Introduction and Aims. Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms. Design and Methods. Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes. Results. Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources. Discussion and Conclusions. In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach.

The Drug Policy Modelling Program (DPMP) at the University of New South Wales has released a report on 'The impact of the COVID-19 pandemic on the non-government alcohol and other drug sector: future implications'. NADA commissioned DPMP to undertake the study to explore the impact of the COVID-19 pandemic on it's members and provide advice on the immediate, medium and long-term actions that need to follow.

COVID-19 has demanded significant changes to funding arrangements, leadership and strategic planning, the types of care provided, and workforce requirements and support. It provides the opportunity to review all aspects of non government AOD treatment services, including the ways in which services are commissioned and funded by governments, and how services are supported, led, and delivered.

The actions resulting from the study are directed at treatment providers, NADA, and non government AOD funders. Whilst many of these actions have commenced, some are longstanding issues impacting on the sector, such as the underfunding of AOD treatment, and recruitment and retention of staff. NADA is committed to working with sector to implement the actions.

The total social and economic costs and harms of alcohol consumption in the Northern Territory (NT) equates to $1.38 billion per year (Smith, Whetton, & d’Abbs, 2019). A comprehensive strategy is required, that includes alcohol treatment services to curb these costs. Typically, alcohol treatment services are defined as clinical interventions such as withdrawal, counselling, residential rehabilitation and pharmacotherapy. However, a broader definition would include a broader range of interventions, such as brief interventions in primary care, and social and emotional wellbeing services provided in the context of reducing alcohol consumption.

This report reflects a Demand Study of Alcohol Treatment Services in the NT. It is a mixed-methods research project examining the current NT alcohol treatment services system. It provides an assessment of how much treatment is currently provided; how much should be provided to meet current demand; and the challenges, barriers and opportunities associated with the planning and delivery of alcohol treatment services in the NT. It responds to multiple recommendations outlined in the NT Alcohol Policies and Legislation Review (Riley, 2017); and a subsequent Northern Territory Government (NTG) commitment to undertake the study in the NT Alcohol Harm Minimisation Action Plan 2018-2019 (NTG 2018). The project is modelled on two recent national demand studies. The first was completed by DPMP and involved a review of treatment service systems across Australia (Ritter et al., 2014). The second was completed by the National Drug Research Institute (NDRI) and involved a qualitative analysis of treatment services involving Aboriginal and Torres Strait Islander people (Gray et al., 2014). The research design has been adapted to meet the unique population distribution, geography and service delivery context of the NT.

This study has been led jointly by Menzies School of Health Research and the Drug Policy Modelling Program (DPMP) at the University of New South Wales, and in partnership with the Aboriginal Medical Services Alliance of the NT (AMSANT).

There were 42,871 episodes/encounters for alcohol treatment in NT in 2016/17, equating to 117 encounters every day across the NT. Aboriginal and Community Controlled Health Organisation (ACCHO) episodes represent the highest number of encounters (41%). The next highest is GP encounters (18%). Self-help also comprises a substantial amount of alcohol treatment in the NT (16%). Brief interventions provided as part of Sobering Up Shelters (SUS) represent the fourth highest number of episodes/encounters (13%). This is a signal that these settings are vital for picking up and referring people into more intensive alcohol treatment pathways.

The subsequent analysis of unmet demand shows that there is currently a relatively small gap between met and unmet demand for alcohol treatment in the NT. It also highlights some areas of additional focus. Key findings reveal:

• There is a large unmet demand for screening and brief intervention, in the order of 18,500 to 19,000 people

• The provision of alcohol treatment (as described in the DASPM care packages), estimates 6,735 people need to be treated in any one year, representing an unmet demand gap of around 2,000 people aged between 18 and 64 years.

• There are currently 158 residential rehabilitation beds provided in the NT for people with alcohol disorders. This is 15% below the modelled estimate of 187 residential rehabilitation beds.

• The level of clinical FTE predicted to meet the care as specified in DASPM is well above the current clinical FTE in the NT. This suggests that while the numbers of people being treated may be about right, the intensity and the level of care is not configured in a way that might best meet needs.

• More treatment is required to respond to mild and moderate needs.

The qualitative component provides a descriptive account of key stakeholder viewpoints from across the alcohol treatment services system. This includes a discussion about alcohol treatment types, including preventative health interventions, brief interventions, counselling, withdrawal services, day programs, residential rehabilitation services and continuing care. The perceived strengths and gaps of each are discussed. A descriptive account of the factors impacting demand; pathways into treatment; intersections with treatment referrals from the criminal justice system; a discussion about the implications of remoteness on treatment accessibility in the NT; and the need for targeted workforce development, are also included.

Background and Aims: The configuration of alcohol and other drug treatment service systems has been influenced by the uptake of market mechanisms for treatment funding and purchasing. This study measured the impact of market mechanisms for funding and purchasing alcohol and drug treatment services on client outcomes.
Design: An observational cross-sectional study, employing multi-level analysis: episodes of care data, nested within person-level data, nested within treatment site and nested within organization.
Setting and participants: One hundred and seventy-eight alcohol and other drug treatment service sites in Australia.
Measurements: Client outcome variables were length of stay and successful treatment completion. Predictor variables were competitive tendering, number of funding contracts, recurrent funding, the ratio of episodes to staff, type of professions, years of clinical experience, staff turnover and type of provider (government; non-government). Analyses controlled for drug type, type of treatment received and client characteristics.
Findings: There were no significant associations between the procurement and contracting variables and length of stay [incidence rate ratios (IRRs) ranged between 1.01 and 1.07, all P > 0.05; Bayes factors (BF) < 0.03], and inconclusive results for treatment completion [odds ratios (ORs) ranged between 1.04 and 1.15, all P > 0.05, BF = 0.51-0.63]. Having an alcohol and other drug (AOD) work-force relative to an 'other' work-force (IRR = 0.79, P = 0.021) and lower case-loads (IRR = 0.99, P = 0.047) may be associated with longer stay in treatment. Receiving services from a government compared to non-government provider may also be associated with less treatment completion (OR = 0.34, P = 0.023, BF = 2.14).
Conclusions: There appears to be no association between client outcomes and procurement and funding contract arrangements for alcohol and drug treatment services.