FOR USERS OF HEROIN, DECADES OF DESPAIR

Before you know it, life just passed you up," the man said. "You lose
everything. You lose your wife, you lose your family, you lose your
friends."

"But after seeing you go back and forth to jail over 10, 15, 20
years," he added, "they just give up on you."

He was speaking of his personal war with heroin addiction, a demon he
had battled for decades. And like the aging addicts described in a
study appearing this month in The Archives of General Psychiatry, the
man, in late middle-age, was intimately familiar with the addiction's
physical and social costs.

The study, begun in the mid-1970's by researchers at the University
of California at Los Angeles, followed male heroin addicts admitted
to a court-ordered drug treatment program in California in the early
1960's. The men were interviewed in 1974 and 1975 and again in the
mid-1980's. The report presented the findings of a 33- year
follow-up, carried out in 1996 and 1997.

Of the 581 men in the original study, the researchers found, 284 had
died, 21.6 percent from drug overdoses or from poisonings by
adulterants added to the drug. Another 38.6 percent died from cancer
or from heart or liver disease. Three died of AIDS. Homicides,
suicides or accidents killed 55 of them.

Yet as disturbing as these numbers were - the death rates were
higher, by several orders of magnitude than those for the general
population - the struggles of the men who were still living were
equally troubling.

For example, of the 242 subjects interviewed in the 33-year
follow-up, at the time in their late 40's to mid-60's, 40.5 percent
reported using heroin within the last year and 20.7 percent tested
positive for the drug in the urinalysis required for the study. Abuse
of other illicit drugs was also frequent (19.4 percent had used
cocaine in the last year; 35.5 percent had used marijuana), as was
the use of nicotine and alcohol.

"The striking thing for me is that a good proportion of this group
continues using," said Dr. Yih-Ing Hser, an adjunct professor at
U.C.L.A.'s Neuropsychiatric Institute and the lead author of the
study.

"Ordinarily," she said, "you'd think that when people are reaching
old age that they cannot continue to do the things they used to, like
hustling for drugs. But that didn't happen."

Among the men in the study who still used drugs, health problems,
unemployment, criminal involvement, social isolation and broken
family relationships were common, as they were for a similar group of
addicted men who took part in focus groups organized by the
researchers.

"Some men in the study did manage to attain abstinence, and the
difference was striking when they came into the interview," said Dr.
Christine Grella, also an adjunct professor at the neuropsychiatric
institute and an author of the study.

"They were well-functioning and they looked good," Dr. Grella said.
"Those who continued to use didn't look good, and they had many
physical problems that were hard for them."

The study, financed in part by the National Institute on Drug Abuse,
found that even the men who achieved periods of abstinence were still
vulnerable to relapse. Those who had abstained for at least five
years were less likely to relapse, but even in this group, 25 percent
resumed heroin use, some after 15 years of abstinence. And among
those abstinent for more than five years, many abused alcohol or
other drugs.

The findings, the researchers said, make it clear that surmounting
heroin addiction can be a long and circuitous process, and that
treatment programs need to take this into account.

"Most people think that those who go to treatment will be immediately
cured," she said, but "heroin is a difficult drug to kick, and
therefore treatment and recovery has to take incremental steps."

Results from the 20-year follow-up, the researchers said, showed that
methadone maintenance therapy helped the men refrain from heroin use.
But only 10 percent of the subjects were enrolled in methadone
maintenance in any given year.

Many researchers believe that methadone maintenance therapy is an
essential component of treatment but say that, for a variety of
reasons, it is often not readily available to addicts. Many programs,
for example, discontinue treatment if a client fails a drug test or
cannot meet the fee, Dr. Hser said.

"That kind of barrier to treatment, is partly responsible for the
outcome we are seeing," she said.

While several national studies have followed addicts over a period of
years, the U.C.L.A. study is the first to track them over three
decades.