Using expressive arts in relapse prevention of young psychotropic substance abusers in Hong Kong

highlights

• Expressive arts are particularly effective preventing males from drug relapse.

• The effects are more apparent for males who fill with guilt and are less verbal.

• Family is found as a double edged sword for young people's growth and development.

• Young drug abusers are unavoidably victims of family conflicts and dysfunction.

• Integration of art and family based interventions are highly recommended.

Abstract

Art therapy has been empirically assessed as an effective form of relapse prevention for substance abusers who are relatively treatment resistant, defensive and unexpressive. In Hong Kong, the use of expressive arts in substance abuse treatment and relapse prevention programs has become increasingly popular in both residential and community-based services. However, unlike in the West, no empirical research has yet been conducted to validate and assess the effectiveness of such therapy within a Hong Kong context. This study adopted a two-group pre- and post- with 6-month follow-up experimental design to examine the effectiveness of an art-based relapse prevention group compared with a cognitive–behavioral relapse prevention group for young psychotropic substance abusers in a community-based outpatient service. The study included both a quantitative questionnaire and qualitative in-depth interviews with each participant. With 6 members in each of the group, only the qualitative data were discussed. The qualitative data revealed that the art-based relapse prevention group was particularly effective for the male participants, who were less verbal and sociable or had a strong sense of inadequacy and guilt about their delinquent behavior. In the experience of the participants, ‘family’ was a double-edged sword in terms of their growth and development. They had no choice but the victims bearing the lack of guidance and sense of loneliness in family conflicts or divorces. However, at the same time, family care, love and support were the greatest motivating factors to keep them abstinent. Therefore, the integration of art- and family-based interventions in drug relapse prevention programs is highly recommended.

Introduction

Early in 2008, the World Drug Report published by the United Nations Office on Drugs and Crime warned that the threat of psychotropic substances had been rising significantly within a global context. The problem of youth drug abuse was also found to be highly related to the worldwide increase in psychotropic substance abuse. Many countries recorded a higher proportion of youth drug abuse than that in the general population (United Nations Office on Drugs and Crime (UNODC), 2008). Although the prevalence of problem drug use in recent years has become gradually stable and commensurate with the growth in the world population, concerns about the problem within the global context remain high because of the chronic, relapsing nature of drug addiction and the possible costs created for the family and community (Ardame, Bassaknejad, Zargard, Rokni, & Sayyah, 2014; United Nations Office on Drugs and Crime (UNODC), 2014).

In line with global trends, Hong Kong has also witnessed an increase in psychotropic substance abuse among young people over the last two decades. In the peak period of 2008, 99% of young drug abusers reported taking psychotropic drugs such as ketamine, cocaine and methamphetamine, also known as “Ice” (Task Force on Youth Drug Abuse, 2008). In 2012, it was 97% (Action Committee Against Narcotics, 2013). Between 2003 and 2008, the levels of drug abuse among young people in Hong Kong had increased significantly, with the percentage of abusers aged under 21 years increasing from 13.9% to 24.2%. During the same period, the mean age of first-time young drug abusers decreased from 15.8 years to 15.4 years (Task Force on Youth Drug Abuse, 2008). In the 2008/2009 Survey of Drug Use among Students, it was also found that more than 90% of primary and secondary schools reported incidents of pupils taking drugs (Li, Tam, & Tam, 2010). Overall, these figures indicated an alarming increase in the level of drug abuse among young people in Hong Kong.

In response to the trends and characteristics of youth drug abuse in Hong Kong, the government implemented a variety of measures, including a Trial School Testing Scheme in the Tai Po District, the establishment of additional counseling centers for psychotropic substance abusers (CCPSAs) and the injection of HKD 3 billion into the Beat Drugs Fund in 2010–11. To a certain extent, these enhanced government measures for drug prevention, education and rehabilitation have had a significant effect on the reported levels of drug use, particularly among young people. Between 2008 and 2013, the overall numbers of drug abusers reported to the Central Registry of Drug Abuse (CRDA) dropped by 29%, from 14,241 to 10,069, while the percentage of abusers aged under 21 decreased by 65% from 3474 to 1182 (Action Committee Against Narcotics, 2013). Around the same time, the percentage of secondary schools that reported incidents of pupils taking drugs decreased from 90% to 82% (Li & Wong, 2013) and the number of drug-related crimes in school also fell from 24 in 2009 to 5 in 2012. However, despite the overall decline in the number of reported drug abusers, many frontline social workers in Hong Kong are concerned about the increasingly hidden nature of youth drug abuse. This phenomenon has been reflected in the statistics released by the CRDA over the last few years.

In 2013, the CRDA reported that more than 80% of drug abusers took drugs in their own homes or at their friends' homes and that half of all abusers reported having abused drugs for at least 4 years, compared with 1.9 years in 2008 (Action Committee Against Narcotics, 2013). Moreover, an increasing proportion of drug abusers were identified in their young adulthood, i.e. aged 21–30 years, instead of during adolescence. In 2009, over half, i.e., 51%, of drug abusers reported for the first time were aged below 21, while in 2012 this figure was 35%. Meanwhile, the proportion of those aged between 21 and 30 years increased from 32% in 2009 to 38% in 2012. These figures suggest that enhanced government measures may defer drug abusers from reporting their situations and receiving rehabilitation services. The dependence symptoms and bodily signs associated with psychotropic substance abuse – e.g., urinary system and brain damage – tend not to be as obvious as those associated with heroin abuse, or may take longer to become apparent in the physical appearance of the users. Thus, drug abuse may remain hidden or unnoticed for a substantial period. Eventually, young drug abusers may become harder to reach. In the long run, this trend may impose extra costs on all parties concerned and undermine efforts aimed at the early prevention of, and intervention in, drug abuse.

To tackle the problem of youth drug abuse, rehabilitation services and approaches adopted by the social service sector are crucial in helping young drug abusers to recover and remain abstinent from drugs. Even though service provision still lags far behind demand within the global context, different substance abuse treatment and rehabilitation services have been developed and experimented, such as residential care and intensive inpatient services, community-based outpatient and day treatments, behavioral therapy, family therapy and outreach programs (Gillvary, 2000, Tang et al., 2012, Witkiewitz et al., 2005). However, regardless of the type of program employed, relapse is still highly prevalent among substance abusers, even after the completion of a treatment program (Bowen et al., 2014, Witkiewitz et al., 2014, Zgierska et al., 2009). According to Witkiewitz et al. (2014), in the United States the rate of relapse among substance abusers who receive specialty treatment is estimated at over 60% within the first year following treatment. In China, the relapse rate is estimated at above 95% after six months of treatment (Wang & Wang, 2007). In Hong Kong, the high relapse rate among substance abusers after treatment remains a significant problem (Cheung et al., 2003, Shek, 2005). According to Cheung et al. (2003), up to 80% of the addicts who complete treatment programs relapse within a year. Therefore, in Hong Kong, further research is required to investigate evidence-based treatments for developing a more sustainable care and rehabilitation system for substance abusers.