The Australian Treatment Outcome Study (ATOS): Heroin

NDARC Staff

Maree Teesson, Shane Darke, Joanne Ross, Katherine Mills, Anna Williamson, Alys Havard and Marian Shanahan

Other Investigators

Michael Lynskey (University of Washington, St Louis, USA); Robert Ali, Richard Cooke and Danielle Bament (Drug & Alcohol Services South Australia (DASSA)); and Alison Ritter, Tracey Holt and Amy Swan (Turning Point Alcohol & Drug Centre, Victoria)

Aims

Design and Method

Heroin users were recruited on entry to treatment through methadone/ buprenorphine maintenance, detoxification and residential rehabilitation services. The study was conducted in Sydney (n=535), Adelaide (n=100) and Melbourne (n=110). In NSW an additional 80 heroin users not currently in treatment were recruited. Using a structured questionnaire, participants were interviewed on entry into treatment for heroin dependence and followed up again at 3 and 12 months post treatment entry. In NSW follow-up was extended to 24 and 36 months.

A major strength of ATOS is the richness of data collected on participants at baseline and follow-up. The measures used examined drug use, criminality, treatment history, injection related risk taking behaviour, overdose, general health, health service utilisation, and psychopathology (Major Depression, Post Traumatic Stress Disorder, Anti Social Personality Disorder and Borderline Personality Disorder). Extended follow up of the NSW cohort provided valuable data on the natural histories of heroin users.

Two PhD projects originated from the ATOS project:

Progress

Benefits

Output

Darke, S., Hetherington, K., Ross, J., Lynskey, M., & Teesson, M. (2004). Non-injecting routes of administration among entrants to three treatment modalities for heroin dependence. Drug and Alcohol Review 23, 177-183.

Darke, S., Ross, J., Teesson, M., & Lynskey, M. (2003). Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Addiction 98,1129-1135.

Darke, S., Ross, J., Teesson, M., & Lynskey, M. (2004). Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence and risk factors. Drug and Alcohol Dependence 73, 1-10.

Darke, S., Williamson, A., Ross, J., & Teesson, M. (2006). Residential rehabilitation for the treatment of heroin dependence: Sustained heroin abstinence and drug-related problems 2 years after treatment entrance. Addictive Disorders & Their Treatment 5, 9-18.

Darke, S., Williamson, A., Ross, J., & Teesson, M. (2006). Reductions in heroin use are not associated with increases in other drug use: 2-year findings from the Australian Treatment Outcome Study. Drug and Alcohol Dependence 84, 201-205.

Darke, S., Williamson, A., Ross, J., Teesson, M., & Lynskey, M. (2004). Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS). Drug and Alcohol Dependence 74, 77-83.

Havard, A., Teesson, M., Darke, S., & Ross, J. (2006). Depression among heroin users: 12 month outcomes from the Australian Treatment Outcome Study (ATOS). Journal of Substance Abuse and Treatment 30, 355-362.

Holt, T., Ritter, A., Swan, A., & Pahoki, S. (2002). Australian Treatment Outcome Study (ATOS): Heroin. Baseline data report: Victoria. Turning Point Alcohol and Drug Centre.

Holt, T., Ritter, A., Swan, A., & Pahoki, S. (2003). Australian Treatment Outcome Study (ATOS): Heroin. Three month follow-up report: Victoria. Turning Point Alcohol and Drug Centre.

Mills, K., Lynskey, M., Teesson, M., Ross, J. & Darke, S. (2003). Prevalence and correlates of Post Traumatic Stress Disorder (PTSD) among people with heroin dependence: Findings from the Australian Treatment Outcome Study (NSW). NDARC Technical Report No. 169. Sydney: UNSW.

Mills, K., Teesson, M., Lynskey, M., Ross, J., & Darke, S. (2004). Young people with heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS). Journal of Substance Abuse Treatment 27, 67-73.

Ross, J., Lynskey, M., Teesson, M., Darke, S., Havard, A., Mills, K., Williamson, A., Hetherington, K. & Fairbairn, S. (2003). Three month outcomes for the treatment of heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS), New South Wales. NDARC Technical Report No. 159. Sydney: UNSW.

Ross, J., Teesson, M., Darke, S., Lynskey, M., Ali, R., Ritter, A. & Cooke, R. (2004) Twelve month outcomes of treatment for heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS) National Drug and Alcohol Research Centre Technical Report No. 196. Sydney, UNSW.

Ross, J., Teesson, M., Darke, S., Lynskey, M., Hetherington, K., Mills, K., Williamson, A., & Fairbairn, S. (2002). Characteristics of heroin users entering three treatment modalities in New South Wales: Baseline findings from the Australian Treatment Outcome Study (ATOS). NDARC Technical Report No.139. Sydney: UNSW.

Shanahan, M., Havard, A., Mills, K., Williamson, A., Ross, J., Teesson, M., Darke, S., Ali, R., Ritter, A., Cooke, R., & Lynskey, M. (2004). Health services use and treatment costs over 12 months among heroin users: Findings from the Australian Treatment Outcome Study (ATOS). National Drug and Alcohol Research Centre. Technical Report No. 203. Sydney, UNSW.

Shanahan, M., Havard, A., Teesson, M., Mills, K., Williamson, A., & Ross, J. (2006). Patterns and costs of treatment for heroin dependence over 12 months: Findings from the Australian Treatment Outcome Study. Australian and New Zealand Journal of Public Health 30, 305-311.

Teesson, M., Havard, A., Ross, J., & Darke, S. (2006). Outcomes after detoxification for heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS). Drug and Alcohol Review 25, 241-247.

Teesson, M., Ross, J., Darke, S., Lynskey, M., Mills, K., Williamson, A., Hetherington, K., Fairbairn, S., Havard, A., Wilhelm, E., & Shanahan, M. (2004). Twelve month outcomes of the treatment of heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS) New South Wales. National Drug and Alcohol Research Centre. Technical Report No. 191. Sydney, UNSW.

Weekley, J., Cooke, R. & Ali, R. (2002). Characteristics of heroin dependent individuals in South Australian Drug Treatment. The first report of the South Australian component of the Australian Treatment Outcome Study – Heroin. DASC Monograph No.13 Research Series.

Weekley, J., Cooke, R. & Ali, R. (2003). Treatment outcomes at 3 months post admission to drug treatment. The second report of the South Australian component of the Australian Treatment Outcome Study – Heroin. DASC Monograph No.15 Research Series.

Williamson, A., Darke, S., Ross, J. & Teesson, M. (2003). Cocaine use among the ATOS NSW sample: Prevalence and related harms. NDARC Technical Report No.161. Sydney: UNSW.

Williamson, A., Darke, S., Ross, J., & Teesson, M. (2004). The effect of cocaine use on short-term outcomes for heroin dependence. National Drug and Alcohol Research Centre. Technical Report No. 190. Sydney, UNSW.

Williamson, A., Darke, S., Ross, J., & Teesson, M. (2006). The effect of persistence of cocaine use on 12-month outcomes for the treatment of heroin dependence. Drug and Alcohol Dependence 81, 293 – 300.

Williamson, A., Darke, S., Ross, J., & Teesson, M. (2006). The association between cocaine use and short-term outcomes for the treatment of heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS). Drug and Alcohol Review 25, 141-148.

Funding

National Health and Medical Research Council, Australian Government Department of Health and Ageing, and Department of Human Services Victoria