Research Article: Changes in opiate and stimulant use through 10 years: The role of contextual factors, mental health disorders and psychosocial factors in a prospective SUD treatment cohort study

Date Published: January 25, 2018

Publisher: Public Library of Science

Author(s): Grethe Lauritzen, Trond Nordfjærn, Antonio Verdejo-García.


To examine temporal changes in opiate and stimulant use among patients in substance abuse treatment over a ten-year observation period and to explore the role of contextual factors, mental health disorders and psychosocial factors on these changes.

A cohort of 481 patients was prospectively interviewed at admission to treatment and after 1, 2, 7 and 10 years. The sample was recruited from 20 facilities in the Greater Oslo region, Norway.

The majority of patients were poly-drug users and 80% had used both opiates and stimulants the last 30 days prior to treatment admission. Last-month use of heroin, other opiates, cocaine and amphetamines declined from 80% to 34% at the end of the observation period. The most substantial reduction was observed between baseline and one-year follow-up. Use of heroin decreased the most from 62% to 16% after 10 years (a reduction of 74%), and the reduction continued from one-year follow-up throughout the observation period. The most important multivariate risk factors for sustained use of these drugs were male gender, having one or both biological parents with severe alcohol or drug problems, having an antisocial personality disorder, and living together with a person who abuses alcohol or drugs. Employment was associated with reduced risk of drug use at 7-year follow-up.

There was a substantial reduction in opiate and stimulant use from baseline to all follow-up assessments, most greatly for heroin. Findings regarding sustained use could suggest familial transmission and the challenges of preventive strategies and treatment efforts in an intergenerational context. Co-occurrence between drug abuse and mental health problems highlights the need of highly specialized competence in SUD treatment.

Partial Text

A strong focus is warranted on outcomes among patients in substance use disorder (SUD) treatment. SUD creates substantial suffering both for the individual and significant others, premature death and huge societal costs. Clinical observations and treatment studies have shown that SUD tends to be a persistent condition, often with need for long trajectories of treatment efforts to obtain drug-free and/or good quality lives [1], [2]. Long-term observations with an overriding aim of exploring the fluctuations and life cycles of drug use along with treatment episodes are scarce. The current prospective study was conducted to follow opiate and stimulant drug use courses during 10 years in a cohort of illicit drug users recruited from Norwegian treatment facilities. The focus was to specifically explore changes in the use of these two categories of drugs due to their high-risk potential of dependence, severe physical and mental harm and deadly overdose potentials. The study also set out to identify predictors of change in use of these drugs throughout the observation period. The current research extends a previous study applying the same data material to examine use of drugs in relation to mental distress [3].

The present study has shown a substantial decrease in opiate and stimulant use in a SUD treatment cohort during a 10-year study period. At baseline, 80% reported use of these drugs last month prior to treatment admission, whereas 34% reported last-month use ten years later. The greatest changes were found for heroin use (74% reduction) and for amphetamine use (44% reduction). Important contextual predictors of sustained use of these drugs were male gender and living with a person who abused drugs. There was a tendency of reduction of use by work income at the two last follow-up waves. Individuals who received additional residential treatment during the observation period had a significant reduction in use. The most important psychosocial factor associated with sustained use was having had one or both biological parents with severe substance-abuse problems, whereas antisocial personality disorder was the strongest predictor of sustained use among the mental health disorders.

The current study has demonstrated a substantial temporal decline in opiate and stimulant use over 10 years in a SUD cohort. These encouraging findings are of importance, as these drugs and the combination of them are known to cause high physical and mental harm as well as comprehensive societal costs. The predictors identified for sustained use warrant a focus towards children growing up in families with severe substance abuse problems and to behaviours and symptoms related to developing personality disorders like ASPD. Moreover, it calls into attention the establishment and maintenance of drug-free relations in the recovery process among patients with SUD and their need for highly qualified services to obtain relational competence. Drug-free households and entering work arenas demands a dualistic interplay between mastering relational and professional skills and a policy of societal integration.