NDARC Technical Report No. 311(2010)
WHOS (We Help Ourselves), a registered charity, was established in 1972 by a group of committed ex-users of alcohol and other drugs, who had identified an innovative and cost effective way to help AOD dependant members within the general community in finding a productive way of living. This humble beginning of a self-help initiative has evolved into a recognised professional organisation today known as 'WHOS'. The organisation has demonstrated the ability to survive the early days of its evolution, the ever-changing trends in the AOD field and to stay abreast of current cutting-edge initiatives.
From 2002 WHOS have routinely been collecting data on all admissions, including demographics, drug use history, and risks and harms associated with drug use. Since WHOS data collection covers the period when there was a marked change in the drug market, it provides an excellent opportunity to see what effect, if any, such changes in drug markets have on admissions and treatment cessation data.
There were three major findings in the present study. Firstly, average age of clients at admission has been increasing from 2002 to 2009. Secondly, the proportion of female clients has been increasing over the same time period. Finally, both length of stay and the proportion of clients that have completed treatment have been increasing from 2002 to 2009.
The average age of clients has been increasing over the years, and is especially evident when compared to data collected on WHOS clients from late 1980 to the early 1990s. There was an increase in the proportion of females over the years; this increase is most likely attributable to the increase in women entering New Beginnings due to an increase in funding and the availability of more beds as a result of this.
Changes in drug use
From 2002 there was an overall decrease in reports for heroin as principal drug of concern and an increase in meth/amphetamine across the services, with the exception of MTAR where no principal drug of concern was reported. In 2009, meth/amphetamine, as principal drug of concern, decreased markedly. Conversely, as meth/amphetamine as principal drug of concern increased across the years, heroin as principal drug of concern decreased. With the recent decrease in meth/amphetamine as principal drug of concern, there has been an increase in heroin.
There has been an increase in alcohol as principal drug of concern in recent years. In all services, whilst alcohol is generally the most common recently used drug, reports of it being the principal drug of concern have increased, with the exception of MTAR (due to the drug-specific target group i.e. opioid maintenance treatment). Reports of cannabis as principal drug of concern have also been increasing, specifically in the last couple of years.
Risks and harms associated with drug use
Most of the clients reported operating heavy machinery (i.e. driving a vehicle) whilst under the influence of drugs. Men were also significantly more likely to operate heavy machinery whilst under the influence than women. As WHOS is a Therapeutic Community organisation that advocates harm reduction, it may be useful to include topics covering the risks and harms associated with drugs/alcohol and driving.
There was a decrease, across the years, in the proportion of clients for all WHOS services reporting that they had shared needles or shared injecting equipment, with the exception of the Sunshine Coast, though this may be related to an increase in recent injection in the Sunshine Coast, whilst in the other services it has been decreasing. Approximately one-quarter of all clients reported that they had shared needles in the preceding 12 months and approximately 50% admitted to sharing injecting equipment – women were significantly more likely to share needles than males.
A significant minority reported engaging in unsafe sexual practices. Females were significantly more likely to report engaging in unsafe sexual practices than males in the three months prior to admission. With the risk of STIs and HIV, WHOS harm reduction groups should continue to focus on the importance of practicing safe sex. Research suggest that involvement in treatment is likely to reduce these risky behaviours after treatment cessation (Gossop, Marsden et al. 2002).
There has been an increase in clients suffering from high psychological distress in the Gunyah and New Beginning services in 2009. There was a decrease in the proportions with high distress scores in the Hunter and these proportions remained stable for the Sunshine Coast and MTAR services. In 2009 an onsite doctor and multiple complex-needs nurses were introduced to WHOS services at Rozelle (Gunyah, New Beginnings and MTAR) as well as a part-time nurse at Hunter. WHOS Sunshine Coast has had the services of a nurse for four years. The introduction of these nursing services was in response to the need to better treat clients with comorbid problems.
Treatment cessation and retention
Despite the changes in demographics and drug use, overall from 2002 to 2009 there has been an increase in mean and median length of stay and the proportion of clients completing treatment across all WHOS services. The exception has been a recent decrease in the proportion completing treatment in both the New Beginnings and Hunter services in 2009. MTAR clients were significantly more likely to complete treatment than clients from drug-free services, though there was no difference in terms of males and females. Future monitoring of these patterns is necessary in order to determine what factors may influence length of stay and treatment completion, though it appears that despite changes in the types of clients that present to WHOS treatment services, treatment completion is not adversely affected. WHOS treatment services appear to be able to offer quality treatment to a wide variety of clients suffering from drug and alcohol dependence and related problems.
Full report attached above.