Factors influencing the course of opiate addiction.

AIMS To describe important non-biological factors which influence the course of opiate addiction. METHOD Studies were reviewed that present empirical results on the long-term course of opiate addiction, progress of opiate addicts during and after treatment, variables that predict remission and abstinence, comparisons of treated and untreated samples, and recovery from opiate addiction without formal help. RESULTS Opiate addiction is a chronic disorder with high mortality risk. The course of opiate addiction often consists of recurring sequences of addictive opiate use and abstinence. Treatment for opiate addiction, especially maintenance treatment, reduces opiate use; however, it is unclear how long after treatment the effects last. In treated samples, long-term opiate use can be moderately predicted from psychosocial factors, such as peer-group relationships, family problems, employment, and social support. Little is known about addicts who do not participate in treatment or who recover without treatment. Common factors that both treated and untreated addicts view as most important to their success are the social environment and their social life and daily activities. CONCLUSIONS In view of the chronic course of opiate addiction and the phenomenon of spontaneous recovery without treatment, the role of drug-abuse treatment as an influencing factor would seem to require further clarification. Current treatment programmes may leave unaddressed important factors that contribute to the recovery of drug addicts.