Determinants of Heroin Relapse in Older Mexican American Heroin Users- Implications for Culturally Responsive Treatment Modalities

Background and Purpose. Latino older adults currently account for 7% of the older adult population in the US.  By 2050, approximately 20% of older adults will be Latinos, constituting the largest minority older adult group. Of concern, individuals aged 35 and older have been identified as the fastest growing group of heroin users.  In 2009, a nationally representative study found drug abuse among individuals aged 50 and 59 increased to 6.2 from 2.7 percent.  The older adult Latino population will increase six fold in the next forty years, thus presenting epidemiological concerns about older Mexican-American heroin injecting drug users (IDU’s), termed tecatos, who are long-term or intermittent, late or new starters, or returning heroin users, relapsing after sustained periods of cessation. Current literature on addictive behaviors provides limited information on older heroin users’ relapse behaviors. This study explores determinants of heroin relapse among tecatos and implications for relapse prevention and culturally responsive interventions using a qualitative approach.  

Methods. Secondary data was used to analyze 18 Intensive Life History Interviews of tecatos that included former heroin users, current heroin users, or users currently in treatment. The interviews were randomly selected from a subsample of 61 ethnographies from the original study sample of 227 subjects. These interviews were transcribed in English and Spanish by language proficient translators. This paper uses an exploratory qualitative research design via content analyses with open, axial, and selective coding to develop categories, concepts, and themes that addressed the research questions. These analyses allowed researchers to explore behavioral patterns, practices, significant events, relationships, and lifestyles or subcultures and exemplars utilizing thick descriptions.  The Successive Approximation model enabled researchers to navigate between abstract, vague ideas to more explicit, concrete detail that led to comprehensive analysis with generalizations.

Results. Four major relapse themes emerged from the analysis. The first theme was direct or indirect enabling from the family of origin. Direct enabling refers to when family members would help respondents score or inject with them. Indirect enabling refers to family members knowing about heroin use and providing tecatos with shelter or money to purchase drugs. The second theme developed from the analysis was associations with other heroin users such as intimate partners and friends. These relationships provided a network of support for continued use and relapse. Respondents identified craving heroin due to cue-exposure at home and in social situations. A third theme that emerged was returning to the environment of initial drug use, especially after being incarcerated. Many of the respondents were incarcerated, which led them to overcome withdrawal and abstain from drug use. Upon release, they returned to communities with a heavy drug presence and began using again. The final theme identifies relapsing based on an inability to cope with life stressors, including homelessness, abuse, violence, death of loved ones, and interpersonal conflict.

Conclusion. This study provides the basis for future relapse quantitative studies among aging Mexican-American IDUs. Furthermore, this data can be used to develop culturally appropriate relapse assessment instruments and clinical interventions by helping professionals.