NDARC Technical Report No. 196 (2004)
Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition, yet the long term outcome following treatment for heroin dependence is rarely studied and has not yet been systematically studied in Australia. Better understanding of the long term outcomes in terms of mortality, drug use patterns, criminality and psychiatric comorbidity has the potential to guide more effective interventions and public health responses both nationally and internationally.
The Australian Treatment Outcome Study (ATOS) is the first large scale longitudinal treatment outcome study of persons with heroin dependence to be conducted in Australia. ATOS is coordinated by the National Drug and Alcohol Research Centre (NDARC), and is conducted in collaboration with the Drug and Alcohol Services Council (DASC) and Turning Point Alcohol and Drug Centre.
The aims of ATOS are:
The current report presents combined 12 month data from New South Wales, South Australia and Victoria.
Thirty eight treatment agencies were randomly selected from within the three main treatment modalities (methadone/buprenorphine maintenance therapy - MT; detoxification - DTX; residential rehabilitation - RR). Seven hundred and forty five individuals entering treatment and 80 heroin users not seeking treatment (NT) were recruited into the study and interviewed by trained research staff using a structured questionnaire. A total of 657 individuals were re-interviewed at 12 months, 80% of the original sample. Data was collected on a variety of domains including: treatment experiences; heroin and other drug use, mental health and criminal activity.
Comparison of ATOS participants interviewed at 12 months and those lost to follow-up
Treatment exposure among the NT group
Heroin and other drug use
Injection-related health and risk-taking
The high rate of sample retention at 12 months is of an international standard and lends validity to the findings. The study indicates that heroin users can be successfully engaged in longitudinal studies. There were substantial reductions in drug use, risk-taking, crime and injection-related health problems across all treatment groups and less marked reductions among the NT group. Psychopathology was also dramatically reduced among the treatment modalities, while remaining fairly stable among the NT group, perhaps due to their lower baseline levels. The important treatment factors associated with positive outcomes at 12 months were the cumulative number of treatment days experienced over the 12 month follow-up period (‘treatment dose’) and the number of treatment episodes undertaken in that time (‘treatment stability’). Overall, at 12 months the general functioning of all groups had substantially improved since baseline.
Citation: Ross, J., Teesson, M., Darke, S., Lynskey, M., Ali, R., Ritter, A. and Cooke, R. (2004) Twelve month outcomes of treatment for heroin dependence: Findings from the Australian Treatment Outcome Student, Sydney: National Drug and Alcohol Research Centre.