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The predominance of the cohort (87.0%) was recruited upon entry to treatment (maintenance therapies, detoxification and residential rehabilitation), and the remainder from non\u2010treatment settings (e.g. needle and syringe programmes). This analysis focused upon 428 participants for whom data on heroin use were available over 10\u201311 years following study entry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Structured interviews assessed demographics, treatment history, heroin and other drug use, overdose, criminal involvement, physical health and psychopathology. Group\u2010based trajectory modelling was used to: (i) identify trajectory groups based on use of heroin in each year, (ii) examine predictors of group membership and (iii) examine associations between trajectory group membership and 10\u201311\u2010year outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Six trajectory groups were identified [Bayesian Information Criterion (BIC)\u00a0=\u00a0\u20131927.44 (<jats:italic>n<\/jats:italic>\u00a0=\u00a04708); \u22121901.07 (<jats:italic>n<\/jats:italic>\u00a0=\u00a0428)]. One in five (22.1%) were classified as having \u2018no decrease\u2018 in heroin use, with the probability of using remaining high during the 10\u201311 years (&gt;\u00a00.98 probability of use in each year). One in six (16.1%) were classified as demonstrating a \u2018rapid decrease to maintained abstinence\u2019. The probability of heroin use among this group declined steeply in the first 2\u20133\u00a0years and continued to be low (&lt;\u00a00.01). The remaining trajectories represented other fluctuating patterns of use. Few baseline variables were found to predict trajectory group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10\u201311 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long\u2010term trajectories of heroin use in Australia appear to show considerable heterogeneity during a decade of follow\u2010up, with few risk factors predicting group membership. Just more than a fifth continued to use at high levels, while fewer than a fifth become abstinent early on and remained abstinent. The remainder showed fluctuating patterns.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.13747","type":"journal-article","created":{"date-parts":[[2017,1,6]],"date-time":"2017-01-06T14:21:22Z","timestamp":1483712482000},"page":"1056-1068","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Trajectories of heroin use: 10\u201311\u2010year findings from the Australian Treatment Outcome Study"],"prefix":"10.1111","volume":"112","author":[{"given":"Maree","family":"Teesson","sequence":"first","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Marel","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane","family":"Darke","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Ross","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Slade","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucy","family":"Burns","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Lynskey","sequence":"additional","affiliation":[{"name":"National Addiction Centre, Institute of Psychiatry Psychology and Neuroscience  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonja","family":"Memedovic","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"White","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L.","family":"Mills","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre University of New South Wales  Sydney NSW Australia"},{"name":"National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use University of New South Wales  Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61530-5"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2010.10.021"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2008.03.006"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61138-0"},{"key":"e_1_2_7_6_1","unstructured":"United Nations Office on Drugs and Crime World Drug Report.2015(United Nations publication Sales No. E.15.XI.6)."},{"key":"e_1_2_7_7_1","unstructured":"JonesC. 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