TOWARDS A SELF-CHANGE-FRIENDLY TREATMENT AND POLICY FOR ADDICTIVE BEHAVIOURS

Abstract

Dr Klingemann and his colleagues reviewed a substantial literature on the current state-of-the-art in natural recovery research, and concluded that natural recoveries from substance use disorders not only occur but are a major pathway to recovery 1. The results of self-change research have given rise to basic questions about the effectiveness of mainstream treatment modalities and drug policies on demand reduction. However, research shows that, like other chronic diseases, drug addiction can be treated effectively and managed over its course. In addition, addiction treatment has also been shown to be an effective way to prevent the spread of diseases, such as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and hepatitis 2. This means that, contrary to the conclusions of Dr Klingemann, we believe recovery is happening in communities, families, hospitals, recovery centres, therapeutic communities, clinics, faith-based programmes and self-help groups in every corner of the world. Effective treatment occurs in a variety of settings, in many different forms and for different lengths of time 3. We think the arguments about the methodology, subjects and conclusions in self-change and treatment research will continue for a long time. Dialectic philosophy holds that ‘external causes are the condition of change and internal causes are the basis of change, and that external causes become operative through internal causes’4. From this viewpoint, it is not whether or not self-change exists, or whether therapy is effective. What we really need is to try to develop treatment approaches and policy that create a good environment to facilitate maturity and change for drug use patients. In fact, recovery from addiction is an established reality, achieved through a variety of treatment modalities when they are matched to the needs of individual patients. Numerous studies have shown that addiction treatments are comparable in effectiveness to treatments for other chronic illnesses 2. In our independent evaluation for the ‘Drug-free Community’ project in Furong District, Changsha, China, we found that in 662 government registered patients with drug use (86.9% were heroin use) history in Furong District, 57.4% of patients had negative drug test results (those who refused to be interviewed or take a drug test were considered as positive), in which the 5-year abstinence rate was 16.6%. The reported reason for abstinence can be divided into two categories: external and internal. External reasons included pressure and help from family (27.2%), economic burden (24.8%) and help from community leaders and policemen (16.3%). Internal reasons included concern about health (16.1%), concern about working and life (11.7%), concern about being caught by the police and ‘change was done to me’ (5.7%). Two conclusions come from the survey: (i) it is not ‘once drug, always drug’, as circulated both in public and professional circles in China, and (ii) change can take place from the inside with external help 5. In the past 30 years drug abuse, along with prostitution and gambling, has been referred to as an ‘ugly social phenomenon in China’. Both lay people and professionals think punishment should be an important component of drug abuse treatment. Professionals who work with drug-dependent people often focus upon interventions for acute conditions in treatment facilities and neglect interventions in the community; and we lack an effective mechanism for integration of different resources from government sectors, such as public security, justice and health sectors in the intervention of drug abuse 6. The concept of self-change has rarely been accepted as a method for stopping drug use. For this reason, we have begun to develop a community-based intervention model, in which we are trying to mobilize the resources in communities and integrate efforts from government sectors, and develop a seamless intervention for patients in five communities in the cities of Changsha, Shanghai and Kunming. The preliminary results of the ongoing project show that the community-based and integrated approach not only reduces drug use and related crime but also increases employment and quality of life. In conclusion, much work needs to be undertaken to understand internal factors if self-change takes place, and what external factors, such as treatment and policy, facilitate the initiation and maintenance of self-change. Given the present evidence base regarding self-change, community-based interventions should be prioritized and tested as a means of encouraging attempts at self-change. Such strategies would also be predicted to increase treatment uptake. The author is supported by Key Projects in the National Science & Technology Program during the 11th five-year Plan Period (2007BAI07B01). None.