Stressful life events and the return to heroin use.

Patients on methadone maintenance were studied to determine which factors influence the continuation of heroin-free treatment, as opposed to the return to drug abuse. Psychosocial data, a Zung Depression Scale, and the Social Readjustment Rating Scale (SRRS) were collected on those patients who returned to heroin use while on a methadone maintenance program during the one year of study (n = 48); they were compared to a control group as well as to themselves during a heroin-free maintenance period. The group of patients returning to heroin use showed the existence of such events as recent loss, depression, and exacerbation of intense affect coinciding with the occurrence of heroin use. Furthermore, their SRRS scores and number of SRRS items were significantly higher than those of the control group and than their own steady-state scores. The number and magnitude of stressful life events seem significantly related to patients' not adhering to methadone maintenance and returning to heroin use. The understanding of the importance and adaptive function of drugs to the addict in regulating and ameliorating otherwise overwhelming and catastrophic affective states is underscored otherwise overwhelming and catastrophic affective states is underscored by this study. The total number of life stress events as well as the specificity of meaning to the patient are both emotionally important in understanding, intervening, and treating these patients.