People experiencing housing insecurity (including homelessness) and those receiving alcohol and other drug treatment services (AODTS) in Australia are particularly vulnerable to preventable disease and premature death (AIHW 2025a, 2025b, 2025c, 2025d; Flatau et al. 2021).

The characteristics of people who received both specialist homelessness services (SHS) and AOD treatment services and died throughout the study period 2012–13 to 2022–23 in Australia are detailed in this article.

Understanding the patterns, trends and causes of deaths among this group may highlight differences in health outcomes and inform prevention services, and improvements to policy and service design.

Analyses presented in this article are based on data from the NACS linked data set using the Specialist Homelessness Services Collection (SHSC), the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) and the National Death Index (NDI).

Data in this report will not match other reports produced by the AIHW about deaths in Australia including People with a history of specialist homelessness services support who have died and People who received specialist alcohol and other drug treatment services and died, due to different methodology. For more information see Technical notes.

For help or support

The AIHW respectfully acknowledges the people who have died who are described in this article.

The material presented below contains suicide and alcohol and other drug related data. Support is available via the following:

  • Crisis and support services for a comprehensive list of organisations providing support.
  • If you have any concerns about your own or someone else’s alcohol or drug use you can discuss this with your local General Practitioner or contact the National Alcohol and Other Drug Hotline on 1800 250 015 or a support and treatment centre.
  • Ask Izzy for connections to support services.

Key findings

Over the study period 2012–23, around 64,900 people died who received either SHS, AODTS or both. Of these, around,

  • 25,900 received AODTS only
  • 27,300 people received SHS only
  • 11,800 people received both SHS and AODTS.

Of the 11,800 people who received both SHS and AODTS who died, around:

  • 2 in 3 (68%) were male
  • 3 in 4 (74%) had a history of experiencing homelessness
  • over half (52%) had a history of injecting drug use
  • almost 2 in 5 (37%) had been treated for alcohol only throughout their treatment history.

Over the study period 2012–23:

  • Median age at death was younger among people who received both SHS and AODTS (46 years) compared with AODTS-only clients (54 years) and SHS-only clients (60 years).
  • Around 3 in 10 (29% or 11,200) deaths in people aged 25–40 in Australia had received either SHS, AODTS or both prior to death at some point since July 2012.
  • Suicide, accidental poisoning and land transport accidents were the leading causes of death for people aged under 35 who received SHS, AODTS or both.

In 2022–23,

  • People who received either SHS, AODTS or both who died, accounted for around 1 in 4 (24% or 186,000) potential years of life lost (PYLL) nationally.
  • People who received both SHS and AODTS support who died, on average, lost more potential years of life per death (27 PYLL) than AODTS-only clients (22 PYLL), SHS-only clients (18 PYLL) and non-SHS AODTS clients (12 PYLL).
  • Over 3 in 5 (63% or 1,300) deaths among people who received both SHS and AODTS were potentially avoidable – over 3 potentially avoidable deaths per day.

 

People who received SHS and AODTS who have died

Around 11,800 people who received both SHS and AODTS died between 2012–23; accounting for around 1 in 20 (5.2%) people who received both SHS and AODTS over the study period.

Around 2 in 3 (68%) people who received both SHS and AODTS who died were male.

Around 1.9 million people aged 10 and over were in scope for this study having received SHS and/or AODTS support for their own alcohol or drug use throughout the period 2012–23. Of these, around 64,900 people died (Table 1):

  • 25,900 had received AODTS only (AODTS-only clients)
  • 27,300 had received SHS only (SHS-only clients)
  • 11,800 had received both SHS and AODTS (SHS and AODTS clients).

Among all client groups, males accounted for a larger proportion of deaths than females. Males accounted for around 3 in 4 (74%) deaths in AODTS-only clients, over half (55%) of deaths in SHS-only clients and around 2 in 3 (68%) deaths in SHS and AODTS clients (Supplementary Table 3.2).

Over the study period, the crude mortality rate among SHS and AODTS clients was 64 deaths per 10,000 person-years; 1.6 times SHS-only clients (39), but lower than AODTS-only clients (79) (Table 1).

Of the 11,800 SHS and AODTS clients who died, most (88% or 10,300 people) had a history of receiving both services either at the same time or within any 2-year period (Table 1). SHS and AODTS clients with a history of ever receiving both SHS and AODTS at the same time had the highest mortality rate (74 per 10,000 person-years); almost 2 times those with a history of receiving services more than 2 years apart (38) (Table 1).

Table 1: Number of deaths and mortality rate among people who received either SHS, AODTS or both, 2012–23 

Client group

Total clients

Deaths

Mortality rate (per 10,000 person years)

AODTS-only clients

559,083

25,867

79.5

SHS-only clients

1,112,523

27,277

39.3

SHS and AODTS clients(a)

229,004

11,803

64.2

Ever received SHS and AODTS support at the same time(b)

84,429

5,153

74.2

Ever received SHS and/or AODTS support within any 2-year period(c)

98,772

5,178

68.4

SHS and/or AODTS support always received 2 years or more between services(d)

45,803

1,472

38.0

Source: Supplementary Table 3.1

(a) Total SHS and AODTS clients, that is, the sum of clients (b), (c) and (d). For SHS and AODTS clients, the timing of the support received reflects a client's experience across the entire study period and does not necessarily reflect the support received immediately prior to death.

Time since last support

Over the study period, a greater proportion of deaths in SHS and AODTS clients occurred within one year of receiving support (61% or 7,200 deaths), compared with SHS-only clients (31% or 8,500 deaths) and AODTS-only clients (40% or 10,300 deaths) (Supplementary Table 3.3).

A greater proportion of deaths in SHS and AODTS clients occurred while a period of support from either SHS, AODTS or both services was ongoing at the time of death (17% or 2,000 deaths) compared with SHS-only clients (6.5% or 1,800 deaths) and AODTS-only clients (6.7% or 1,700 deaths) (Supplementary Table 3.3).

Of the 2,000 SHS and AODTS clients who died while support was ongoing, around (Supplementary Table 3.3, see Definitions and important data quality notes):

  • 1 in 12 (8.6% or 175) were receiving both SHS and AODTS when they died
  • 1 in 2 (52% or 1,100) were receiving only SHS when they died
  • 2 in 5 (40% or 820) were receiving only AODTS when they died.

Age at death

Over the study period, around 3 in 10 (29% or 11,200) deaths in people aged 25–40 in Australia had received either SHS, AODTS or both prior to death at some point since July 2012.

Median age at death was younger among people who received both SHS and AODTS (46 years) compared with SHS-only (60 years) and AODTS-only clients (54 years).

Over the study period 2012–23, the median age at death among SHS and AODTS clients was 46 years; younger than AODTS-only clients (54 years) and SHS-only clients (60 years) (Supplementary Table 3.3). Among SHS and AODTS clients who died, median age at death was younger among females (45 years) than males (46 years). By contrast, median age at death was younger in male AODTS-only clients (53 for males; 56 for females) and similar among SHS-only clients (60 for both males and females).

Over the study period, the proportion of SHS and AODTS clients who died aged 65 and older (5.7%) was lower than SHS-only clients (39%), AODTS-only clients (25%), and much lower than people who did not receive SHS or AODTS support (non SHS or AODTS clients) (85%) (Supplementary Table 3.2, Figure 3).

Over the study period, around 3 in 10 (29% or 11,200) deaths in people aged 25–40 in Australia had received either SHS, AODTS or both prior to death and within the study period. A similar proportion of all deaths in males aged 25–40 (29% or 7,600) and females aged 25–40 (27% or 3,600) in Australia had received either SHS, AODTS or both prior to death (Supplementary Table 3.2).

Figure 3: Deaths (per cent), by age and client group, 2012–2023

The stacked bar chart shows 30% of total deaths at age 37 had received support from SHS, AODTS, or both prior to death.

The stacked bar chart shows 30% of total deaths at age 37 had received support from SHS, AODTS, or both prior to death.

Source: Supplementary Table 3.2.

Time since last support

Over the study period 2012–23, the median age at death was younger among SHS and AODTS clients receiving ongoing support when they died (44 years) compared with AODTS-only clients (48 years) and SHS-only clients (54 years) receiving ongoing support when they died (Supplementary Table 3.3).

Of the 2,000 SHS and AODTS clients who died while support was ongoing, median age at death varied based on which service was received closest to death (either SHS, AODTS or both):

  • 40 years among those receiving both ongoing SHS and AODTS when they died
  • 44 years for those receiving only ongoing SHS when they died
  • 44 years for those receiving only ongoing AODTS when they died.

Potential years of life lost

In 2022–23, people who received either SHS, AODTS or both who died, accounted for around 1 in 4 (24% or 186,000) potential years of life lost (PYLL) nationally.

In 2022–23, people who received both SHS and AODTS support who died, on average, lost more potential years of life per death (27 PYLL) than AODTS-only clients (22 PYLL), SHS-only clients (18 PYLL) and non-SHS AODTS clients (12 PYLL).

Potential years of life lost (PYLL) is an estimate of the number of years longer a person might have lived had they not died prematurely. For example, dying before the age of 75 is considered premature; therefore, a person who died aged 55 would have lost 20 years of potential life. For more information, see Deaths in Australia, Age at death. Potential years of life lost is only applicable to people aged 10–74 years in this report and the study period is limited to 2018–19 to 2022–23. For more information, see Technical notes.

In 2022–23, around 24% (186,000 PYLL) of all the PYLL in Australia were among people who had received either SHS and/or AODTS, an increase from 19% in 2018–19 (Supplementary Table 3.4).

In 2022–23, SHS and AODTS clients had a higher average PYLL per death (27 PYLL) than AODTS-only clients (22 PYLL), SHS-only clients (18 PYLL) and non-SHS AODTS clients (12 PYLL); consistent with the younger median age at death (46 years) among SHS and AODTS clients (Supplementary Table 3.3).

In 2022–23, SHS and AODTS clients who died accounted for around 1 in 15 (6.9% or 53,700) PYLL nationally (Supplementary Table 3.4). Of the 53,700 PYLL (Supplementary Table 3.4):

  • around 2 in 3 (65% or 35,100) PYLL were among males
  • over half (54% or 28,900) of PYLL were among those who received both SHS and AODTS within 1 year prior to death.

In 2022–23, males who received both SHS and AODTS who died accounted for 1 in 14 (7.1%) PYLL among all males, higher than for females who accounted for around 1 in 16 (6.4%) PYLL among all females (Supplementary Table 3.4).

Time since last support

In 2022–23, SHS and AODTS clients that received support up to 6 months prior to death had higher average PYLL (29–31 PYLL) than those who received support beyond 6 months prior to death (24–28 PYLL) (Supplementary Table 3.4).

Principal drug of concern

Over the study period 2012–23, among deaths in people who received both SHS and AODTS, almost 2 in 5 (37% or 4,400) were treated for alcohol only throughout their specialist AOD treatment history.

A principal drug of concern (PDOC) refers to the main substance which an AODTS client stated led them to receive treatment. A person may have multiple treatment episodes over their lifetime and may receive treatment for different PDOCs in each treatment episode. For example, a person may receive treatment for alcohol use in one treatment episode, followed by another treatment episode for heroin use. Some people may receive treatment for the same PDOC each time they receive treatment (that is, each episode). These episodes could occur in the same year, or in different years. In the results presented here, if a client is treated for two different PDOCs, they may be counted more than once. For example, a client treated for alcohol and heroin will be included in results for 'Alcohol and another drug' and 'Heroin and another drug'. See the AODTS NMDS Annual Reporting Technical notes for more information on how drugs of concern are classified. 

The information presented below on PDOC includes all treatment episodes a client received for their own drug or alcohol use over the study period. That is, it presents a combination of all PDOCs a client has received treatment for, at any point between 1 July 2012 and 30 June 2023. This is because some drug use and drug combinations may be associated with a greater rate of death. To only include the PDOC a client received in their last treatment episode prior to death would mask any differences the combination of PDOCs may have on a person’s outcomes. 

Due to the nature of this study, the service and PDOC history will not be as complete for those clients who died earlier in the reporting period, as those clients who died later in the reporting period. Similarly, the analysis here only presents a client’s PDOC history over the entire study period, which may mask changes over time for specific PDOC combinations.

The information below does not indicate whether a client’s PDOC was related to, caused by, or present in their death. These findings serve to highlight mortality among clients with different PDOC treatment histories, warranting its further analyses. 

For more information on PDOC analysis used in this article see Technical notes.

Over the study period 2012–23, among the 11,800 SHS and AODTS clients who died (Figure 4):

  • almost 2 in 5 (37% or 4,400) were treated for alcohol only throughout their specialist AOD treatment service history.
  • around 1 in 8 (12% or 1,400) were treated for alcohol and another drug throughout their specialist AOD treatment service history.

SHS and AODTS clients who died were more likely to have received specialist AOD treatment for multiple drugs of concern during their treatment history than AODTS-only clients (Supplementary table 3.7 and Figure 4). Over the study period, 1 in 9 (11% or 1,300) SHS and AODTS clients who died were treated for 3 or more PDOC(s) throughout their treatment history; higher than AODTS-only clients (2.3% or 600).

Female SHS and AODTS clients who were treated for pharmaceuticals only (7.0%) or pharmaceuticals and another drug (6.4%) accounted for a greater proportion of deaths than their male counterparts (5.0% and 5.3% respectively) (Supplementary table 3.7).

Over the study period, a greater proportion of deaths among SHS and AODTS clients occurred in those who received specialist AOD treatment services for heroin only or pharmaceuticals only compared with other PDOC(s) and combinations of PDOC(s) (Figure 4, Supplementary table 3.7).

  • Among the 5,200 SHS and AODTS clients who received specialist AOD treatment services for heroin only, around 1 in 9 (11% or 590) died; a higher proportion than AODTS-only clients (7.8%).
  • Among the total 6,000 SHS and AODTS clients who received specialist AOD treatment services for pharmaceuticals only, around 11% or 660 people died; a higher proportion than AODTS-only clients (9.9%).

Figure 4: Deaths among people who received SHS and/or AODTS, by principal drug of concern and sex, 2012–2023

The horizontal bar chart shows among deaths in SHS and AODTS clients, most (4,373) had received AODTS for the treatment of alcohol only.

The horizontal bar chart shows among deaths in SHS and AODTS clients, most (4,373) had received AODTS for the treatment of alcohol only.

Source: Supplementary Table 3.7.

Additional specific vulnerabilities – history of homelessness or injecting drug use

Over the study period 2012–23, of the 11,800 people who received both SHS and AODTS who died, around 3 in 4 (74%) had a history of experiencing homelessness and over half (52%) had a history of injecting drug use.

Over the study period 2012–23, of the 11,800 SHS and AODTS clients who died (Supplementary Table 3.5):

  • Around 3 in 4 (74% or 8,800) had a history of homelessness; a higher proportion than SHS-only clients (48%).
  • Over half (52% or 6,100) had a history of injecting drug use; a higher proportion than AODTS-only clients (27%).

Median age at death among SHS and AODTS clients with a history of homelessness was younger (45 years) than SHS-only clients with a history of homelessness (56 years). Similarly, median age at death among SHS and AODTS clients with a history of injecting drug use was younger (44 years) than AODTS-only clients (47 years) (Supplementary Table 3.5).

Among SHS and AODTS clients, males were more likely to have a history of homelessness (78%) and history of injecting drug use (54%) compared with females (67% and 48%, respectively) (Supplementary Table 3.5). However, median age at death was younger among females with a history of homelessness (43 years) and history of injecting drug use (43 years) compared with males (46 years and 45 years respectively) (Supplementary Table 3.5).

Underlying cause of death

Over the study period 2012–23, suicide, accidental poisoning and land transport accidents were the leading causes of death for people aged under 35 who received SHS, AODTS or both.

For information about how causes of death are classified, see Technical notes. Accidental poisoning is caused by exposure to a substance in an amount that unintentionally causes death, which includes accidental drug overdose. In 2022–23, most deaths from accidental poisoning in Australia were caused by other and unspecified drugs and biological substances, followed by antiepileptics, sedatives and psychotropics, and then narcotics, opioids and hallucinogens. For information on accidental poisoning see Injury in Australia: Accidental poisoning. Information on which specific substance was associated with accidental poisoning deaths in this article is not specified.

Over the study period 2012–23, among all client groups, suicide and accidental poisoning were more common underlying causes of death among younger clients while liver disease and coronary heart disease were more common among older clients (Supplementary Table 3.6, Figure 5).

Among people aged 18–64 who had received SHS, AODTS or both who died, around 1 in 7 (14% or 6,300) had died from suicide and around 1 in 6 (16% or 7,300) had died from accidental poisoning (Supplementary Table 3.6).

Suicide

Over the study period, around 79,800 people aged 18–64 in Australia died from suicide. Of these, around 1 in 12 (8.0% or 6,300) deaths were among people who received support from SHS, AODTS, or both prior to death and within the study period; somewhat higher among females who died from suicide (9.3% or 1,800 deaths) than males (7.5% or 4,500 deaths) (Supplementary Table 3.6).

Among SHS and AODTS clients aged 18–64, suicide accounted for around 1 in 7 deaths (14% or 1,600 deaths); similar among males (14% or 1,100 deaths) and females (14% or 490 deaths). A higher proportion of AODTS-only clients aged 18–64 died from suicide (15% or 3,000 deaths) than SHS and AODTS clients (14% or 1,600 deaths) and SHS-only clients (11% or 1,800 deaths).

Accidental poisoning

Over the study period, around 41,200 people aged 18–64 in Australia died from accidental poisoning. Of these, around 1 in 5 (18% or 7,300) deaths were among people who received support from SHS, AODTS, or both prior to death and within the study period; a similar proportion among males (18% or 5,100 deaths) and females (17% or 2,200 deaths).

Among SHS and AODTS clients aged 18–64, accidental poisoning accounted for around a quarter (25% or 2,800) of deaths; higher than AODTS-only clients (16% or 3,000) and SHS-only clients (9.1% or 1,500) aged 18–64 who died from accidental poisoning.

Over the study period, most deaths in SHS and AODTS clients were aged 35–54 (Supplementary Table 3.2). Among SHS and AODTS clients who died aged 35–44 years, a greater proportion of clients died from accidental poisoning (34% or 1,100) than among AODTS-only clients (26% or 1,000) and SHS-only clients (17% or 465). However, a lower proportion of SHS and AODTS clients who died aged 35–44 years, died from suicide (15% or 455) than AODTS-only clients (21% or 840) and SHS-only clients (16% or 450).

Figure 5: Deaths among people who received SHS and/or AODTS, by selected causes of death, client group, sex and age, 2012–23

The bar chart shows accidental poisoning and suicide were more common underlying causes of deaths in younger age groups than older age groups across all client groups.

The bar chart shows accidental poisoning and suicide were more common underlying causes of deaths in younger age groups than older age groups across all client groups.

Note: Data are limited to the top 10 ranked causes of death in each client group and age group. See table 3.6 for further detail.

Source: Supplementary Table 3.6.

Potentially avoidable deaths

In 2022–23, over 3 in 5 (63% or 1,300) deaths among people who received both SHS and AODTS were potentially avoidable – over 3 potentially avoidable deaths per day.

Potentially avoidable deaths are deaths from conditions that could have been prevented or treated with timely and effective health care. Potentially avoidable deaths are classified using nationally agreed definitions based on cause of death for people aged under 75. For more information, see the Australian Health Performance Framework.

Note that potentially avoidable deaths contribute to but do not account for total potential years of life lost, the latter being a measure of all premature death (not just death that was potentially avoidable).

Potentially avoidable deaths are only applicable to people aged 10–74 years in this report and is also limited to 2018–19 to 2022–23. For more information, see Technical notes.

In 2022–23, over half (57% or 4,900) of deaths among people who received SHS, AODTS or both were potentially avoidable (Supplementary Table 3.8). Of the 4,900 potentially avoidable deaths, around:

  • 1,800 deaths were among AODTS-only clients
  • 1,900 deaths were among SHS-only clients
  • 1,300 deaths were among SHS and AODTS clients.

The proportion of potentially avoidable deaths among SHS and AODTS clients (63%) was higher than among AODTS-only clients (54%), SHS-only clients (55%) and non-SHS or AODTS clients (46%) (Supplementary Table 3.8).

Time since last support

As time since last support increased, the proportion of potentially avoidable deaths among SHS and AODTS clients varied (Supplementary Table 3.8). Throughout 2018–19 to 2022–23, among SHS and AODTS clients who died:

  • over 2 in 3 (69% or 900) deaths among those who received ongoing support were potentially avoidable
  • over 2 in 3 (69% or 1,100) deaths among those who received support between 1–6 months prior to death were potentially avoidable
  • 2 in 3 (66% or 690) deaths among those who received support between 6–12 months prior to death were potentially avoidable
  • 3 in 5 (58% or 1,300) deaths among those who received support more than 2 years prior to death were potentially avoidable.

Throughout 2018–19 to 2022–23, the proportion of potentially avoidable deaths was higher among males than females who died while receiving ongoing SHS and specialist AOD treatment services (70% of males compared with 68% of females), within 1–6 months prior to death (71% of males compared with 66% of females) and more than 2 years prior to death (60% of males and 54% of females) (Supplementary Table 3.8).

Throughout 2018–19 to 2022–23, SHS and AODTS clients who died while receiving ongoing support had a higher proportion of potentially avoidable deaths (69% or 900) compared with SHS-only clients (61% or 475) and AODTS-only clients (61% or 510) receiving ongoing support. This pattern was similar among male and females (Supplementary Table 3.8).

Figure 6: Percentage of deaths that were potentially avoidable, by client status and time since last support, ages 10–74, 2018–19 to 2022–2023

This heat map shows people who received SHS and AODTS had a higher proportion of potentially avoidable deaths across all time since support categories compared with AODTS-only clients and SHS-only clients.

This heat map shows people who received SHS and AODTS had a higher proportion of potentially avoidable deaths across all time since support categories compared with AODTS-only clients and SHS-only clients.

Source: Supplementary Table 3.8.

Data