Treatment and Rehabilitation

Background: In Hong Kong, drug addiction among young adults has become an increasingly prevalent issue, with many turning to drug use as a means of coping with stress, mood-related problems, and boredom. Surprisingly, over 80% of young adults with drug addiction do not seek professional help or other forms of social support in dealing with problems resulting from taking drugs. Currently, most drug rehabilitation services in Hong Kong focus on reducing drug use and providing psychoeducation on drug-related mental health issues. However, there is a critical need to innovate and revamp these services to better support young adult drug abusers in coping with their addiction.

Aims: The objectives of this project were to integrate creative arts into drug rehabilitation services in Hong Kong, and explore its effectiveness, acceptability and practicality among young adult drug abusers and caseworkers. Additionally, this project aimed to promote social change by using the arts to provide support for individuals struggling with drug addiction.

Method: The program evaluation study assessed the potential benefits of the two major program components: (1) the creative arts intervention program for drug rehabilitees, and (2) the Train-the-Trainer program for frontline professionals. Evaluation for the creative arts intervention program adopted a mixed-methods, randomised controlled study design, with two assessment time points (T₀ and T₁) using quantitative and qualitative inquiry methods. For this research initiative, a total of 260 drug rehabilitees were included in the evaluation in Hong Kong and quantitative data were collected on two separate time points: baseline (T₀) and 8-week follow-up (T₁); amongst them, 132 were young adult participants aged between 21 and 35. In the focus group interview, we interviewed 30 young adult drug rehabilitees at the end of the program completion. For the Train-the-Trainer program, 30 caseworkers filled in an exit poll survey upon completion of the 4-day training and 10 of them were invited to participate in the focus group interview. All data were collected between June 2019 and May 2023. For the quantitative data of a randomised-controlled study, descriptive statistics and independent t-tests were used to assess sample homogeneity, and Repeated Measures ANOVAs with Bonferroni Test were adopted to assess the effect of the intervention. Whereas quantitative data for the train-the-trainer program, descriptive statistics were produced to obtain an overall satisfaction and perceived effectiveness of the training modules in enhancing the caseworkers' knowledge, skills, and efficacy in conducting creative arts drug rehabilitation program. For both studies, qualitative data were analysed using thematic analysis to identify the themes and sub-themes that emerged from the in-depth interview sessions for the rehabilitees and frontline professionals.

Results: Results of the randomised-controlled study yielded emerging evidence to suggest the effectiveness of the creative arts interventions in enhancing positive affect in rehabilitees (aged between 21 and 35) who participated in the creative arts intervention, compared with the treatment-as-usual condition. Findings also showed potential gains in alleviating anxiety, reducing self-defeating tendency, enhancing drug-related coping through stopping unpleasant emotional thinking, adopting problem-focused coping, as well as improving drug avoidance self-efficacy. Further exploration might be needed to understand the value of the intervention program in reducing depressive symptoms and negative affect, and improving self-soothing tendency. Similar findings were also reported in the aggregate data with participants ranging from 21 to 60, yielding additional information to support the potential benefits and effectiveness of the creative arts intervention in improving the psychosocial well-being of drug rehabilitees. Focus group interviews with rehabilitees attending the program revealed additional gains reported by the participants, including improved mood management, enhancing social relationships, cultivating self-awareness, self-confidence, and psychological flexibility. Participants regarded the non-verbal expression, embodiment and concretization of experience, as well as creativity; artistic pleasure is the key element underlying their positive changes; emphasis was placed on the facilitation skills of the facilitator to instil hope and common humanity and facilitate interpersonal learning. Evaluation of the train-the-trainer program showed that the training program was regarded as practical, insightful, and satisfying by frontline professionals who participated in the training. While the trainees regarded that the training was helpful in enhancing their knowledge competence, practice competence, and self-competence in delivering creative arts intervention to their service users, they expressed enthusiasm for further training to enhance their skills in this area and to work around the environment challenges they encountered in implementing creative arts interventions in the drug rehabilitation setting.

Conclusion: Creative arts intervention is a culturally relevant, emerging evidence, and person-centred approach to drug rehabilitation in Hong Kong. The creative arts intervention is well-received by both the service users and frontline professionals in the field – both parties found the application of creative arts in rehabilitation service effective, meaningful, and satisfying. Findings from the present study also revealed that creative arts did not only benefit young adults drug rehabilitees but also those who are older in age. Frontline professionals shared their passion for further training and their support to the furtherance of creative arts interventions as an alternative to traditional form of drug rehabilitation. Further research efforts and training resources will contribute to the course and the holistic well-being of those who are struggling with the issues of addiction.

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Background: The issue of drug abuse has emerged as a significant global challenge for the next decade. Consequently, there is a need to increase the availability of treatment interventions, including pharmacological, psychosocial, and rehabilitative approaches.

Aims: This study aims to explore the characteristics of offenders exhibiting drug-abuse behaviour, examine the rehabilitation process for such offenders, identify potential mechanisms to enhance rehabilitation outcomes, and estimate the reduction in social costs associated with potential improvements in the rehabilitation process.

Method: Employing a mixed-method approach, this research study involved in-depth desk research to review relevant information from various sources. The research team also analysed data from the Correctional Services Department dataset of drug addiction treatment centre (DATC) offenders aged 15 to 30 at the time of admission between 2013 and 2019 to examine the recall rate of offenders. Additionally, focus group interviews and one-on-one discussions were conducted with a total of 130 individuals, including 100 drug users and 30 stakeholders, to elicit feedback on existing drug abuse treatment and rehabilitative services.

Results: The research findings reveal that approximately 58% of DATC offenders were recalled, with drug relapse being the main reason for 78% of those recalled. The study also demonstrated that age, marital status, conviction history, attendance of rehabilitation programs, and visitation during incarceration were closely associated with recall and/or reoffending. Offenders with stronger social support networks faced a lower risk of recall. Furthermore, the study identified that while the existing system has positive aspects, such as utilizing pre-existing community resources, it also requires improvements. One area needing enhancement is the coordination between different stakeholders in the system to increase efficiency.

Conclusion: In conclusion, the research team recommended the improvements to the existing treatment and rehabilitation system to prevent the escalation and recurrence of drug problems. Implementing such improvements would not only reduce the social, medical, and economic costs associated with drug abuse but also prevent drug-related criminal activities and recurring reoffending.

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Background: There is an unclear link between drug rehabilitation and the outcome effects of treatment programmes and interventions adopted for psychotropic drug users.

Aims: To explore local stakeholders’ views on programmes for psychotropic drug abusers; develop a set of programme evaluation guidelines specific to the Hong Kong context; and explore the concept of Quality of Life (QoL) to incorporate users’ overall wellness into outcome indicators.

Method: We conducted a two-wave Delphi study with 44 panellists to identify what could/should be done to improve the efficacy and effectiveness of treatment evaluation in the local context. Validation exercises were also conducted through a two-wave questionnaire survey administered to 271 psychotropic drug abusers.

Results: Panellists reached consensus on the need for a more coherent use of a combination of subjective and objective measurement tools to measure the intended outcomes of a given programme. Reducing harm could be one of the important outcome indicators for drug rehabilitation process in leading to drug abstinence. A new Need-based Quality of Life Scale (NBQoL) was also developed and validated.

Conclusion: Individualised and cross-disciplinary interventions are recommended with aligned theories of change and corresponding outcome indicators.

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Background: Sport and exercise are well known for their positive impact on health, but studies on how effective they are for the rehabilitation of drug abusers are relatively limited. This project provided opportunities for drug abusers to engage in sport training, and investigated the effectiveness of physical activity on rehabilitation of drug abusers and maintaining abstinence from drug abuse.

Aims: To measure the effectiveness of sport trainings for reducing drug use frequency among drug abusers, and the impacts on different dimensions of health and fitness.

Method: Sport training courses for drug abusers were implemented over a period of 3 years. Each course was held once a week over 10 weeks. A total of 169 drug abusers aged under 40 joined the sport training courses on a voluntary basis. They were invited to undergo physical fitness tests and to complete a series of questionnaires before the beginning of the sport training courses (pre-test). Among the 169 participants, 78 of them eventually completed the courses and underwent another physical fitness tests and questionnaires (post-test) in which changes on their level of fitness and wellness were examined.

Results: Many significant improvements were found among the drug abusers after the completion of the sport trainings, including the increase on physical activity level, flexibility, muscular strength, muscular endurance and balance, motivation for physical activity, mental, emotional, physical and intellectual levels, together with higher scores in life satisfaction, self-anchoring, drug avoidance self-efficacy, active coping for stress and challenges against drug uses.

Conclusion: Research findings of this project support that sport and physical activity as intervention treatment had positive impact for drug abusers on their resistance against and recovery from drug abuse.

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Background: People with substance use disorder (SUD) manifest cognitive deficits which affect their everyday functioning. The research on cognitive training for SUD is limited. We developed the Mobile Functional Cognition Program (MFCP) and piloted tested in 2015-2017.

Aims: In this study, we studied the effectiveness of the MFCP. We hypothesized that participants going through MFCP would improve cognitive and everyday functioning compared to those who received social activities.

Method: The research is a randomized controlled trial. Service users at the Counselling Centers for Psychotropic Substance Abusers (CCPSAs), the Drug Treatment and Rehabilitation Centers (DTRCs), the Methadone Clinic, and the Substance Abuse Clinic at United Christian Hospital were recruited into this study. Participants’ cognitive function and everyday functioning were measured by Cognistat (NCSE) and Canadian Occupational Performance Measure (COPM) at baseline and after treatment. A repeated measure analysis of variance (ANOVA) was used to compare the treatment effect of MFCP versus social activities.

Results: A total of 134 service users have been approached. The final study sample included 53 in the experimental group (go through MFCP) and 57 in the control group (go through social activities). A repeated measure ANOVA revealed no significance between group differences in the outcomes. Schèffe test found that both the experimental and control group had significant improvement after treatment.

Conclusion: According to this study and past experience, the MFCP was practical and easy to use and have potential benefit for people with SUD. Further study using time-series design is suggested to investigate if the MFCP would lead to a better rate of improvement over social activities.

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Background: Studies of the central nervous system demonstrated that uncaria rhynchophylla (Gouteng) interaction with ketamine appeared to improve the consolidated memory of the mice and downregulate the number of dead cells in regions of the central nervous system induced by ketamine.

Aims: To perform experiments on animal models so as to investigate the effect of Gouteng as a potential therapeutic intervention for ketamine damage, or whether it could replace ketamine as another abuse agent, and provided evidence for the underlying mechanism of effect of Gouteng on the central nervous system.

Method: Methods employed included behavioral, biochemical, immunohistochemical and histopathological studies. Toxic effects of ketamine on the liver and heart were studied via observation on histopathology and electrocardiogram (for heart).

Results and Conclusion: Gouteng showed promise as an adjunct treatment on the toxicity created by ketamine. However, it was important to note that, Gouteng, like any medicine, the long-term usage of which will lead to increase of serum transaminase and creatinine levels. Proper supervision and advice by a Chinese medicine practitioner and/or a medical practitioner in Western medicine was a must for human ketamine patients.

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