Long term outcomes of treatment for heroin dependence: The Australian Treatment
Outcome Study (ATOS)
Dr Christina Marel
Despite the “heroin drought” earlier this century, heroin use and dependence has remained
as one of the major clinical problems for agencies treating illicit substances in Australia. The
immediate harms associated with heroin use and dependence are well know (e.g.,
overdose, increased risk of blood borne viruses). However, the long-term health and social
consequences of heroin dependence, and the natural history of heroin dependence, remain
poorly understood.
In 2001, the National Drug and Alcohol Research Centre (NDARC), University of New South
Wales, started the Australian Treatment Outcome Study (ATOS), a large longitudinal study
of treatment outcomes for heroin dependence. The NSW component of ATOS recruited 615
people from 19 agencies treating heroin dependence in Sydney between February 2001 and
August 2002. These agencies included opiate maintenance programs, drug free residential
agencies, and detoxification facilities. In addition, a group of heroin users not currently in
treatment were recruited into the study from needle and syringe programmes. Participants
were followed up at 3-months post-baseline, and then yearly for 3 years.
The findings from the first 3 years of the ATOS study have been extensively reported in
academic journals, NDARC technical reports, bulletins, national and international
conferences, and seminars. In summary, at the 3 year follow-up, past-month rates of heroin
use had dropped to 34% and only 22% of participants were heroin dependent. Eight percent
had maintained continual abstinence from heroin for the entire 3-year period. Reductions in
heroin use were accompanied by reductions in other drug use. There were also substantial
reductions in overdose, risk-taking, crime, injection-related health problems and
improvements in general physical and mental health. Positive outcomes were associated
with more time in maintenance therapies and residential rehabilitation and fewer treatment
episodes overall. Major depression was consistently associated with poorer outcome.
The 3 year findings from ATOS have been instrumental in informing policy and practice, and
in the development of new research examining integrated treatment programs for mental
health disorders which commonly co-occur with heroin dependence and impair treatment
outcomes (e.g., depression and post-traumatic stress disorder). However, it is well known
clinically that heroin dependence is a remarkably persistent and, in many cases, lifelong
condition. There is however, an absence of research examining the natural history of heroin
dependence and factors associated with relapse and remission.
In 2011, NDARC obtained funding from the National Health and Medical Research Council to
conduct an 11-year follow-up of those in ATOS. With this extension, we aim to conduct the
first examination of the long-term trajectory of heroin dependence in Australia. Specifically,
we will be examining factors associated with patterns of relapse and remission, physical and
mental health, and mortality.
Many of the individuals who initially participated in the study were very keen to stay
involved, however, with the passage of time it is difficult to contact some people whose
circumstances have changed. Currently, we have located and interviewed just over 45% of
the original cohort.
It would be greatly appreciated if providers could spread the word amongst staff and clients
that ATOS has resumed. To assist with this, a short flyer has been placed at the end of this
article which may be placed on service noticeboards, or given to persons you believe may
have been involved. We are very eager to hear from all those who originally took part in
ATOS, regardless of their current circumstances. ATOS participants’ time is greatly valued
and participants will be remunerated for their contribution.
The success of the ATOS study and all that has come from it would not have been possible
without the generous assistance of alcohol and other drug service providers and the
consumers who volunteered to be involved. It is hoped through the continued involvement
of ATOS participants in the 11 year follow-up, that further knowledge can be generated
regarding how to best treat heroin dependence.
If you have any questions, please contact Dr Christina Marel at the National Drug and
Alcohol Research Centre on c.marel@unsw.edu.au or 02 9385 0155.
Did you take part in the Australian
Treatment Outcome Study ?
We are looking for people who were part of the Australian Treatment Outcome Study
(ATOS), a study run by the National Drug and Alcohol Research Centre (University of New
South Wales), looking at what treatments work best for heroin users in Australia.
ATOS started in 2001-2002 and most people had their first interview at a drug treatment
service (e.g., at a methadone clinic, detox, or rehab) or at an NSP. These same people were
interviewed again several times up until 2005. If you were in this study, some of the
interviewers you would have talked to are Kath, Kate, Alys, Anna, Sandra, Ev and Nicky.
The study has been re-funded for an 11-year follow-up, and we are looking for the same
people we interviewed between 2001 and 2005 to do another interview. If you think you
were interviewed as a part of ATOS, please call Jo on 9385 0304 or 0477 426 503. The
interview will take about an hour and you will be given $40 for out of pocket expenses.