Peer-delivered Follow-up Text Communication After a Brief Motivational Interviewing (MI) for Adolescent Drug Abusers
Condition: Drug Abuse; Adolescent Behavior
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      A pilot randomized control trial will be conducted attaching to the MedPAC services to
      evaluate the feasibility and acceptability of a Motivational Interviewing (BMI) interaction
      via instant messaging apps on reducing the drug abuse among youth in Hong Kong.
    

Detailed description: 
      Youth who persistently abuse substances often experience an array of problems, including
      academic difficulties, health-related problems (including mental health), poor peer
      relationships, and involvement with the juvenile justice system. Additionally, there are
      consequences for family members, the community, and the entire society. Although many youths
      engage in risky, experimental drug use without developing later life addiction, the early age
      of first drug use is strongly associated with risk for developing a substance use disorder
      later in life.

      According to the Central Registry of Drug Abuse Sixty-seventh Report in 2018, the total
      number of reported drug abusers in Hong Kong has been decreasing in last decade, however,
      about 40% of them were aged 25 or below. Reported by 2017/18 Survey of Drug Use among
      Students, the number of students claiming to have used drugs has gone up by 23 per cent
      compared to the last survey. Combining with the two reports, there were lifetime drug-taking
      17800 students, while only 471 drug-users aged under 21 were reported. In addition, the 2017
      figures revealed that 58% of the abusers took drugs at home/friend's home only, which had
      increased substantially from 43% in 2008. The statistics above alarm that the drug abuse and
      the hidden nature of drug-taking among the youth aged 25 or below which cannot be overlooked
      or undervalued.

      The psychological and social factors associated with the initiation and continuation of drug
      abuse are different for the youth and adult. Previous research has confirmed that the
      recovery from drug abuse is influenced by the users' intention to change, which is determined
      directly by their perceptions of anti-drug and their perceived self-efficacy to change.
      While, drug-abusers' attitude, social influences, and demographic characteristics have more
      indirect effects on recovery from drug abuse.

      Most of the youth drug-abusers reported that the major reasons to take drugs for the first
      time are "curiosity" and "to seek excitement", which indicated an insufficient anti-drug
      awareness among the high-risk population. While except for the conform bringing by
      drug-abusing, social and psychological factors, such as peer identification, depression,
      anxiety, stress was reported as major reasons for youth to continue using drugs. It prompts
      us individualized interventions that clearly communicated information about the risks of drug
      abuse should be designed for the youth.

      Government has organized several drug abuse treatment and rehabilitation programme. However,
      as shown in the report, about 88% of youth drug-abusers had never sought others' help. Except
      for the feeling that drug giving, absence of problem lead to that they mostly did not
      consider themselves addicted, which was the major reason for the youth having no awareness to
      seek for others' help. In addition, consideration about the stigma, fear of not knowing what
      to expect from the treatment and the whole lifestyle change, and worries about withdrawal
      symptoms were the main barriers to keep the youth from seeking drug abuse treatment. To bring
      the usage of drug abuse treatment and rehabilitation programme into full play, these barriers
      should be resolved for drug-abusing youth.

      Considering the reasons above, specifically promoting and supporting service should be
      developed to increase the anti-drug awareness of the youth, enhancing help-seeking
      consciousness, and promote treatment and rehabilitation for youth drug-abusers or those
      exposed to drug abuse.

      Telephone counselling is effective in promoting addiction behaviour, both in Hong Kong and
      overseas. As reported in a previous study, the clients prefer to use online counselling as it
      was less confronting than traditional forms of counselling by providing a private and
      emotionally safe environment. Therefore, the telephone format encourages those who are
      reluctant to get help face-to-face to seek direct anti-drug advice. In addition, the
      telephone method is proven to be more effective than other health promotion intervention such
      as mass media as it allows the counsellor to directly interact with the caller, thus
      addressing the problem at the right moment. Comparing with face-to-face counselling, analyses
      have consistently reported that telephone counselling allows a large segment of drug-abusers
      to be reached at a minimal cost. Hence, the use of telephone counselling in helping
      drug-abusing youth cannot be ignored.

      Comparing with general counsellors, there are several advantages using peer as counsellors.
      There is evidence supporting that the use of peer counsellors can increase the appeal of
      addiction services to youth users. Since most youths are not eligible to hold positions of
      power in their society, they find themselves, subject to authority. Such a power differential
      makes communication between adult and youth difficult. When one is trying to engage the youth
      in drug abuse prevention initiatives, this power differential manifests itself also as a
      knowledge gap. The adults' command over jargon and the "science" of drug addiction often acts
      as a deterrent for the youth who may otherwise willingly engage in debate. Comparing with
      adults, the equality in power status between the youth makes peer-based risk communication
      successful. With similar age, peers can address concerns relevant to their experience, which
      help the high-risk youth to aware of the problem of drug abuse. Explanation and consideration
      from peers could be more effective in helping drug-abusing youth to eliminate or reduce the
      fear of unknown to expect from the treatment and the whole lifestyle change, and worries
      about withdrawal symptoms. Hence, they could be more willing to attempt to seek further help
      and treatment.

      Moreover, a thorough understanding of drug-abusing youth, especially the psychological and
      social factors that cause them to initiation and continuation of drug abuse, is necessary to
      design individualized interventions to these drug-abusers. The trained peer counsellors
      provided individualized advice to the drug-abusing youth to improve their self-efficacy to
      resist the urge to drug and control over their own behaviour. Peers can better understand the
      problems that people their age faced such as peer pressure, conflict with parents and
      teachers and girl-boy relationships. The empathy on the social and psychological problem
      between the youth could be a good approach for drug-abusing youth to pour out their
      pressures, which is associated with the prevention of relapse. As stated above, peer
      counselling could be a potential method in increasing awareness of drug abuse, promoting
      help-seeking and preventing relapse of drug abuse among the drug-abusing youth.

      On the other hand, the collaborator of this project, the Society for the Aid and
      Rehabilitation of Drug Abusers (SARDA) found in 1961, has rich experience in addiction
      counselling and drug treatment and rehabilitation. SARDA has seven affiliated treatment and
      rehabilitation centres and one clinic, which can accept the referral cases who need further
      treatment and rehabilitation service. The medical doctors in the clinic have sound knowledge
      of the drug abused, counselling skills, and can handle patients with drug overdose or drug
      abuse. In addition, medical doctors, experienced counsellors in SARDA will be invited to give
      lectures in a training programme held for the student counsellors.
    

Intervention name(s): Brief Motivational Interviewing interaction; General health communication
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Telephone peer counselling+ Brief Motivational Interviewing interaction, and telephone-based interview after receiving all information.; Telephone peer counselling+ General health communication, and telephone-based interview, and telephone-based interview after receiving all information.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: drug abuse; brief motivational interview; peer counselling; instant messaging; adolescent