Short-term Outcomes for the Treatment of Heroin Dependence Findings From the Australian Treatment Outcome Study (ATOS)

Aims: To examine drug use, crime, physical and mental health at 3 months postentry to treatment for heroin dependence. Design: Longitudinal cohort study. Setting: Sydney, Melbourne, and Adelaide, Australia. Participants: Seven hundred forty-five individuals recruited on entry to treatment for heroin dependence in the 3 main treatment modalities (methadone/buprenorphine maintenance therapy; detoxification; residential rehabilitation), and 80 heroin users who were not seeking treatment at baseline. Measurements: Structured questionnaires were used to measure drug use, crime, psychopathology, and physical health. At 3 months 10% of the cohort were randomly selected and provided a hair sample as a biologic measure of heroin use for the month preceding interview. Findings: A 3-month follow-up rate of 88% (n= 728) was achieved. There were substantial reductions in heroin use, polydrug use, injectionrelated risk-taking, heroin overdose, and criminal activity, as well as improvements in physical and mental health. Improvements were less marked among the nontreatment group. There was strong concordance between the cohort's self-reported heroin use and hair analysis results. Positive outcomes tended to be associated with a greater cumulative number of treatment days, and fewer treatment episodes. Conclusions: Treatment works in the short term. Greater treatment exposure was related to improvements across a range of outcomes.