Treatment

Many types of treatment are available in Australia to assist people with problematic drug use. Most aim to reduce the harm of drug use through treatments such as counselling, and information and education. Additionally, some use a structured drug-free setting with abstinence-oriented interventions to help prevent relapse and develop skills and attitudes that assist clients to make changes leading to drug-free lifestyles.

In 2017–18, 209,287 closed treatment episodes were provided to clients. The number of closed treatment episodes has increased by around 46% over the last 10 years, up from 143,672 in 2008–09. In the last year, there has been an increase in the number of reported treatment episodes, up from 200,751 in 2016–17. Nationally, clients seeking treatment received an average of 1.6 treatment episodes in 2017–18.

Treatment types

In 2017–18, counselling continued to be the most common main treatment type provided to clients, comprising almost 2 in 5 (39%) closed treatment episodes. Assessment only was the second most common main treatment type (16%), followed by support and case management only (15%) and withdrawal management (12%).  For clients receiving treatment for someone else’s drug use, the most common treatment type was counselling (71%), followed by information and education only (12%) and support and case management only (8%).

Counselling was the most common main treatment type in all jurisdictions except in South Australia and the Northern Territory, where assessment only was the most common (42% and 47% of closed episodes, respectively). In the Australian Capital Territory information and education only was the most common (32%). The differences in main treatment reporting may apply to jurisdictional differences in service provision in some cases, e.g. assessment only as main treatment type relates to a number of police drug diversion referrals in South Australia.

Nationally over the last 10 years, the proportion of episodes for the four most common main treatment types has changed. For example, support and case management only has increased (from 9% to 15% of closed treatment episodes), while withdrawal management has decreased (from 18% to 12% of closed treatment episodes). Counselling and assessment only have slightly increased (from 37% to 39% and 15% to 16% of closed treatment episodes, respectively), although these proportions have fluctuated over the 10 years.

Treatment delivery setting

Nationally, the majority of closed treatment episodes were provided in a non-residential treatment facility setting (64%), followed by residential treatment facilities (16%) and outreach settings (13%).

Non-residential treatment facilities, such as community-based NGO’s and hospital outpatient services, were the most common delivery setting for clients receiving treatment for heroin (69%), cannabis (69%), amphetamines (65%) or alcohol (63%) as their principal drug of concern.

Residential treatment facilities, where clients reside in a facility that is not their home or usual place of residence, were the second most common treatment setting for clients with heroin (21%), alcohol (20%) or amphetamines (19%) as their principal drug of concern.

Outreach settings, that is, any outreach environment where AOD specialist treatment is provided that is not a client’s home or usual place of residence and is not covered by non-residential and residential treatment facilities, were the second most common setting for clients receiving treatment for cannabis as their principal drug of concern (17%).

For treatment episodes delivered in a non-residential treatment facility, counselling was the most common (53%) main treatment type. In residential facilities, withdrawal management was the most common (49%) main treatment type, while support and case management only was the most common (33%) main treatment type in outreach settings.

Length of treatment

Among clients seeking treatment for their own drug use, the median duration of closed treatment episodes was just under 3 weeks (19 days). Almost 4 in 5 (80%) closed treatment episodes ended within 3 months, and 30% of closed treatment services ended within one day. Around 7% of treatment episodes lasted 6 months or longer.

The duration of closed treatment episodes varied by main treatment type. The median duration of closed treatment episodes was 57 days for clients receiving counselling, 52 days for clients receiving rehabilitation, 26 days for clients receiving support and case management only, 8 days for clients receiving withdrawal management, and 1 day for clients who were provided with an assessment only.

Treatment duration also varied by principal drug of concern. The median duration of closed treatment episodes was 23 days for clients receiving treatment for heroin, 29 days for clients receiving treatment for amphetamines, 26 days for clients receiving treatment for alcohol, and 14 days for clients receiving treatment for cannabis. Since 2016–17, the median duration of heroin treatment episodes has decreased (23 days in 2017–18, compared with 29 days in 2016–17). Alternatively, the median duration of cocaine treatment episodes increased (22 days in 2017–18, compared with 15 days in 2016–17).

During the 5 years prior to 2017–18, clients receiving treatment for heroin as their principal drug of concern tended to have longer treatment episodes compared with clients receiving treatment for alcohol, amphetamines or cannabis. However, in 2017–18, treatment episodes for alcohol (26 days) and amphetamines (29 days) were longer compared with clients receiving treatment for heroin (23 days).

Reasons for cessation

In 2017–18, more than half (63%) of closed treatment episodes for a client’s own drug use were expected/planned completions, followed by 20% of closed treatment episodes ending due to unplanned completion and 7% being referred to another service/change in treatment mode.

Over the last 10 years, closed episodes for each reason for cessation have remained relatively constant.

Where ecstasy was reported as the principal drug of concern, 86% of treatment episodes ended due to an expected/planned completion. Where amphetamines were the principal drug of concern, 26% of treatment episodes ended due to unplanned completion, the highest proportion of closed episodes among all principal drugs of concern.