Shane Darke1, Christina Marel1,2, Tim Slade1,2, Joanne Ross1,2, Katherine L Mills1,2, Maree Teesson1,2. 1. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia. 2. NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Abstract
OBJECTIVE: We report on patterns and correlates of sustained abstinence at the 11-year follow-up of the Australian Treatment Outcome Study cohort. METHOD: This report is a longitudinal cohort analysis of patterns of recent and sustained abstinence. RESULTS: A total of 431 (70.1%) of the original 615 participants were interviewed, and 10.2% were deceased. The mean elapsed time since heroin initiation was 20.4 years (SD = 7.2). At the 11-year follow-up, heroin abstinence over the preceding month was reported by 75.2%. A period of at least 1 month's abstinence across the follow-up was reported by 97.7% and at least 1 year by 89.9%, whereas 52.2% reported an abstinence period of 5 or more consecutive years. Sustained abstinence across the entire follow-up period was reported by 5.6%. Independent correlates of 5 or more consecutive years of heroin abstinence were female gender (odds ratio [OR] = 1.73), not being currently enrolled in a drug treatment program (OR = 2.16), and fewer treatment episodes across the follow-up (OR = 0.90, 95% CI [0.85, 0.96]). CONCLUSIONS: The clinical profile of the cohort at the 11-year follow-up was encouraging, with the majority currently heroin abstinent, a proportion that has increased across time. Although only a small minority maintained abstinence over the entire period, half had sustained abstinence for at least 5 consecutive years. With the exception of gender, baseline characteristics made poor predictors of long-term abstinence. Treatment stability, however, appears crucial in maintaining abstinence.
OBJECTIVE: We report on patterns and correlates of sustained abstinence at the 11-year follow-up of the Australian Treatment Outcome Study cohort. METHOD: This report is a longitudinal cohort analysis of patterns of recent and sustained abstinence. RESULTS: A total of 431 (70.1%) of the original 615 participants were interviewed, and 10.2% were deceased. The mean elapsed time since heroin initiation was 20.4 years (SD = 7.2). At the 11-year follow-up, heroin abstinence over the preceding month was reported by 75.2%. A period of at least 1 month's abstinence across the follow-up was reported by 97.7% and at least 1 year by 89.9%, whereas 52.2% reported an abstinence period of 5 or more consecutive years. Sustained abstinence across the entire follow-up period was reported by 5.6%. Independent correlates of 5 or more consecutive years of heroin abstinence were female gender (odds ratio [OR] = 1.73), not being currently enrolled in a drug treatment program (OR = 2.16), and fewer treatment episodes across the follow-up (OR = 0.90, 95% CI [0.85, 0.96]). CONCLUSIONS: The clinical profile of the cohort at the 11-year follow-up was encouraging, with the majority currently heroin abstinent, a proportion that has increased across time. Although only a small minority maintained abstinence over the entire period, half had sustained abstinence for at least 5 consecutive years. With the exception of gender, baseline characteristics made poor predictors of long-term abstinence. Treatment stability, however, appears crucial in maintaining abstinence.
Authors: John Strang; Nora D Volkow; Louisa Degenhardt; Matthew Hickman; Kimberly Johnson; George F Koob; Brandon D L Marshall; Mark Tyndall; Sharon L Walsh Journal: Nat Rev Dis Primers Date: 2020-01-09 Impact factor: 52.329
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