Alcohol treatment in Australia: Client characteristics and patterns of service use, 2013–14 to 2022–23

The Alcohol and Other Drug Treatment National Minimum Data Set (AODTS NMDS) includes information about the principal drug of concern (PDOC) that the client stated led them to receive treatment. In this report, the criteria include clients who have received treatment only for alcohol, or for alcohol and another PDOC across multiple episodes between 2013–14 and 2022–23. For further information see Technical notes – Overview of analysis variables and inclusion criteria. 

Process analysis of intensive treatment pathways for alcohol

Process analysis describes the flow of treatment provided to clients whose PDOC was alcohol, by key treatment characteristics. The following analysis includes all treatment episodes (at least 13) provided to clients in the intensive cohort between 2013–14 and 2022–23. For more information, see What is process analysis?

Principal drug of concern

Between 2013–14 and 2022–23, 9,936 clients received 199,568 treatment episodes in at least 3 years (noting these do not need to be consecutive). Process analysis by principal drug of concern (PDOC) for intensive treatment indicated that while around half (47%) of all clients received an initial treatment episode for alcohol, there were many different PDOC combinations in the treatment sequences for clients who received treatment for alcohol and another PDOC.

In Figure intensive treatment 1 treatment episodes ranked according to the number of episodes for each PDOC (left-hand side column). The probability of the subsequent episode involving treatment for the same or a different PDOC is shown by the intensity of colour across the row. For example, alcohol ranked the highest (most treatment episodes involved this PDOC) and the next most common treatment involved another episode of treatment for alcohol (77%).

Of all the treatment sequences of clients who received intensive treatment for alcohol and another PDOC:

• The majority of treatment episodes provided for alcohol as the PDOC involved a subsequent treatment episode for alcohol (77%, or 55,095).
• Initial treatment episodes for amphetamines (18% of all treatment episodes for this cohort), cannabis (18%), pharmaceuticals (4.9%) or heroin (4.6%) were the subject of treatment, subsequent treatment episodes most commonly involved either:

• the same PDOC initially treated, ranging from 35% or 3,569 of episodes for other drugs of concern to 67% or 22,450 of episodes for amphetamines), or
• alcohol as the next most common PDOC (ranging from 11% or 904 of episodes for heroin to 32% or 3,265 of episodes for other drugs of concern) (Figure intensive treatment 1, Table alcohol treatment 14).

Figure intensive treatment 1: Intensive treatment pathways for clients who received treatment for alcohol and another principal drug of concern, by principal drug of concern, 2013–14 to 2022–23

Main treatment

For clients who received intensive treatment for alcohol only or alcohol and another PDOC, around 1 in 3 (both 34%) of all treatment episodes were initially for counselling.  Where clients did not receive an initial treatment episode for counselling, just under 1 in 4 initial treatment episodes involved assessment only or withdrawal management for alcohol only (22% and 24%, respectively) or alcohol and another PDOC (19% and 17%, respectively).

While the initial episode of treatment showed some similarities for clients who received treatment for either alcohol only or alcohol and another PDOC, process analysis indicated that there were many different sequence flows from one main treatment type to another and these differed between clients who received treatment for alcohol only or alcohol and another PDOC.

Of all the treatment sequences of clients who received intensive treatment for alcohol only:

• Clients who received either counselling, assessment only, rehabilitation, withdrawal management, other treatment, or information and education as a main treatment type most commonly received a subsequent episode for the same main treatment type (ranging from 22%, or 1,184 of episodes for rehabilitation to 62% or 1,694 of episodes for information and education). 
• Clients who received either pharmacotherapy or support and case management most commonly received a subsequent episode for withdrawal management (30%, or 71 episodes and 25%, or 1,404 episodes, respectively). 
• If clients did not receive the same main treatment type in a subsequent episode:
  • Withdrawal management was the most common subsequent treatment after an episode for other main treatment (31%, or 962), pharmacotherapy (30%, or 71), support and case management (25%, or 1,404), or assessment only (21%, or 1,634).
  • Counselling was the most common subsequent treatment after an episode for rehabilitation, (19%, or 998 respectively), and withdrawal management (18%, or 2,341 respectively) (Figure intensive treatment 2, Table alcohol treatment 11).

Of all the treatment sequences of clients who received intensive treatment for alcohol and another PDOC:

• Clients most commonly received a subsequent episode for the same main treatment type (ranging from 22% or 3,134 of episodes for rehabilitation to 43%, or 11,696 of episodes for support and case management). 
• The next most common subsequent treatment after receiving the same main treatment type is either withdrawal management or counselling but for a smaller proportion of episodes (Figure intensive treatment 2, Table alcohol treatment 11).

Figure intensive treatment 2: Intensive treatment pathways for clients who received treatment for alcohol only or alcohol and another principal drug of concern, by main treatment, 2013–14 to 2022–23

The trace analyses represent sequences of treatment episodes in the order in which clients received treatment between 2013–14 and 2022–23. These traces reveal the most common pathways among clients who received intensive treatment for alcohol, by key treatment characteristics. For more information, see What is process analysis?

Principal drug of concern

Trace analysis indicated that there were 52 unique sequences by PDOC among clients who received intensive treatment for alcohol only across 13 or more treatment episodes occurring in at least 3 years between 2013–14 and 2022–23. For clients who received intensive treatment for alcohol and another PDOC, there were many more, around 6,800 unique sequences. 

For clients who received intensive treatment for alcohol only, the most common pathway involved 13 consecutive treatment episodes for alcohol and this was similar in all age groups (ranging from 15% (50, and 140 clients) for clients aged under 30, and 40–49 to 23% (37 clients) aged 60+), sex (16% (238 clients) for males and 17% (199 clients) for females), and remoteness area (ranging from 16% (245 clients) in Major cities to 20% (75 and 32 clients) in both Inner and Outer regional areas) (Figure intensive treatment 3, tables alcohol treatment 29–31). 

In contrast, for clients who had received intensive treatment for alcohol and another PDOC, there were many unique pathways with no dominant pattern. There were many different combinations of PDOCs with no common sequences of PDOCs or number of episodes in these treatment pathways. Some general patterns emerged by sex, age group, and remoteness area. For example: 

• For male clients, pathways were more likely to contain multiple episodes where amphetamines were the PDOC, in addition to alcohol, compared to female clients whose pathways were more likely to include multiple episodes where alcohol was the PDOC.
• Clients living in:
  • More remote areas were more likely to receive more treatment episodes than those living in Major cities.
  • Outer regional and Remote and very remote areas were more likely to have greater variation in both the range of PDOCs and their sequences.  
• For clients aged 10–19 when they first received treatment the most common initial episode was for either cannabis or alcohol followed by subsequent episodes for either alcohol or cannabis.
• For clients aged 20–29 and 30–39 when they first received treatment the most common initial episode was for either cannabis, alcohol or amphetamines followed by subsequent episodes for alcohol, amphetamines or cannabis. 
• For clients aged 40–49 and over 50 when they first received treatment the most common initial episode was for either alcohol or another drug of concern followed by subsequent episodes for alcohol or another drug of concern (Figure intensive treatment 3, tables alcohol treatment 29–31).

Figure intensive treatment 3: Intensive treatment pathways for clients who received treatment for alcohol, by age group, sex, or remoteness area, 2013–14 to 2022–23

Main treatment

Trace analysis indicated that there were around 2,600 unique sequences by main treatment type among clients who received intensive treatment involving 13 or more episodes in at least 3 years for alcohol only between 2013–14 and 2022–23. For clients who received treatment for alcohol and another PDOC, there were many more, around 7,245 unique sequences. Because there were so many unique sequences for clients who received intensive treatment, there were no dominant patterns. Clients received many different combinations of main treatment types including with varying numbers of episodes in these pathways (Figure intensive treatment 4, tables alcohol treatment 32–34).

Figure intensive treatment 4: Intensive treatment pathways for clients who received treatment for alcohol, by main treatment type, age group, sex, or remoteness area, 2013–14 to 2022–23