Introduction
Alcohol and other drug (AOD) use in Australia contributes to a significant burden of physical and social harms, including chronic disease, mental illness, injury, substance dependence and premature death (AIHW 2018). Support for those who use alcohol and drugs, as well as their families and friends, are available through specialist AOD treatment services. These services may provide several treatment types to those seeking treatment for their own AOD use, ranging from providing one-off information and education sessions to residential rehabilitation programs and withdrawal management.
Due to the chronic nature of alcohol and drug dependence, clients seeking AOD treatment often experience cycles of treatment, recovery, relapse and repeated treatment (Lubman D et al 2014). When entering AOD treatment, clients and services will identify the clients’ goals and develop a treatment plan accordingly. Such goals could include the abstinence from, or managed use of a substance and develop a treatment plan accordingly. While treatment objectives vary from client to client, specialist AOD treatment commonly involves multiple episodes of different treatment types over time. For example, a treatment plan might include assessment, supervised withdrawal and rehabilitation, and multiple episodes of follow-up counselling (Kelly JF et al 2019; Lubman D et al 2014).
Studies in both Australian and international contexts have found that stable retention in treatment over time is a predictor of more positive treatment outcomes (AIHW 2011; Lubman D et al 2014). As AOD treatment is often structured around multiple discrete treatment episodes, client engagement over the course of treatment can be examined through how each episode ends. For example:
- Treatment episodes ending as planned (such as where the client has met their treatment goals or by mutual agreement with the service) may indicate more positive client engagement with services.
- Conversely, treatment ending with an unplanned completion (such as a client ceasing to participate against advice or without notice) may indicate less effective engagement between a service and a client.
As such, understanding how clients end each treatment episode is important to the design and delivery of effective treatment services.
In Australia, publicly funded treatment services for AOD use are available in all states and territories. Data from publicly funded AOD treatment services in Australia are collected through the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS). The NMDS includes information on client characteristics, such as age and sex. It also holds information on treatment episodes (the periods of contact between a client and treatment provider), including the principal drug of concern, treatment type, setting and duration.
For further information on the AODTS NMDS, see Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS).
The National Drug Strategy (NDS) 2017–2026 provides a framework for a coordinated approach to minimising AOD-related harms in Australia. Its purpose is to build ‘safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social and economic harms’ (DoH 2017).
The NDS recognises measuring performance as one of its priority actions, which includes ‘robust evaluation processes to effectively measure impact or outcome of work undertaken, including consistent monitoring and reporting of treatment outcomes.’ The NDS also identifies priority populations, including both young and older people, and priority substances, including alcohol and methamphetamines.
Understanding why people leave AOD treatment and how these reasons vary by demographic and treatment characteristics can inform our understanding of treatment outcomes. These findings will contribute to building the evidence base for AOD treatment design and delivery.
For further information, see the National Drug Strategy 2017–2026 Australian Government Department of Health and Aged Care web page .
How is completion of AOD treatment measured?
Reason for cessation is a variable in the AODTS NMDS that records how a client completed an AOD treatment episode. In previous analyses, this variable has been treated as a proxy for treatment outcomes (AIHW 2021). Identifying the circumstances in which clients complete their treatment can inform design and delivery of treatment services.
Reason for cessation can be grouped broadly into 4 categories:
- Treatment ended as expected/planned
- Treatment ended unexpectedly
- Client was referred to another service or changed their treatment mode
- Other (imprisoned, died or reasons not elsewhere classified).
For further information on the attributes and limitations of this variable, refer to the Technical notes.
What does this report examine?
This report will examine differences in reason for cessation of AOD treatment for alcohol and amphetamines as a principal drug of concern, across treatment characteristics, including treatment intensity over time and individual treatment episode characteristics.
To achieve this, the report uses closed treatment episode data from the AODTS NMDS, spanning a 10-year period from 2011–12 to 2020–21 and client data from 2013–14 to 2020–21.
This report aims to explore:
- How patterns of service use and differences in treatment intensity over multiple episodes relate to completion of AOD treatment.
- Whether there are differences in completion of treatment for alcohol compared to amphetamines as the principal drug of concern, client remoteness and treatment type.
Australian Institute of Health and Welfare (AIHW; 2011). “Review of the Alcohol and Other Drug Treatment Services National Minimum Data Set.” Drug treatment series no. 11. Cat. no. HSE 94. Canberra: AIHW.
AIHW (2018). “Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011.” Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.
AIHW (2019). “Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment, 2016–17.” Cat. no. HSE 212. Canberra: AIHW.
AIHW (2021). “Patterns of intensive alcohol and other drug treatment service use in Australia: 1 July 2014 to 30 June 2019.” Cat. no. HSE 251. Canberra: AIHW.
Department of Health (2017). “National Drug Strategy 2017–2026.” Canberra: DoH.
Kelly JF, White WL (2011). “Addiction recovery management: theory, research and practice.” Springer Science+Business Media. New York.
Lubman D, Manning V, Best D, Berends L, Mugavin J, Lloyd B et al. (2014). “A study of patient pathways in alcohol and other drug treatment: Patient Pathways National Project.” Fitzroy, VIC: Turning Point.