MinisymposiumFamily support, quality of life and concurrent substance use among methadone maintenance therapy clients in China
Introduction
The methadone maintenance therapy (MMT) programme has a relatively short history in China. The Chinese Government initiated pilot studies of MMT in 2004 based on international scientific evidence of its efficacy in reducing heroin use, transmission of human immunodeficiency virus (HIV) and criminal behaviour.1, 2 The first eight pilot clinics were established in the five provinces with the greatest numbers of drug users and HIV cases: Guangxi, Guizhou, Sichuan, Yunnan and Zhejiang.3, 4 An evaluation study of these pilot programmes showed a reduction in heroin use and drug-related crime, and an increase in employment and healthy family relationships among those who received MMT.5 With the success of the pilot clinics, the MMT programme has been rapidly scaled up. By December 2009, 680 MMT clinics had been established in 27 provinces across China, cumulatively serving more than 240,000 clients. However, MMT programmes are facing challenges, including low coverage of the total drug-using population6 and the high client drop-out rate.7 In addition, a substantial proportion of clients continue illicit drug use while participating in MMT programmes. This paper provides a useful insight into the potential role of the family in improving the efficacy of MMT programmes and the client experience.
Drug use is commonly seen as an individual choice and experience in most Western cultures.8 The case is very different in China because of the family-oriented culture.9, 10 In traditional Chinese culture, individuals are not viewed as independent agents. They are embedded in a system with the family as the basic unit. Family identity is often considered to be equally, or even more, important than individual identity.11, 12 Previous studies revealed that most parents of drug users in China took personal responsibility for the fact that their children were using drugs, and these parents felt psychological pressure and shame in front of their neighbours and friends.13 On the other hand, drug users often rely to a greater extent on their family than their social network for support. More than half of HIV-positive injecting drug users voluntarily disclosed their serostatus to their family members, and were more likely to seek support from family members than friends.10
Given the important role that families play in the life of drug users, this study examines the role of family support in MMT in China. It posits that a good understanding of the role of family support in the lives of MMT clients can better inform the design of an HIV-related intervention, and also make existing programmes more efficient and more accessible to the targeted population. This study will test two hypotheses: (1) whether family support for MMT clients will improve their quality of life; and (2) whether family support will reduce the concurrent substance use among MMT clients in China.
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Study sites and participants
The data were collected in Zhejiang and Jiangxi Provinces between March and September 2008. At the time of the study, there were a total of 28 MMT clinics located in different counties or cities in these two provinces, and all of them were included in the study. Twenty MMT clients were selected at random from each of the 28 MMT clinics using a random number table, yielding a total sample size of 560. The selected clients were approached by MMT service providers when they came to the clinic for
Results
The background characteristics of the participants are summarized in Table 1. Among the 560 MMT clients interviewed, 471 (84.1%) were male, 310 (55.4%) were aged between 30 and 39 years, 350 (53.6%) had obtained a junior high education, and 168 (30.0%) were unemployed at the time of the study. The majority (398, 71.1%) were injecting drug users, 309 (55.2%) had a history of drug use of more than 10 years, and 474 (84.6%) had been registered as drug users by the local police department. The
Discussion
Past research has demonstrated that drug abuse is a complex issue and is linked to many social, economic, criminal and health challenges facing different societies.17 Drug use is a family disease; when one member of a family is a drug user, the impact radiates through the entire family.13 The importance of the family has been shown in other studies regarding drug use prevention and treatment. In the USA, a study among American-Indian adolescents found that positive family relationships mediated
Ethical approval
Institutional Review Boards of the University of California, Los Angeles and the Chinese Centre for Disease Control and Prevention.
Funding
University of California, Los Angeles/Fogarty AIDS International Training & Research Program, D43 TW000013.
Competing interests
None declared.
Acknowledgements
The authors wish to thank all those who participated in this study, including colleagues at the Chinese Centre for Disease Control and Prevention for their help and support. This study would not have been possible without local investigators and the research participants.
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