Alcohol and other drug treatment services in Australia annual report

COVID-19

From 2019–20 to 2021–22, restrictions related to the COVID-19 pandemic continued and impacted delivery of services including AOD treatment for withdrawal management and residential rehabilitation. The latter included closure of services for a period of time in some states. Withdrawal and rehabilitation bed-based occupancy decreased compared to pre-COVID-19 occupancy in most states. Counselling and face-to-face outreach services also moved to providing telehealth services to ensure social distancing and public health guidelines were met. The number of AOD referrals decreased and the number of admission cancellations increased for residential withdrawal and rehabilitation services. The majority of providers moved to a telehealth model and discontinued face-to-face contact with clients unless the client received withdrawal or rehabilitation services.

Summary information provided by states and territories, regarding the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) data collection:

New South Wales

From 2019–20 to 2021­–22, the ongoing impact of COVID has seen:

• services use telehealth, primarily telephone or video conferencing for group sessions
• staff turnover and sickness impacting ability to deliver services, including increased workload as well as additional tasks (for example, ongoing cleaning)
• some treatment services (such as withdrawal management and residential rehabilitation services) were impacted due to social distancing rules and continued to have limited occupancy rates and bed capacity in both non-government and government services. These constraints meant services had to reduce the availability of treatment places
• constraints to service delivery also had an impact on data collection including less timely data uploads due to staff working from home. Local health districts also reported unexpected data system loading issues
• risk management practices and PPE increased workloads for staff and mask wearing was a barrier to engaging with clients and seeing non-verbal cues
• some services closed, which increased the workload of services that remained open
• all home visits/ external (outreach) service visits were suspended for a period of time
• difficulty accessing technology for some clients
• new client assessments decreased as treatment places were limited
• access for agencies regarding ICT infrastructure and internet capacity highlighted a divide for regional and rural services; weak connectivity contributed to potential decline of some service delivery
• some local health districts reported workforce and service delivery issues, which may have impacted the number of closed episodes
• regional and rural services were less affected; however, access to metropolitan services by rural clients was affected.

Victoria

The impact of COVID from 2019–20 to 2021–22 saw the majority of providers move to telehealth service provision, discontinuing face-to-face contact with clients unless they were receiving residential withdrawal and rehabilitation services.

Impacts on residential withdrawal and rehabilitation services included:

• bed based units operating at reduced bed capacity during lockdowns, ensuring social distancing requirements were met. Occupancy across all residential services fell compared to pre-COVID as a result of social distancing requirements
• COVID-19 restrictions also reduced the number of referrals and increased the number of admission cancellations to residential withdrawal and rehabilitation services
• wait times between referrals and admissions also increased due to reduced capacity. Leave and visitors were prohibited during residential stays to decrease risk
• services reduced the number of referrals and increased the number of admission cancellations.

While the number of non-residential withdrawal episodes increased slightly between 2019–20 and 2020–21, during extensive COVID-19 lockdowns non-residential withdrawal service contacts included an electronic process rather than face-to-face, which may have been coded as ‘other’ setting rather than a non-residential treatment facility setting.

Queensland

From 2019–20 to 2021–22, the impact of COVID-19 has seen:

• a decrease in closed treatment episodes across all treatment types for the period of Mar–Jun 2020, particularly for counselling and information and education
• there was also a decrease in the reporting of diversion referrals from the justice system due to public restrictions being in place and restricted operation of the Magistrates Courts. From March to August 2020, most police and court diversion appointments were scheduled to occur by telephone, with only a few providers offering face-to-face appointments. In 2020–21, diversion referral episodes from the justice system increased compared to 2019–20, potentially due to the easing of public restrictions
• in January 2022, there was a lockdown in Queensland and services continued to provide treatment episodes via different modes of delivery. There was a drop in appointments for the Police Drug Diversion Program, Illicit Drugs Court Diversion Program and Drug and Alcohol Assessment Referral Program. Diversion treatment episodes (and hence AODTS interventions) also decreased between financial years; however, this may be for a number of reasons (including COVID lockdown).
• Referrals to the Police Drug Diversion Program, Illicit Drugs Court Diversion Program and Drug and Alcohol Assessment Referral Program (DAAR) have continued to decline, continuing a trend that commenced in 2015-16.

Western Australia

As a result of COVID–19, services offered more telehealth appointments and organisations continued to report COVID impacted service delivery from 2019–20 to 2021–22. Examples include:

• inability to recruit staff due to border restrictions
• staff sickness and isolation periods affecting workforce availability
• staff not being vaccinated in line with government requirements
• residential services were required to close beds at times due to government public health restrictions, which may result in less episodes at some agencies
• decreased bed capacity across residential services, including rehabilitation and withdrawal services.

South Australia

From 2019–20 to 2021–22, the impacts for treatment service delivery due to COVID-19 included:

• a proportion of counselling services shifted from face-to-face appointments to telehealth and telephone clinical support to clients in treatment
• there was decreased bed capacity across residential services and withdrawal services, reducing the amount of people accessing these services
• medically assisted treatment for Opioid Dependence prescription review periods were increased from 3 to 6 months during COVID restrictions
• Drug and Alcohol Services SA (DASSA) were asked to implement a Work from Home (WFH) mandate
• eligibility criteria for entry into DASSA’s inpatient withdrawal management facility was reviewed during COVID-19, resulting in cannabis and amphetamine withdrawal management clients being referred to outpatient services and SA's non-government sector.

Tasmania

COVID-19 restrictions in Tasmania from 2019–20 to 2021–22 saw:

• an overall reduction in the number of closed AOD treatment episodes in Tasmania from April 2020, as a result of COVID-19 restrictions
• rehabilitation and counselling episodes decline over the April to June 2020 period and face-to-face outreach services moved to providing telehealth services. From mid-July 2020, in-person service delivery resumed from a telehealth model; however, social-distancing measures remained. This resulted in a minor reduction in capacity for some bed-based services
• inpatient withdrawal units were operating at reduced capacity for the entire 2021–22 period due to COVID-19 restrictions
• a small decrease in the average new referrals (episode) totals for non-residential settings was noted in July 2020, potentially due to client hesitancy to access health settings. However, this temporary trend reversed by August 2020
• reduced face to face appointments on site with preference for services to be conducted through telehealth and phone.

Australian Capital Territory

As a result of COVID-19 restrictions from 2019–20 to 2021–22:

• services slowed intake into residential withdrawal programs, which slowed admission to rehabilitation programs and decreased bed capacity in residential rehabilitation and withdrawal services
• services shifted to telehealth services and online programs (for example, face-to-face programs, including group programs, were suspended, or reconvened online)
• staff illness and absence affected programs during both the lockdown period and other parts of the year, requiring staff to isolate at home if unwell and to take time off work
• agency staff relocated to working from home
• reductions in service operating hours
• ceased or reduced intake of new clients to residential and non-residential treatment services.

Northern Territory

From 2019–20 to 2021–22:

• COVID-safe procedures in residential rehabilitation resulted in a decrease in the number of people that could be accommodated in each facility (for example, one person per room) to ensure social distancing guidelines were adhered to. While different service types were impacted in different ways, no service completely closed during this time. There was short-term reduction in capacity, but this eased quickly to business-as-usual once services learnt how to operate under the new COVID environments
• outreach services increased to compensate for reduced residential services.

Policy, legislation and environmental changes

New South Wales

In 2019–20, a number of natural disasters impacted the 2019–20 NSW reporting period, including large areas of NSW experiencing unprecedented bushfires between October 2019 and March 2020, and in February 2020 some areas of NSW experienced flooding. 

During 2023, there was a transition between data warehouses, this may have impacted the data for the 2022-23 period.

South Australia

South Australia reported a high proportion of episodes of treatment where amphetamines are the principal drug of concern and assessment only is the main treatment type. This is related to assessments provided under the Police Drug Diversion Initiative. This program is legislated in South Australia, unlike other jurisdictions, and therefore results in a higher percentage of assessment only services with high rates of engagement with methamphetamine users. In addition, due to the Cannabis Expiation Notice legislation in South Australia, adult simple cannabis offences are not diverted to treatment and so are excluded from the data.

The South Australian Police Drug Diversion initiative also saw a change in legislation from April 2019 [Statutes Amendment (Drug Offences) Bill 2018, where youth are no longer diverted immediately for an Assessment. Adults who have been apprehended twice in four years are no longer eligible for an Assessment. 

Northern Territory

As of 2018 all agencies; regardless of setting, are instructed to complete a separate assessment only episode prior to the commencement of treatment. This policy relates to monitoring the volume of assessment work performed by agencies, particularly in relation to certain alcohol-related legislatively-based programs such as the Banned Drinker Register (BDR).