title: Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome Study.
abstract: OBJECTIVE
  To determine the long-term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin-dependent Australians.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Sydney, Australia.
  
  
  METHODS
  A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow-up interviews at 3, 12, 24 and 36 months post-baseline, and again at 11 years post-baseline; 431 (70.1%) of the original 615 participants completed the 11-year follow-up.
  
  
  METHODS
  Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow-up interview.
  
  
  RESULTS
  At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk-taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.
  
  
  CONCLUSIONS
  In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Maree
authors.initials: M
authors.lastname: Teesson
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Christina
authors.initials: C
authors.lastname: Marel
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Darke
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ross
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Slade
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Burns
authors.affiliation: National Addiction Centre, Institute of Psychiatry, London.
authors.forename: Michael
authors.initials: M
authors.lastname: Lynskey
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Sonja
authors.initials: S
authors.lastname: Memedovic
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: White
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia.|NHMRC Centre for Research Excellence in Mental Health and Substances Use, University of New South Wales, Australia.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Mills
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data*; D003865:Major Depressive Disorder / Q000150:complications / Q000401:mortality*; D017831:Diagnosis, Dual (Psychiatry); D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D003932:Heroin / Q000506:poisoning; D006556:Heroin Dependence / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008603:Mental Health; D016485:Needle Sharing / Q000706:statistics & numerical data; D009517:New South Wales / Q000453:epidemiology; D010554:Personality Disorders / Q000150:complications / Q000401:mortality*; D017678:Sex Distribution; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D003932:Heroin
keywords: Cohort; criminality; heroin; longitudinal; mortality; psychiatric comorbidity