title: Substance use outcomes following treatment: Findings from the Australian Patient Pathways Study.
abstract: OBJECTIVE
  Our understanding of patient pathways through specialist Alcohol and Other Drug treatment and broader health/welfare systems in Australia remains limited. This study examines how treatment outcomes are influenced by continuity in specialist Alcohol and Other Drug treatment, engagement with community services and mutual aid, and explores differences between clients who present with a primary alcohol problem relative to those presenting with a primary drug issue.
  
  
  METHODS
  In a prospective, multi-site treatment outcome study, 796 clients from 21 Alcohol and Other Drug services in Victoria and Western Australia completed a baseline interview between January 2012 and January 2013. A total of 555 (70%) completed a follow-up assessment of subsequent service use and Alcohol and Other Drug use outcomes 12-months later.
  
  
  RESULTS
  Just over half of the participants (52.0%) showed reliable reductions in use of, or abstinence from, their primary drug of concern. This was highest among clients with meth/amphetamine (66%) as their primary drug of concern and lowest among clients with alcohol as their primary drug of concern (47%), with 31% achieving abstinence from all drugs of concern. Continuity of specialist Alcohol and Other Drug care was associated with higher rates of abstinence than fragmented Alcohol and Other Drug care. Different predictors of treatment success emerged for clients with a primary drug problem as compared to those with a primary alcohol problem; mutual aid attendance (odds ratio = 2.5) and community service engagement (odds ratio = 2.0) for clients with alcohol as the primary drug of concern, and completion of the index treatment (odds ratio = 2.8) and continuity in Alcohol and Other Drug care (odds ratio = 1.8) when drugs were the primary drugs of concern.
  
  
  CONCLUSIONS
  This is the first multi-site Australian study to include treatment outcomes for alcohol and cannabis users, who represent 70% of treatment seekers in Alcohol and Other Drug services. Results suggest a substantial proportion of clients respond positively to treatment, but that clients with alcohol as their primary drug problem may require different treatment pathways, compared to those with illicit drug issues, to maximise outcomes.
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Manning
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
authors.forename: Joshua Bb
authors.initials: JB
authors.lastname: Garfield
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|3 Sheffield Hallam University, Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Best
authors.affiliation: 4 Centre for Health and Social Research, Australian Catholic University, Melbourne, VIC, Australia.
authors.forename: Lynda
authors.initials: L
authors.lastname: Berends
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|5 Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.|6 Stockholm University, Stockholm, Sweden.
authors.forename: Robin
authors.initials: R
authors.lastname: Room
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|5 Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.
authors.forename: Janette
authors.initials: J
authors.lastname: Mugavin
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Larner
authors.affiliation: 7 Curtin University, Perth, WA, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Lam
authors.affiliation: 8 University of Sheffield, Sheffield, UK.|9 School of Rural Health, Monash University, Melbourne, VIC, Australia.
authors.forename: Penny
authors.initials: P
authors.lastname: Buykx
authors.affiliation: 7 Curtin University, Perth, WA, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Allsop
authors.affiliation: 1 Turning Point, Eastern Health, Fitzroy, VIC, Australia.|2 Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D014739:Victoria; D014904:Western Australia; D055815:Young Adult
keywords: Alcohol; continuity of care; drug; mutual aid; substance dependence; treatment outcomes