everyday lives (Hawkins, Catalano, & Miller, 2007). Individuals HEROIN ADDICTION FROM THE LIFE COURSE PERSPECTIVE 6 whose parents modeled substance use may be more likely to repeat that behavior, having learned that coping method instead of healthier alternatives (Hser, Longshore, & Anglin, 2007). These individuals then in turn may be more likely to develop a dependency because of genetic factors that make them more susceptible to addiction (Hawkins, Catalano, & Miller, 2007). The life course perspective explains why someone with a genetic vulnerability for substance dependence, combined with use modeled in the home and traumatic or stressful events during dependency, might be more likely than someone with a healthier track of development to become substancedependent. The use of qualitative methods will help in understanding the heroin user’s perspective of addiction and psychosocial outcomes. This study will attempt to address two research questions: How do earlier life and current experiences shape addiction and recovery for adults with heroin addiction? And how do adults with heroin addiction describe and evaluate their family, peer, and community relationships over time? HEROIN ADDICTION FROM THE LIFE COURSE PERSPECTIVE 7