Background Government and non-governmental organization before. Therefore, the phenomenon

Background

Drug
addiction has been a well known worldwide social problem for decades. Along
with the improvement and modification from the Hong Kong government made
towards the law enforcement, preventive and remedial measures, yet this
addictive behavior and related criminal case has never been eliminated in the
society. Also, lots of drug abusers would relapse even though they have
received rehabilitative service provided by the Government and non-governmental
organization before. Therefore, the phenomenon reflects that there should be
some limitation within the existing service or intervention model. This paper
aims to review the existing healthcare service in Hong Kong for drug abusers in
a micro-level and tries to suggest intervention model/therapy which may provide
some insights for the service development in future for the field.

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Drug
addiction definition

According to
National Institute on Drug Abuse (2014), a United
States federal-government research institute, “Addiction is defined as a
chronic, relapsing brain disease that is characterized by compulsive drug
seeking and use, despite harmful consequences. It is considered
a brain disease because drugs change the brain—they change its structure and
how it works. These brain changes can be long-lasting, and can lead to the
harmful behaviors seen in people who abuse drugs”.

In Hong
Kong, drug abuse is defined as “the taking of substance that harms or threatens
to harm the physical, mental or social wellbeing of an individual, in doses
above or for periods beyond those normally regarded as therapeutic”(Census and
Statistics Department, 2016). Actually drug addiction
is not merely a health-related problem; it is also a social problem in a
chronic condition which can continue for many years. Nevertheless, drug addiction
has not yet been included as a particular diagnosis in the latest version of
The Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), which is a worldwide used manual that offers standard
language and criteria for the categorization of mental disorder.

DSM has its fifth
version published in 2013; in the latest edition, the categories of substance
abuse and substance dependence were substituted by a single category “substance
use disorder” (American Psychiatric Association, 2013). In spite of the nature
of substance, the diagnosis of substance use disorder is base on a group of
morbid behavior which refers to the usage of that particular substance. Those
morbid behaviors divided into four main types: impaired control, social
impairment, risky use and pharmacological indicators (tolerance and withdrawal)
(APA, 2013). Substance use disorder classifies the negative outcomes of
sustained and persistently utilization of substances and those outcomes are not
happen instantaneously but as a
prolonged addiction progress.

Prevalence
in Hong Kong

Compared
with other countries, especially Western ones, Hong Kong government actually select
and adopt a relatively strict attitude towards illegal drug use. While cannabis
is regard as legal recreational drugs in some countries such as United States
and Canada, it is still classified as illegal in Hong Kong nowadays. Due to the
culture of nightclubs and rave parties, the trend of drug use has once risen
again in the beginning of 21st century (Narcotics Division, 2002); soon
afterwards the government has carried out various measurements to beat the
raising trend, however, until recent years there are still approximately 2000
newly reported drug abuse case for each year in Hong Kong (Narcotics Division,
2017).

In
accordance with the latest figures given by the Central Registry of Drug Abuse (CRDA):
comparing with the first
half of 2016, the total number of reported drug abusers in the first half of
2017 has been decreased over 20% (from 5,211 to 3,994); at the same time, the number of newly reported drug
abusers has been reduced around 30%. Although it showed a decrease in the
figure, half of them were young adults aged between 21 to 35, it reflected that
the condition of drug abuse within this age group still need the government and
society to pay more attention to it (The Government, 2017). The newest figure
from CRDA also disclosed that the newly reported drug abusers’ median drug
abuse history was around 3.9 years, which means a drug abuser being discovered
his/her habit by the government or non-governmental organization only when
he/she addicted to drugs for around 4 years in average, the phenomenon revealed
that the hidden drug abuse condition is still in a quite severe circumstances.

Among the
psychotropic substance abused by drug addicts, methamphetamine (or known as “Ice”)
was the most common type reported (982 cases), other usual abused drugs including
triazolam/midazolam/zopiclone, cocaine and ketamine etc
(The Government, 2017). The most common reason of drug abuse among the reported
cases (Narcotics Division, 2017) is “Relief of
boredom/Depression/Stress”, the second one is “Peer influence/To identify with peers” and the third one is “To
avoid discomfort of its absence”. From the figure shown,
it revealed that the ability or coping skills of drug abusers facing negative
emotions and pressure is relatively weak, they also place importance on the
identification from peers, and these may provide some insights for the way of preventive
education and intervention model afterwards.

 

Relationship between drug
addiction and holistic well-being

There is no
doubt to say that drug addiction brings so much unfavorable impacts towards
personal wellbeing, including emotional, physical and interpersonal aspects. Since
methamphetamine (“Ice”) is the most common used psychotropic drugs in Hong Kong
nowadays, the society should emphasize the promotion of awareness of public
towards the consequences of “Ice”. According to a South China Morning Post news
article “Hong Kong’s growing drug problem” (2016), it state that methamphetamine
(“Ice”) was discovered as the major cause to explain why around 25% patients in
the psychiatric ward in a New Territories hospital would suffered from severe
medical condition such as hallucination and delusion. Drug abusers who frequently
take “Ice” usually suffer from more severe mental conditions comparing with
those who take other forms of drugs such as ketamine. They will carry symptoms
which similar to schizophrenia, including reduced social activities, confused
thoughts, auditory hallucination etc (“Hong Kong’s
growing”, 2016). Regarding the physical impacts, the misuse of “Ice” would
lead to consequences of irregular heart rate, hypertension or even other
disorders similar to dementia, since the drug would intensify the abusers’
sensitivity, some of them may feel itchy on their skin (“Hong Kong’s
growing”, 2016).

Actually
long-term usage of illicit drugs could lead to damages in brain for short-run
and also long-run. It may cause some mental illness such as depression, anxiety
disorder, paranoia etc (NIDA, 2017). 
Drugs abusers may carry twofold chances of suffering from anxiety and
mood disorder when comparing with the general public (NIDA, 2017).

Apart from the
mental and physical impacts brought by drugs to the abusers, the World Health
Organization (2009) has pointed out that there is a complicated relationship
between illicit drugs and interpersonal violence, there are different levels of
outcome caused by different kinds of drugs such as some of them may related to
violence behavior more than the others.  The
abuser’s personality, biological elements, environmental factors and
socio-cultural causes are all take part in this relationship.

There is also
a bidirectional relationship between violence and drug abuse, if a person
participate in drug abuse, it can enhance the likelihood of being a victim
and/or attacker in a violence; on the other hand, when a person get involve in
violence could increase the chance of starting drug abuse (WHO, 2009). The
influence brought by drug-related interpersonal violence could be considerable;
it would affect one’s health, the unity and development of society, at the same
time more resources will be utilized in the health care system and legal
system. Now there are accounts for millions of abusers all over the world, the
effects caused by the illicit drugs could place a huge burden to the whole
society (WHO, 2009).

Besides, as suggested
by Gould (2010), chronic drug abuse can induce cognitive deficits, as many
kinds of drugs can produce cognition-related withdrawal symptoms which make temperance
much more difficult. For example, cocaine and opioids can elicit deficits in
cognitive flexibility, amphetamine
can induce deficits in attention and impulse control, and cannabis cause deficits
in cognitive flexibility and attention. 
Chronic use of illicit drugs can cause enduring cognitive decline, the
level of deficit will differ from the types of drugs, environment and
biological factors.

Mechanism
of addiction

Apparently
there are too many researches and data to prove that drug abuse would bring
negative impact towards our emotional, interpersonal and physical aspects, but
what is the reason of the abusers still maintains this behavior even though
they fully understand the adverse influence? Even though we are not specialist
in medical field, it would be better for us to understand more about the
relationship between addiction and brain system.

Drugs
actually are chemical substance which can influence our brain through “tapping
into its communication system and interfering with the way neurons normally
send, receive, and process information (NIDA, 2014)”. Some drugs such as
cocaine and amphetamine, can induce the neurons to liberate “abnormally large
amounts of natural neurotransmitters or prevent the normal recycling of these
brain chemicals (NIDA, 2014)”.

In addition,
as suggested by McLellan, Lewis, O’Brien, & Kleber (2000),
addictive drugs have significant impact on the brain circuitry involving the
control of learned and motivated behaviors. To illustrate, opiates and cocaine would
have notable impact towards the dopamine system through various mechanisms
neurochemically; such as cocaine can increase the level of dopamine while
opiates disinhibit dopamine neurons. “Animals that receive mild electrical
stimulation of the dopamine system contingent on a lever press will rapidly
learn to press that lever thousands of times, ignoring normal needs for water,
food, or rest. Cocaine, opiates, and several other addictive drugs
produce supranormal stimulation of this reward circuitry (McLellan et al., 2000)

As stated by
the National Institute on Drug Abuse (2014), the behavior of drug addiction can
influence the brain’s reward system through deluging the circuitry with
dopamine. Dopamine originally is a neurotransmitter which balances emotions,
motivation, feelings of pleasure etc. Drug addictive behavior would overstimulated
the reward system and finally, the abusers need to strengthen the behavior of
taking drugs to gain the reward again.

Existing
health care services provided to drug abusers in Hong Kong (?cite)

Similar to
many western developed countries, Hong Kong is using multi-modality model to
provide drug treatment and rehabilitative service to drug abusers in order to
fulfill the needs of individual with different background and situations. The
general aim of the services is to help drug abusers to abstain from drugs and
re-integrate into society. Now in Hong Kong, there are two main types of
services which include community-based and residential nature provided for
heroin abusers and psychotropic substances abusers, usually involve with the
approach of individual and group counseling, social skills training, vocational
training and aftercare service etc. In this paper, we would place the focus on
the services provided to psychotropic substances abusers.

At present,
there are three main kinds of services specially provided for psychotropic
substances abusers in Hong Kong, including counseling programme, voluntary in-patient / residential drug rehabilitation programmes
and substance abuse clinic, and also one additional centre for drug counseling
operated by Caritas Hong Kong.

Currently there are total
11 counselling centre for psychotropic substance abusers (CCPSA) to offer drug counseling
services for the abusers and their family members, it also cover on-site
medical support services provided by registered psychiatric nurses in order to
promote the motivation and readiness of drug abusers to seek treatment. In general,
most of the CCPSA would provide similar services including drug treatment
counseling, family members mutual groups, preventive education to community and
schools; professional training to the workers in the health care field, some of
them would provide outreach services in nighttime in order to take the
initiative to reach the potential drug abusers.

There are around 17 non-governmental
organizations operating the voluntary in-patient / residential drug
rehabilitation programmes, including several Christianity therapeutic organizations,
offering a series of programmes which used various intervention models, in
order to match the needs from different drug abusers who are searching for
residential therapy willingly.

At present there are total 7 substance
abuse clinics (SAC) managing by 7 service clusters from the Hospital Authority.
These SAC would receive the referrals made from other CCPSA, non-governmental
organizations or other health care related agencies, or even by the patients’
direct contact. Service covers from counseling, drug treatment, consultation
and diagnosis from clinical psychologist and psychiatrist etc.

Intervention
model commonly used among the drug treatment services in Hong Kong

As mentioned above, in order to cater
the various needs of drug abusers from different background, Hong Kong is
adopting multi-modality approach in the drug treatment and rehabilitation
service including community based and residential services in voluntary or
compulsory nature (Narcotics Division, 2015). Among the residential services,
or known as drug treatment and rehabilitation centres (DTRCs) in Hong Kong,
there are 39 DTRCs operated by 17 non-governmental organizations, and more than
10 organizations are carrying religious background and adopting the
Christianity therapeutic approach.

Different from other DTRCs, for those
using Christianity as the main intervention approach of drug treatment, they
would involve more religious elements into their residents’ daily routine. In
general, Christianity drug treatment centre usually located in relatively
remote area, away from the city centre. They don’t rely on medicine to treat
the addiction; they will hold Christianity assembly everyday, involved reading
bible together, and provide counseling which based on bible principles, some of
the centres may have on-site preacher to talk with the residents regarding
their spiritual level.

Christianity drug treatment centre
general believes that drug abusers have to face and tackle the original bad
habits in life while they are abstaining from drugs. Therefore, the residents
living in the centre would be requested to abstain from cigarettes, alcohol or
even foul language; the main focus of drug treatment is holistic recovery in
body-mind-spirit aspects, thus relapse prevention and harm reduction may not be
the largest emphasis in their treatment (???????????????, 2005?).  

Apart from religious treatment,
therapeutic community is the main intervention model used by The Society for the Aid and Rehabilitation of Drug
Abusers, which is one of the largest organizations specializing at drug
treatment in Hong Kong. Therapeutic community approach believes there is always
underlying problems behind drug addiction such as psychological deficits,
developmental problems or emotional problems etc; drug abusers usually utilize
addictive behavior to avoid the personal problems and responsibility. Therefore,
the main purpose of therapeutic community is to foster the personal growth,
transform the original negative behavior and distorted thoughts, in order to
rebuild positive and responsible attitude and behavior (???????,
2013?).

Therapeutic community is a social
psychological form of treatment used for addictions, apart from Hong Kong; it
is also widely used in United States to treat youth with severe problems.
Therapeutic community carries two special features (Winters, 1999): “the use of the community itself as therapist and teacher in the
treatment process” and it’s “a
highly structured, well-defined, and continuous process of self-reliant program
operation”.

As therapeutic community is a highly
organized and structured environment, almost all daily routines in the
residential home are arranged everyday, such as the sundry duties, cleaning
jobs, meals etc. Every resident has its own role and responsibility.  Therapeutic community believes the residents
are a part of the community, they have the right to take part in the operation
and share the duties to manage the community, therefore, the role of therapist
is not focus on certain staff or worker but the whole community itself contains
a therapeutic effect (???????, 2013?).

In additional to the residential
services, community based service is also one main form of intervention model
used in Hong Kong.  Those CCPSAs, SACs mentioned
above are also kinds of community-based service provided to drug abusers. According
to the United Nations Office on Drugs and
Crime (2014), community-based treatment carries several features: located in
the community, continuum of care, integrated in community health and social
services, mobilization of community resources and
participation etc. It was suggested that community-based treatment is the most
cost-effective approach in supporting drug abusers and their families. For the
clients using community-based treatment have a remarkable drop-off of
emergency-room visits, hospital stays and criminality which shown by the
evidence from across the world (UNODC, 2014).

Suggestions for interventional model / therapy

According to
the National Institute on Drug Abuse (2012), “no single
treatment is appropriate for everyone”. Treatment provided to
drug abusers should vary from the kinds of drugs and the features of the patients,
it is crucial to match the appropriate treatment model and services
corresponding to the patients’ specific needs and background such as gender,
age, culture etc in order to help him/her get back to a functional life.

To review the existing service content
provided by most of the drug treatment services in Hong Kong, apart from those
carries with religious background, others would mainly tackle with drug abusers’
body and mind (emotional and interpersonal) aspect, and rarely focus on
spiritual level. However, spirituality actually can increase individual’s
motivation, and which motivation is a good facilitator that can help preventing
someone towards high-risk behaviors including drug abuse; in addition, it has
been suggested that combining spirituality with traditional
cognitive-behavioral therapy would lead to better treatment outcomes (Webster, 2015).

As mentioned before, the most common
reason of drug abuse is “Relief of boredom/Depression/Stress” (Narcotics Division, 2017),
it can reflected that stress can increase the
likelihood of drug use, and can lead to relapses subsequent to treatment
(Marcus, M. T., & Zgierska, A., 2009). In order to increase the
involvement of spirituality into the field, mindfulness-based therapy is one of
the approaches which is effective in reduction in anxiety and prevent
depressive relapse shown by various researches (Leigh, Bowen, & Marlatt., 2005), and it was
started to take into consideration as the treatment of substance abuse
disorders (Marlatt et al., 2004). Whether in a remedial treatment or a
preventive approach, the participation of mindfulness-based therapy could offer
assistance to individual towards positive emotions.

 

Regarding
the preventive education existing in the field currently, the target audience are
commonly the primary and secondary school students, community members etc. Nevertheless,
supervision and monitoring from parents are also vital for preventing children
to take drugs, therefore, family-based preventive education should be emphasize
more in future, which is not merely deliver the message about harmful effects
of drugs or how to distinguish the drug abuse behavior etc, it should be more
about enhancing family bonding and relationships including topics related to
parenting skills, practices in family discussion about the abuse of drugs etc.
Family bonding is a foundation of the relationship between children and
parents, and family-focused interventions can help to improve parenting
behavior which can finally reduce the risk of children’s taking drugs (NIDA,
2003). Therefore, preventive education should involve enhancing the family
bonding through encouraging the parents to show support towards their children
and improve their communication. In addition, some of the frontline workers
also noticed that drug abusers are more likely to abstain from drugs
successfully when they got supportive family members
(Narcotics Division, 2015) therefore we
should not underestimate the role of family in drug prevention and treatment.

Concerning
the latest trend of drug abuse in Hong Kong mentioned previously, in spite of
the decreasing trend in figures of total drug abusers, the situation among the young
adulthood (group aged 21-35) still need more attention and the drug history of
newly reported cases are worth concern too. Preventive education provided to
the specific age group should be strengthen through the CCPSAs and other
related NGOs, they may try to co-operate with high-risk workplace such as
nightclubs, cafes, cybercafés, or even commercial companies to offer seminars
or workshops to their employees since some of the drug abusers may come from different
working background. Since many of the working drug abusers may not able to
receive a long-term residential treatment as they may already have new family,
offering them with vocational training and job counseling could be part of the
rehabilitative treatment as an alternative also.

Conclusion

From a micro
view, the health-care services provided to drug abusers in Hong Kong are in a
relatively mature state through the cooperation and entire effort made by the
government, community and other NGOs at recent decades.  In future, the development of the whole drug
treatment services could pay more attention especially to certain target groups
such as female drug abusers, ethnic minorities’ abusers, drug abusers couple
and their next generation. Besides, utilizing more the spirituality-related
approach would be beneficial to an individual apart from traditional therapy as
it can help the patient to gain the inner source of strength so that he/she
could have greater motivation to keep away from bad habits. Remedial drug
treatment is crucial for the patients’ recovery without doubt, yet the
preventive work is far more important since it can reduce the social problems
and burden of the government. The field could make use of the resources
provided by the government to explore innovative approach to alleviate the
problem and carry out relevant research to recognize the effective intervention
model.