A number of drugs make up a small proportion of closed treatment episodes. These drugs may be less prominent in treatment services because they are relatively uncommon, or people who use them may be less likely to seek treatment than people who use other substances. Information about treatment for nicotine, ecstasy and cocaine is included in this section, not just because of their prevalence among the population, but also the increased harms that these substances bring to an individual and/or the community.

Drug descriptions

Nicotine

Nicotine is the stimulant drug in tobacco smoke. It is highly addictive and causes dependency (ADCA 2013). Tobacco use (9.3%) was the highest risk factor contributing to the total burden of disease and injury in Australia in 2015 (AIHW 2019). The health effects of smoking include premature death and tobacco-related illnesses such as cancer, chronic obstructive pulmonary disease and heart disease.

Ecstasy

Ecstasy is the popular street name for a range of drugs said to contain the substance 3, 4 methylenedioxymethamphetamine (MDMA): an entactogenic stimulant with hallucinogenic properties. Ecstasy is usually sold in tablet or pill form, but is sometimes found in capsule or powder form. The short-term effects of ecstasy include euphoria, feelings of wellbeing and closeness to others, and increased energy. Harms include psychosis, heart attack and stroke. Little is known about the long-term effects of ecstasy use, but there is some research linking regular and heavy use of ecstasy to memory problems and depression (ADCA 2013).

Cocaine

Cocaine is a stimulant drug, originally derived from the leaves of the coca plant, that is typically snorted or injected. The effects of cocaine have a rapid onset, generally appearing within seconds or minutes, and dissipate within about 30 minutes after consumption. The acute effects of cocaine include euphoria and increased alertness, as well as undesirable outcomes including insomnia, cardiac arrhythmia, and stroke. Chronic use is associated with both psychological and physical health problems, including erosion of the nasal cavity, anxiety, psychosis, and cardiac arrest (ADCA 2013).

Results from the National Drug Strategy Household Survey (AIHW 2020) showed that in 2019:

  • around 1 in 7 (14.0%) Australians aged 14 and over were current smokers and 11.0% were daily smokers
  • the daily smoking rate among people aged 14 and over declined between 2016 and 2019 (from 12.2% to 11.0%), continuing a long-term downward trend
  • from 2016 to 2019, there were increases in the recent use of cocaine (from 2.5% in 2016 to 4.2% in 2019) and ecstasy (from 2.2% to 3.0%)
  • there were also increases in recent use of hallucinogens, inhalants and ketamine, though use of these drugs remained uncommon (all less than 2.0% in 2019).

The selected drugs of concern—nicotine, ecstasy and cocaine—were more likely to be reported as an additional drug of concern rather than a principal drug of concern (tables AODTS Selected drugs.1, SD.8). For example, in 2019–20 nicotine was reported as a principal drug of concern in only 1.1% of treatment episodes, but was listed as an additional drug of concern in 13.1% of episodes.

Table AODTS Selected drugs.1: Summary characteristics of other selected drugs of concern, 2019–20 (%)
  Nicotine Ecstasy Cocaine
Client data
Sex(a)
Male 57.1 74.9 87.6
Female 42.7 25.1 12.3
Indigenous status(a) (b)
Indigenous 15.5 5.1 5.1
Non-Indigenous 80.9 92.3 92.4
Age(a)
10–19 21.1 38.9 6.9
20–29 20.0 52.7 50.4
30–39 22.3 6.2 29.3
40–49 17.0 1.6 11.1
50+ 19.6 0.6 2.4
Closed treatment episodes
Drugs of concern
Principal drug of concern 1.1 0.6 1.0
Additional drug of concern 13.1 1.6 1.5
Referral to treatment
Self/family 19.8 16.3 39.1
Health service 33.6 17.8 23.0
Corrections 4.0 4.3 7.0
Diversion 31.8 49.4 15.2
Other 10.8 12.3 15.7
Main treatment type
Counselling 23.1 26.2 44.8
Information and education  10.9 39.4 12.2
Assessment only 43.2 16.0 18.2
Withdrawal management 9.2 3.3 4.4
Other(c)  13.5 15.1 20.3
Treatment setting
Non-residential treatment facility 71.0 71.9 77.3
Residential treatment facility 1.3 3.6 9.2
Other(d) 27.7 24.1 13.6
Treatment completion
Expected cessation 77.6 79.4 63.7
Unexpected cessation 8.9 10.7 19.2
Other(e) 13.5 79.9 17.1
Median duration (episodes) 1 days 1 day 36 days

(a)     Based on valid SLK client data.

(b)     The proportion of clients for Indigenous status may not sum to the total, due to missing or not reported data.

(c)     Includes support and case management, pharmacotherapy, other and rehabilitation.

(d)     Includes where treatment is delivered in the client’s own home or usual place of residence or in an outreach setting.

(e)     Includes administrative cessation.

Sources: Tables SC.6–8, SD.9, SD.66, SD.69, SD.73, SD.76–79, SD.117–118, SD.121–127, SD.130, SD.133–134, SD.137–143.

The proportion of episodes with nicotine, ecstasy or cocaine as the principal drug of concern has remained stable at around 1%–2% for each drug each year since 2014–‍15 (Table SD.9). Typically, these 3 principal drugs of concern have together contributed around 2%–3% of the total number of treatment episodes each year since 2014‍–‍15.

Nicotine

In 2019–20, nicotine was reported in 14% of all closed treatment episodes, either as a principal or additional drug of concern:

  • nicotine was a principal drug of concern in just 1.1% (2,379) of treatment episodes (tables AODTS Selected drugs.1, SD.9). Since 2010–11, the proportion of episodes with nicotine as the principal drug has remained stable at 1–2% (Table SD.9).
  • nicotine was listed as an additional drug of concern in 13% (28,535) of episodes
  • most treatment episodes with nicotine as an additional drug of concern occurred when the principal drug of concern was alcohol (34%), amphetamines (33%), or cannabis (22%) (tables SD.7–8).

The low proportion of episodes in which nicotine was the principal drug of concern likely relates to the wide availability of support and treatment for nicotine use within the community. For example, general practitioners, pharmacies, helplines, and web services all offer support for nicotine use. Additionally, people might view AOD treatment services as being most appropriate for drug use that is beyond the expertise of general practitioners. However, therapy to quit smoking is becoming an integral part of some AOD services as a parallel treatment with other drugs of concern.

Client demographics

Where nicotine was the principal drug of concern:

  • 57% of clients were male and 15% were Indigenous Australians
  • over 3 in 5 clients were aged under 40 years (63%) and 17% were aged 40–49 (tables AODTS Selected drugs.1, SC.6–8).

Treatment

For treatment episodes where nicotine was the principal drug of concern in 2019–20:

  • the most common source of referral was from health services (34%), followed by a police or court diversion program (32%) (Table AODTS Selected drugs.1)
  • assessment only (43%), counselling (23%), and information and education only (11%) were the most common main treatment types (tables AODTS Selected drugs.1, SD.74)
  • 7 in 10 (71%) treatment episodes took place in a non-residential treatment facility (Table SD.76)
  • over half (57%) of episodes ended within 1 day, and almost 3 in 10 (29%) lasted 2 days to 3 months (Table SE.25)
  • the median duration of episodes was 1 day (tables AODTS Selected drugs.1, SD.79)
  • over three–quarters (78%) of episodes ended with an expected cessation, while 10% ended due to other reasons (such as court diversion, imprisonment or death) and 9% ended unexpectedly.
  • expected cessations were most common where the main treatment type was assessment only (46%), and least likely for rehabilitation (1%) (Table SD.78).

Ecstasy

In 2019–20, ecstasy was reported in 3% of all closed treatment episodes, either as a principal or additional drug of concern:

  • Ecstasy was a principal drug in less than 1% of treatment episodes (1,255).
  • An additional drug of concern in 2% (3,529) of episodes.
  • The proportion of episodes with ecstasy as a principal drug has remained stable around 1% of all closed treatment episodes since 2010–11 (708 episodes). When reported as an additional drug of concern, it decreased from 3% (4,754) of episodes in 2010–11 to 2% (3,529) in 2019–20 (additional drugs of concern may not be the subject of any treatment within the episode) (tables AODTS Selected drugs.1, SD.9).
  • Additional drugs of concern reported with ecstasy include cannabis (39%), amphetamines (30%), or alcohol (19%) (Figure DRUGS1; tables SD.7–8).

Client demographics

Where ecstasy was the principal drug of concern:

  • three-quarters (75%) of clients were male and 5% were Indigenous Australians
  • half of the clients (51%) were aged 20–29 and 41% were aged 10–19 (tables SC.6–8).

Treatment

For treatment episodes where ecstasy was the principal drug of concern in 2019–20:

  • in nearly half (49%) of treatment episodes, the client’s source of referral was from police and court diversion (tables AODTS Selected drugs.1, SD.125)
  • the most common main treatment type was information and education (39%), followed by counselling (26%) (Table SD.121)
  • most treatment episodes took place in a non-residential facility (72%) (Table SD.124)
  • over half (55%) of episodes ended within 1 day and over 1 in 3 (35%) ended in 2 days to 3 months (Table SE.25)
  • the median duration of episodes was 1 day (tables AODTS Selected drugs.1, SD.127)
  • 4 in 5 (79%) episodes ended with an expected cessation, while 11% ended unexpectedly
  • expected cessations were most common where the main treatment type was information and education only (49%) (Table SD.126). 

Cocaine

Cocaine was reported in 3% of all closed treatment episodes, either as a principal or additional drug of concern:

  • cocaine was a principal drug in less than 1% (2,086 ) of treatment episodes
  • an additional drug of concern in 2% (3,322 episodes)
  • though the proportion of episodes with cocaine as a principal drug has remained at less than 1% of all closed treatment episodes since 2010–11, the number of treatment episodes increased by 4-fold from 2010–11 (501 episodes) to 2019–20 (2,086)
  • where cocaine was listed as an additional drug of concern, also increased since 2010–11 (2,011episodes) to 2019–20 (3,322 ) (tables AODTS Selected drugs.1, SD.9)
  • additional drugs of concern reported with cocaine included amphetamines (36%), alcohol (31%), and cannabis (18%) (Figure DRUGS1; tables SD.7–8).

Analysis of AODTS NMDS data from 2002–2003 to 2017–2018 similarly found treatment episodes where cocaine was the principal drug of concern were increasing, the rate was higher among males than females (10 per 100,000 compared with 1.7 per 100,000 among females) across all years and since 2015–16 higher among people aged 20–29 (Man et al. 2021). State/territory, main treatment type and referral sources were investigated to determine whether these factors may be driving increases in treatment episodes; analyses indicated these variables did not drive increases in 2016–2017 and 2017–2018 (Man et al. 2021).

Client demographics

Where cocaine was the principal drug of concern:

  • nearly 9 in 10 (88%) clients were male and 5% were Indigenous Australians
  • half of the clients (50%) were aged 20–29, and 30% were aged 30–39
  • 1 in 14 clients (7%) were aged 10–19 (tables AODTS Selected drugs.1, SC.6–8).

Treatment

For treatment episodes where cocaine was the principal drug of concern in 2019–20:

  • around 2 in 5 clients (39%) were referred by self/family, followed by health service (23%) (tables AODTS Selected drugs.1, SD.133)
  • the most common main treatment types were counselling (45%), assessment only (18%), (tables SD.137–138)
  • treatment was most likely to take place in a non-residential treatment facility (77%) (Table SD.140)
  • around 1 in 4 (26%)  episodes ended within 1 day and nearly half (46%) lasted from 1–6 months (Table SE.25)
  • the median duration of treatment episodes was 36 days, though this varied by treatment type; for example, median duration was 1 day for information and education, and 75 days for counselling (tables AODTS Selected drugs.1, SD.143)
  • nearly 2 in 3 (64%) treatment episodes ended with an expected cessation, while 19% ended with an unplanned completion (Table SD.134)
  • expected cessations were most common where the main treatment type was counselling (42%) (Table SD.142).

References

See reference list.