NDARC Technical Report No. 139 (2003)
Introduction: Heroin use, with its associated harms, represents a serious public health concern, and generates many challenges for treatment providers. In Australia, an estimated 74,000 individuals are thought to be heroin dependent, with more people treated for dependence on opioids than any other drug class. Despite this, little is known about how effective the main treatment options are in practice.
The Australian Treatment Outcome Study (ATOS) is the first large scale longitudinal study of treatment outcome for 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.
The aims of ATOS are:
- To describe the characteristics of people seeking treatment for problems associated with heroin use in Australia;
- To describe the treatment received; and
- To examine treatment outcomes and costs at 3 and 12 months after commencement of treatment.
The current report addresses the first aim and presents data from the New South Wales arm of the study.
Method: Nineteen treatment agencies were randomly selected from within the three main treatment modalities (methadone/buprenorphine maintenance therapy; detoxification; residential rehabilitation) stratified by area health service. Five hundred and thirty five individuals entering treatment and 80 heroin users not seeking treatment were recruited into the study and interviewed by NDARC staff using a structured questionnaire. Valid and reliable instruments such as the Opiate Treatment Index (OTI), Short Form-12 (SF-12) and Composite International Diagnostic Interview (CIDI) were used to measure drug use, health, criminal activity, and psychiatric comorbidity. Consent and locator details were obtained to facilitate follow-up at 3 and 12 months.
- Entrants to treatment for heroin dependence tend to be long-term polydrug users with previous treatment experience. A significant minority (8%) had only ever smoked heroin.
- There were high levels of criminal involvement reported, with over half of participants having committed crime in the preceding month.
- There are extremely high levels of depression among the sample, with a quarter being clinically depressed at the time of interview.
- Suicide is a major clinical issue among heroin users, with 34% of the sample having ever attempted suicide, and 13% having done so in the preceding year.
- Post Traumatic Stress Disorder is common (41%) among the sample and, like suicide, is a major clinical issue for heroin users.
- While high levels of psychiatric distress and other drug-related harms were evident across all treatment modalities, the residential rehabilitation group reported more severe problems than the other modalities.
Conclusion: Comorbid psychiatric and drug problems are prevalent among the ATOS sample and are likely to influence treatment outcomes. These baseline findings will be taken into consideration when assessing the 3 and 12 month follow-up data.