Specialist Outpatient Substance Use Treatment Services

There is high demand for specialist substance use treatment services in Australia, however, much of this demand is unmet. Outpatient counselling is the most common form of treatment accessed, but clients only attend an average of 1.6 treatment sessions. A recent meta-analysis of 48 randomized controlled trials of psychosocial treatments in alcohol outpatient settings, found the duration of treatment attendance had no impact on long-term alcohol outcomes. Together these findings suggest that not all clients who present to substance use services need intensive psychosocial or pharmacological treatment, and some may benefit from brief interventions. Stepped care models which offer low intensity brief interventions first, followed by more intensive treatment to clients who request, are assessed to require more (e.g. presence of withdrawal symptoms), or do not respond to treatment; have been recommended as a way to meet the unmet demand and maximise the cost-effectiveness of outpatient substance use treatment in Australia. Yet, there is still limited research examining stepped care models, or the efficacy of brief interventions within specialist settings. 

Only one meta-analysis has examined the efficacy of brief interventions for people seeking treatment from specialist substance use services. Twenty studies compared brief interventions to more extended substance use treatment, finding no differences in alcohol outcomes. A more recent high-quality randomized controlled trial also found no difference in the alcohol outcomes following three sessions of motivational interviewing with feedback, compared to a 12 session psychosocial intervention. While findings suggest that brief interventions were no less effective in reducing alcohol use in specialist outpatient AOD treatment settings, than more extended interventions, further research is required to establish equivalency.