Peer-delivered Follow-up Text Communication After a Brief Motivational Interviewing (MI) for Adolescent Drug Abusers

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* age 25 years old or below,
* report taking drugs within the past 30 days,
* be able to speak Cantonese, read Traditional Chinese,
* accept to received counseling use messaging apps (such as WhatsApp, WeChat, and SMS text messenger),
* have verbally consented to join the follow-up intervention.

Exclusion Criteria:

* have acute psychosis or other mental problems,
* be undergoing other drug abuse recovery treatment.