The Research Outcome Study in Ireland (ROSIE) is being conducted by a team at the National University of Ireland, Maynooth, on behalf of the National Advisory Committee on Drugs (NACD).  The aim of the study is to recruit and follow opiate users entering treatment and to document their progress after six months, one year and three years.  

At baseline, the study recruited 404 opiate users aged 18 years or over entering treatment or, in the case of a sub-sample of 26 (6%), attending needle-exchange services.  The participants were engaged in one of three different forms of treatment: methadone maintenance/reduction (53%, n=215), structured detoxification (20%, n=81) and abstinence-based treatment (20%, n=82).  

The treatment outcomes presented in the first two papers in the ROSIE Findings series have been reported in previous issues of Drugnet Ireland.  The third paper in the series, Findings 3,1 provides a summary of the outcomes for people in the abstinence modality one year after treatment intake.  

The abstinence modality is defined as: ‘any structured programme which required individuals to be drug-free (including free from any pharmacological intervention) in order to participate in, and remain on, the programme’.  Participants are required to attend a structured programme of daily activities and are given intensive psychological support.  Abstinence-based treatment occurs in both inpatient and outpatient settings.  Residential rehabilitation programmes can differ considerably in terms of their underlying philosophy and programme structure.  Programmes may be either short-term (4–12 weeks) or long-term (3–12 months).  

The ROSIE abstinence cohort comprised 82 individuals, the majority recruited from inpatient settings (85%, n=70), with the remainder being treated in outpatient settings (15%, n=12).  Those recruited from inpatient settings were attending one of the three main types of residential rehabilitation programme identified in the international literature: 12-step/ Minnesota Model, Christian house or therapeutic community.  The analysis presented in Findings 3 is based on the 56 participants who provided valid answers to each individual question during their treatment intake and one-year follow-up interviews.  

The abstinence participants were typically male (89%), had an average age of 27 years and were largely dependent on social welfare payments (70%).  Just less than half (47%) had children but the majority (77%) of these did not have their children in their care.  Most had spent some time in prison (72%) and 16% had been homeless in the 90 days prior to treatment intake interview.

Treatment completion rates

The treatment completion rate was high, with 66% of participants successfully completing their abstinence programme (n=37).  Just over one-quarter of the cohort (27%, n=15) dropped out of treatment, 2% (n=1) transferred to another treatment type before completing the programme and the remaining 5% (n=3) were still engaged in their treatment programme at one year. 

In addition to those still engaged in their abstinence treatment programme one year after treatment intake, 64% of participants (n=36) reported that they were in some form of drug treatment.  Less than one-quarter of the cohort (23%, n=13) were on a methadone programme, 23% (n=13) were attending one-to-one counselling and 37% (n=21) were attending group work (Narcotics Anonymous (NA) meetings, aftercare programmes and structured day programmes).  

Drug use outcomes

The number of participants who reported using heroin, non-prescribed methadone, non-prescribed benzodiazepines, cocaine, cannabis or alcohol in the 90 days prior to interview decreased between treatment intake and one-year follow-up.  The most substantial reduction was in cocaine use, both in terms of the proportion of participants using the drug (46% at treatment intake compared with 14% at one year), the frequency of use (an average of 10 out of 90 days at treatment intake compared with an average of 2 out of 90 days at one year) and the quantities consumed (an average of 1 gram per day at treatment intake compared with an average of 0.3 grams per day at one year).  

Crime outcomes

Overall, the proportion of participants who reported no involvement in crime had risen considerably at one year (76%) compared to treatment intake (43%).  There was a reduction in the percentage of participants involved in acquisitive crime, from 35% (n=19) at treatment intake to 13% (n=7) at one year.

Risk behaviour outcomes

Findings 3 states that there was a non-significant reduction in the number of participants who reported injecting drug use.  There were no changes in participants’ injecting-related risk behaviours.  The proportion of participants who reported and overdose within the previous 90 days remained at 4% (n=2) over the two time periods. 

Health outcomes

Ten symptoms were used to measure the physical health of participants (see paper for details).  The number of participants who reported nine of the ten physical health symptoms reduced between treatment intake and one year.  

Ten symptoms were also used to measure the mental health of participants (see paper for details).  There was a reduction in the number of participants who reported suffering from any five of the ten mental health symptoms.  

Service contact

Findings 3 reports an increase in participants’ contact with GPs and with employment/ education agencies. 

The authors state that the findings presented in this paper demonstrate that participation in an abstinence-based treatment programme is followed by positive outcomes in relation to drug use, involvement in crime, and physical and mental health symptoms.  The outcomes for ROSIE participants in abstinence-based treatment compare favourably with international outcome studies.  As noted in the paper, the forthcoming results from the ROSIE three-year follow-up will provide stronger evidence on the effectiveness of abstinence-based treatment programmes and on whether or not the improvements observed after one year will be sustained. 

1. Cox G, Comiskey C and Kelly P (2007) ROSIE Findings 3: Summary of 1-year outcomes: abstinence modality. Dublin: National Advisory Committee on Drugs.