Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity at a Female Residential Drug Treatment Centre in Hong Kong

Academic journal article East Asian Archives of Psychiatry

Psychiatric Morbidity at a Female Residential Drug Treatment Centre in Hong Kong

Article excerpt

Introduction

In recent years a change in the pattern of drug abuse has been observed in Hong Kong. There has been a gradual increase in the preference for psychotropic drugs (ketamine, ecstasy, methamphetamine, triazolam / midazolam / zopiclone, cannabis, cocaine, cough mixtures, and solvents) and a simultaneous decline in the use of opiates, particularly in the young. According to the Central Registry of Drug Abuse (CRDA) of the Narcotics Division, Security Bureau, heroin is used much less frequently than psychotropic drugs. (1) Ninety eight percent of substance abusers under 21 years admitted were using psychotropic drugs; only about 3% reported heroin use. (2)

Several American and European studies (3-6) have found a high rate of psychiatric co-morbidity in substance abusers. Externalising disorders are very common in adolescents, (7) whereas in adults, depression, anxiety, and post-traumatic stress disorders are more common. (8,9) In the National Co-morbidity Survey in the US, the odds ratio for the 12-month co-occurrence of any affective disorder with drug dependence was 3.9, and the corresponding figure for any anxiety disorder was 3.6. (10)

Relatively little is known about the psychiatric co-morbidity of substance abusers in Hong Kong. In a local survey of over 3300 subjects, 35% with generalised anxiety disorder also suffered from co-morbid substance misuse. (11) In a 2005 study of 95 ketamine abusers recruited from nightclubs and drug counselling centres, 26% had lifetime psychiatric diagnoses and substance use disorders. The 2 most common diagnoses were depressive disorder (13%) and drug-induced psychotic disorder (6%). (12) Data on subjects treated in residential drug treatment centres in Hong Kong are lacking.

In overseas residential treatment centres, clinically significant depression was noted in over 50% of substance abusers using the Beck Depression Inventory (13) and the Patient Health Questionnaire. (14) In these overseas studies, the subjects mostly abused alcohol (44%), cocaine (11%) or both (31%), which was a pattern that differed from local drug abuse. As untreated psychiatric disorders worsen drug dependence treatment outcomes, the early identification and treatment of psychiatric disorders should be a priority (15) in general and residential substance abuse facilities. (16,17)

The pattern of drug abuse and its clinical characteristics differ to some extent depending on gender. More women than men abuse ketamine, methamphetamine, ecstasy, and hypnotics. (18) Up to 42% of women take their first drug before 16 years old, whereas the corresponding figure for men is 39%. (19) Female drug abusers also have a higher rate of morbidity, attain lower education levels, and enjoy poorer social support. (20) The common reason for women starting drug abuse is self-medication to cope with problems in life. (21) Gender disparities in substance abuse have been increasingly studied worldwide, (20) but studies in Hong Kong are lacking.

The aim of this study was to describe the demographic characteristics, pattern of drug abuse, and type of psychiatric co-morbidity in female substance abuse patients treated in a residential setting.

Methods

Subjects

Subjects were recruited between November 2009 and February 2010 from a local residential detoxification centre for female substance users run by the Society for the Aid and Rehabilitation for Drug Abusers (SARDA) in Hong Kong. This non-governmental welfare organisation, established in 1961, provides free drug treatment and rehabilitation service. The typical rehabilitation programme consists of 6 to 18 months at the residential treatment centre, followed by 3 to 6 months at a halfway house.

The study protocol was approved by the Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee. Every subject signed a consent form. Consent was also obtained from the parent or guardian if the subject was under the legal age of 18 years. …

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