Academic journal article East Asian Archives of Psychiatry

Referral Patterns and Clinical Characteristics of Subjects Referred to Substance Abuse Clinic of a Regional Hospital in Hong Kong

Academic journal article East Asian Archives of Psychiatry

Referral Patterns and Clinical Characteristics of Subjects Referred to Substance Abuse Clinic of a Regional Hospital in Hong Kong

Article excerpt

Introduction

The Prince of Wales Hospital (PWH) is the main medical facility serving the Northeast area of the New Territories in Hong Kong. It has a catchment population of 1.2 million, which is about one-sixth that of the entire special administrative region.1 Patients considered to be drug abusers and suspected of having mental disorders are referred to the PWH Substance Abuse Clinic (SAC). A change in the pattern of drug abuse in Hong Kong has been observed in recent years. There has been a gradual increase in the use of psychotropic drugs and a simultaneous decline in the use of opiates, particularly among the younger persons. According to the Central Registry of Drug Abuse (CRDA) of the Narcotics Division, Security Bureau, the recent decline in heroin use has been accompanied by a corresponding increase in psychotropic drug use. (2) Among drug abusers aged under 21 years, 99% reported psychotropic drug use, while only about 2% reporting heroin use. (3) The literature contains ample evidence of an association between psychotropic drug abuse, psychosis, and major mood disorders. (4,5) Studies involving adolescents have generally yielded a high rate of co-morbid mental health problems, (6) as have studies in adults, in the United States more than 60% of such drug abusers reported depression, anxiety or traumatic distress. (7,8)

No data are available on psychiatric co-morbidity rates among drug abusers in Hong Kong. The objective of the current study was to describe the demographics, clinical characteristics, referral patterns, and psychiatric co-morbidities of drug abusers in Hong Kong.

Methods

Study Population

This retrospective chart review covers the 36-month period from 1 January 2007 to 31 December 2009. All new patients seen at the PWH SAC during this period were included in the study. The SAC accepts referrals of patients aged 12 years or above, but not those suffering from alcohol-related disorders or on conditional discharge (as defined in Section 42B of the Mental Health Ordinance). The other precondition for SAC acceptance was active substance abuse within the previous 12 months.

The study protocol was approved by the Chinese University of Hong Kong--New Territories East Cluster Clinical Research Ethics Committee.

Data Collection

When a patient first attended the clinic, his or her source of referral, age, gender, level of education, marital status, district of residence, occupation, type of drugs misused, co-morbid psychiatric diagnosis, and previous treatment were recorded on a standard form. All patients were diagnosed according to the 10th edition of the International Classification of Diseases. (9)

Statistical Analysis

The data were analysed using the Statistical Package for the Social Sciences, Windows version 15.0. Patients' socio-demographic characteristics, types of drugs misuse, and co-morbid psychiatric diagnoses were calculated using descriptive statistics.

Results

Socio-demographic Characteristics, Referral and Drug Abuse Patterns

The socio-demographic characteristics of the sample and the referral patterns are shown in Table 1. With the establishment of 2 Counselling Centres for Psychotropic Substance Abusers in the region studied, referrals from social workers increased to 43% in 2009, rendering them the main source of referral. The frequencies of both primary and secondary drug abuse, as well as the total frequency of drug abuse, are shown in the Figure. In addition to their primary drug abuse, 100 (76%) of the subjects reported regular use of a second substance, whilst 26% of these subjects reported regular use of 3 or more drugs.

Co-morbid Psychiatric Disorders and Treatment at First Attendance

The distribution of suspected psychiatric disorders and psychiatric diagnoses are presented in Table 2. Four patients underwent immediate hospitalisation at their first attendance; 1 had a typical manic episode with psychotic symptoms, 1 exhibited a delusion of infestation, and the other 2 were depressed and posed a substantial suicidal risk. …

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