Abstract The phenomenon of episodic heroin use by patients maintained on a surrogate opiate has been noted by clinical investigators since the early 1970s. Several investigators have hypothesized that relapse to heroin use is related to stressful events in the patient's life, and retrospective studies give some support to this hypothesis. In the present study, we asked patients every month to rate their situation with respect to 11 life areas. There were significant negative correlations between the absolute scores in most life areas and the amount of heroin use. However, the relationship between changes in life-area scores and changes in heroin use was less clear. Our data indicate that of patients who have substantial increases in heroin use, many do have negative changes in one or more life areas. However, not all patients who have such negative changes in life-area scores respond by increasing their heroin use.