Compulsory Drug Treatment Research Articles

‘Can we predict aggression?’—Determining the predictors of aggression among individuals with substance use disorder in China undergoing enforced detoxification through machine learning

BackgroundThe general aggression model has shown that both individual and situational factors can predict aggression. However, past research has tended to discuss these two factors separately, which might lead to inconsistency. This study addresses this gap by examining the importance of each predictor of aggression in a Chinese compulsory drug treatment population and further explores the predictors of aggression in various substance use disorder populations. MethodAnalyses were conducted using a sample of 894 male participants (mean = 38.30, SD = 8.38) in Chinese compulsory drug rehab. A machine learning model named LightGBM was employed to make predictions. We then used a game-theoretic explanatory technique, SHAP, to estimate the effect of predictors. ResultsIn the full-sample model, psychological security, parental conflict, and impulsivity were the top 3 predictors. Depression, childhood abuse, and alexithymia positively predicted aggression, whereas psychological security, family cohesion, and gratitude negatively predicted aggression. There were significant differences in the predictive effects of depressants and stimulants. Although the importance of predictors varied between drug-use groups, several individual and situational factors were consistently the most important predictors. LimitationsAll participants in this study were male, and the data were acquired through self-reports from the participants. Domestic and nondomestic aggression are not distinguished. Additionally, our findings cannot support causal conclusions. ConclusionThis study tested a series of classical theories of the predictors of aggression in China's compulsory drug treatment context and extended the ideas of the GAM to various substance use disorder groups. The findings have important implications for aggression treatment.

Using Illicit Drugs to Lose Weight among Recovering Female Drug Users in China: An Exploratory Qualitative Study.

The population of female drug users has been growing in China, and these women have been found to care deeply about their weight. Against this backdrop, this study examines the relationship between Chinese women’s illicit drug use and their intentions to lose weight, keep fit, and maintain a slim body shape. The participants of this study were 29 women who all had experience with illicit drug use for weight control. These women were drawn from a female compulsory drug treatment center located in eastern China. Semi-structured interviews with these 29 participants were conducted between 2013 and 2016. Expectations of losing weight and pursuing their ideal slim body shape were found to be an important reason for the study participants’ initiation of drug use, its maintenance, and failures to achieve abstinence. These Chinese female drug users were generally satisfied with weight loss outcomes subsequent to drug consumption. A fuller appreciation of Chinese women’s weight-loss-related illicit drug use patterns is much needed to help devise strategies and policies to deal with this growing problem. These include changing the dominant aesthetic cultural preference for thinness, paying particular attention to the functional use of illicit drugs in drug treatment programs, and having special interventions for women who interact with drug users within their social networks.

End compulsory drug treatment in the Asia-Pacific region

In March, 2012, 12 UN entities called on governments worldwide to close compulsory drug detention and rehabilitation centres for people “suspected of using drugs or dependent on drugs, people who have engaged in sex work, and children who have been victims of sexual exploitation” because of health and human rights concerns.1 In 2020, 13 UN agencies reiterated that statement, focused on centres in Asia and the Asia-Pacific region, citing continued human rights violations, including lack of due process, forced labour, inadequate nutrition, physical and sexual violence toward detainees, and denial of evidence-based drug dependence treatment and basic health-care services in these facilities.

Prison in Iran: A Known UnknownN.R.Anaraki. Cham, Switzerland: Palgrave Macmillan (2021) 117pp. €106.99hb; €85.99e‐book ISBN 978‐3‐030‐57169‐6; 978‐3‐030‐57169‐9

<i>Prison in Iran: A Known Unknown</i>N.R.Anaraki. Cham, Switzerland: Palgrave Macmillan (2021) 117pp. €106.99hb; €85.99e‐book ISBN 978‐3‐030‐57169‐6; 978‐3‐030‐57169‐9

Keeping concerned significant others at a distance in compulsory treatment for people with substance use in Sweden

While previous drug treatment research has focused on the importance of supportive social relationships for recovery from alcohol and drugs, less is known about how this theme relates to compulsory drug treatment. This study analyzes how staff at four compulsory treatment institutions for adult drug users in Sweden rationalize the importance of maintaining contact with concerned significant others (CSOs) during the client’s treatment. Four focus groups (22 participants) were carried out and analyzed thematically. This study shows that staff perceives the client’s initial isolation as a necessity, primarily making CSOs a problem or distraction in relation to the recovery process. Moreover, staff position CSOs in two broad categories, as either ‘problematic’ or ‘resourceful’ in relation to a client’s recovery. The two categories are used to justify individual regulation between clients and their CSOs, which varies between strictness and leniency. In addition, staff position themselves as guides, finding it necessary to help clients regulate problematic CSOs themselves and strengthen the link to those who are seen as resources. These two forms of regulatory work – setting rules and providing guidance – are analyzed in terms of disciplinary and pastoral power.

Locked Up and Locked Out: Client Perspectives on Personal Relationships While in Compulsory Drug Treatment

This qualitative study explores clients’ perspectives on their personal relationships while in compulsory drug treatment. Interviews with 31 participants (14 female and 17 male) were conducted at four compulsory treatment institutions for adults who use drugs in Sweden. Taken together, our study reveals that clients in general had to struggle to maintain social relationships due to strict restrictions on their interpersonal contact and communication. Feelings of isolation and anxiety characterized much of their relationships during the treatment period, with emotional withdrawal commonly described as a way to cope. Moreover, some participants expressed shame and guilt over the pain and suffering they had subjected their family members to through their drug use, feelings that put additional strain on the contact. The emotionally and socially significant relationships described by our interviewees provide links to other personal roles and settings than those prescribed by the institution. At the studied institutions, however, little attention was given to this relational dimension of the clients’ situation. Based on the results of the present study, possibilities for improvement of compulsory drug treatment are discussed.

Suicide Attempts and Perceived Social Support among Chinese Drug Users: The Mediating Role of Self-Esteem and Depression.

Suicidal behavior is a severe problem among drug users. This study examines influential factors related to suicide attempts and analyzes possible mediators of the relationship between perceived social support and suicide attempts amongst Chinese drug users under compulsory institutional drug treatment. Taking perceived social support as the independent variable, we found that the relationship between suicide attempts and perceived social support is mediated by self-esteem as a protective factor and depression as a risk factor. Path analysis shows that self-esteem contributes relatively more to the indirect effects than depression does, accounting for 31.1% and 24.2% of the total effect, respectively. Generally speaking, the findings of this study point to an urgent need for addressing suicide attempts among Chinese drug users while treating self-esteem as the protective factor that deserves as substantial attention as depression receives.

Compulsory and voluntary drug treatment models in China: A need for improved evidence-based policy and practice to reduce the loaded burden of substance use disorders

In China, the majority of people who use drugs (PWUD) identified by authorities are admitted to compulsory isolated detoxification centers in which their treatment is administered by administrative and judicial systems that restrict their freedom. China's compulsory isolated detoxification centers have been criticized as an abuse of human rights. The two other primary models of drug treatment in China include community-based treatment and medically-oriented voluntary treatment. This article presents an overview of the three primary treatment models for PWUD currently practiced in China. The existing compulsory and voluntary treatment models predominantly operate separately from each other, and lack evidence-based guidelines. A drug treatment system that embraces social support, psychosocial interventions and well-qualified health-based workforce is currently lacking. We propose that China needs to employ a localized model that is composed of well-facilitated and evidence-based treatment methods for both compulsory and voluntary treatment for PWUD to reduce the burden of illicit drug use. The implementation of these models of care, however, need to be tailored to the country's historical background, large population of PWUD and cultural settings in order to succeed. Urgent changes in drug treatment policies and practices are needed by the Chinese governments at different levels, organizations and front-line practitioners if we are to see a reduction in the incidence and impact of harms related to substance use in China.

Sex, Drug, and HIV/AIDS: The Drug Career of an Urban Chinese Woman

This case study is based on the life history of an urban Chinese woman, Lydia, who has become an AIDS patient through injecting heroin use. Adopting theories of drug career and biopolitics, this study depicts Lydia’s drug-centered life. From the perspective of a drug career, this article vividly illustrates her experience of drug initiation, escalation, maintenance, and finally achievement of abstinence. In addition, this study also shows how drug use has penetrated all dimensions of Lydia’s life including intimate relationships, financial arrangements, and compulsory drug treatment; in the end, contracting HIV was when she finally hit rock bottom and worked to get rid of her heroin dependence. From the perspective of biopolitics, this article focuses on the institutional and social structure transformation that is reflected by Lydia’s personal experience, especially the social service, treatment, and intervention programs provided for her during an era of increasingly growing drug use and HIV-infected population.

Different transmission routes and the risk of advanced HIV disease: A systematic review and network meta-analysis of observational studies

BackgroundA substantial proportion of people living with HIV (PLHIV) present for care with advanced HIV disease (AHD), which may result in difficulty reaching the “90–90–90” target to end AIDS in 2030. We assessed the risk of AHD for different transmission routes to summarize the evidence for priority prevention strategies for key populations. MethodsObservational studies published before September 10th, 2019 in the PubMed, EMBASE, Web of Science and Chinese electronic databases were analysed. The outcomes of interest were the number of PLHIV and AHD patients and their associated transmission routes. We assessed the risk of AHD among the different transmission routes using the multi-armed network meta-analysis based on the Bayesian method. The associations between AHD and regional policies for sex work and compulsory drug treatment were estimated using ecological linear regression. FindingsOne hundred and one articles were included, covering 1,297,872 PLHIV with 478,830 patients who developed AHD. The network analysis revealed that among PLHIV, heterosexual contact was associated with the highest risk of AHD, followed by injection drug use (odds ratio [OR]=0•56, 95% credible interval [CrI] 0•47–0•68), and men who have sex with men (OR=0•54, 95% CrI 0•46–0•63). Regions that criminalized sex work and compulsory drug treatment had higher risks for AHD than those that did not. InterpretationOur findings suggest HC is at a higher risk of AHD compared to IDU and MSM. This justifies the need to expand prevention campaigns and maintain efforts to increase HIV testing in the heterosexual population.

Loneliness and depression among Chinese drug users: Mediating effect of resilience and moderating effect of gender.

This study aims to explore potential correlations between gender, loneliness, resilience, and depression simultaneously among Chinese drug users; and especially to investigate the mediating effect of resilience and the moderating effect of gender on the correlation between loneliness and depression. Participants of this study included 513 drug users (399 men and 114 women) who were under treatment in two compulsory drug treatment institutions in one Eastern Chinese city. All participants completed the UCLA (University of California, Los Angeles) loneliness scale, the Zung self-rating depression scale, and the Connor-Davidson resilience scale. A correlation matrix was constructed to analyze correlations between these three characteristics. Path analyses were performed in the PROCESS for SPSS in order to test the mediating effect of resilience on the association between loneliness and depression; while a series of hierarchical multiple regressions were conducted in SPSS 22.0 to test the moderating effect of gender on the association between loneliness and depression. Compared to male drug users, female ones reported higher average scores on loneliness and depression, which indicated that female drug users suffered severer loneliness and depression. Resilience partially mediates the link between loneliness and depression and gender acts as a moderator for the relationship between loneliness and depression.

Anxiety and sleep quality in Chinese persons with a substance use disorder: A moderated mediation model of rumination and mindfulness

A moderated mediation model was used to test how anxiety influences sleep quality via rumination, and when the association between anxiety, sleep quality and rumination is most potent in Chinese persons with a substance use disorder. The cohort comprised 104 registered substance users recruited from two compulsory drug treatment institutions in the city of Guangdong in Eastern China. All subjects completed the Beck Anxiety Inventory, the Ruminative Response Scale, the Mindful Attention Awareness Scale and the Pittsburg Sleep Quality Index. Path analyses were performed in PROCESS for SPSS to test the mediating effect of rumination on the association between anxiety and sleep quality. Finally, the conditional process analysis was performed to test how the moderating effect changes under different levels of mindfulness. The mediating analysis documented that the effect of anxiety on sleep disorders was mediated via rumination. Mindfulness was found to act as a moderator on the relationship between anxiety and poor sleep quality. Conditional process analysis revealed that anxiety had a significant impact on poor sleep quality across low, middle and high levels of mindfulness; however, the indirect effect of rumination on the relationship between anxiety and poor sleep quality was just moderated by mindfulness on low and middle levels of mindfulness. These findings deepen prior studies by explaining (1) how anxiety is associated with sleep quality via rumination, as well as (2) the circumstances in which the correlated effect is determined by mindfulness among substance users. Therefore, contribute to the existing literature.

The lived experiences of becoming a homeless person with addiction in Tehran: how they are withdrawn from the mainstream community?

ABSTRACTUnderstanding the experiences of street addicted people can help clarify the process of engaging people with this social problem. This study aims to discover the challenges of drug-dependent street people by exploring their lived experiences. This study was conducted using content analysis of qualitative interviews with 22 street recruited from within compulsory drug treatment centers in Tehran. Participants were selected through purposive sampling and their experiences of homelessness and addiction were collected through a semi-structured interview. After analyzing the data, three categories and eight sub-categories were determined. The main categories included instability, social distrust, and economic vulnerability. Instability includes experiences such as rejection from their home, street attraction, and avoiding returning home. The social distrust theme consists of experiencing the stigma related to addiction and high-risk behaviors. The economic vulnerability encompasses gradual capital loss and weakening their work status in the context of a weak economic foundation. Dependent drug use added to those isolating experiences leads to weakened family ties, and social and economic interactions and finally results in being disconnected completely from the community mainstream.

The risk environments of people who use drugs accessing two harm reduction centers in Tehran, Iran: A qualitative study

BackgroundIran has developed the most robust harm reduction infrastructure in the Middle East, marked by availability of low threshold methadone maintenance treatment (MMT), needle and syringe program (NSPs), and condom distribution services. However, little is known about the socially situated risk factors that make harm reduction clients—specifically those enrolled in MMT—vulnerable to relapse or continued illicit drug use. In this study, we sought to understand the “risk environment” of clients enrolled in harm reduction services in Tehran, Iran. MethodsThrough observation and in-depth interviews with 22 drop-in-center clients and 8 staff members from July to August 2017, we explored the risk environments of clients of two drop in centers (DICs) in Tehran. All interviews were transcribed, coded and analyzed using a qualitative thematic analysis. ResultsWe found that compulsory drug treatment programs, social stigma, police encounters, and difficulties in obtaining governmental identification documents, among other factors, contribute to social marginalization of DIC clients. ConclusionMany interviewed DIC clients continued to use illicit substances (particularly methamphetamine) despite having access to methadone treatment. This study underscores the panoply of social and structural barriers that DIC clients face while attempting to engage in treatment and harm reduction services. Following the “risk environment” framework, it is essential to identify the structural factors shaping individual behaviors that perpetuate experiences of social marginalization and poor health outcomes in this population.

A qualitative study of methamphetamine initiation among Chinese male users: Patterns and policy implications

China is a major producer and distributor of methamphetamine (meth) worldwide. Within the last two decades, China has seen rapid growth in meth use, especially among young men. However, patterns of Chinese male users’ initiation of meth is rarely explored. To address this void in the literature, this study adopts China’s mian’zi culture to explore Chinese male meth users’ initiation patterns qualitatively. Semi-structured interviews were conducted with 35 male meth users from seven Chinese compulsory drug treatment institutions. Thematic analysis was applied to data analysis. Most participants reported their beginning to use meth as a strategy or approach to handling peer influence stemming from structured social networking. The motivation to have fun with friends, colleagues, or business fellows to maintain these people’s mian’zi, together with the curiosity about meth and lack of understanding that meth is a potentially addictive drug, contribute to male users’ meth initiation. Moreover, we found that most male meth users’ initiation occurs in enclosed locations, such as nightclubs, karaoke rooms, hotels, and private residences because these locations were considered “safe.” Additionally, some participants initiated meth use because they perceived it could be a way of harm reduction from heroin or alcoholism. However, such perception neglects the harmful outcomes of the concomitant use of meth with other drugs or alcohol. We suggested social support programs for young Chinese men who are located in high-risk social networking where meth use is accepted as a way of interaction. Up-to-date drug education on meth is also necessary for school students, and mass media could play its role in educating the public about potential risks of meth use.

Pleasure and Risk: A Qualitative Study of Sexual Behaviors Among Chinese Methamphetamine Users

In China, the number of methamphetamine (meth) users has increased dramatically in recent years. This issue has caused researchers to consider the association of meth use with public health concerns, such as the spread of sexually transmitted infections (STIs). Despite the potential outcomes of meth use, qualitative research has not as yet explored Chinese meth users’ sexual experiences and feelings associated with meth use. To contribute to the literature, this study employed semistructured interviews to collect data from 19 female and 16 male Chinese meth users (mean age = 31) who were predominantly heterosexual and were recruited from seven compulsory drug treatment institutions in Eastern China. Most participants had completed nine or fewer years of education. Gender similarities and differences were observed in the participants’ pursuits of sexual pleasure while using meth. Meth use can enhance the likelihood of high-risk sexual behaviors in both genders and therefore increases the number of public health issues. Men largely dominated the discussion of unprotected sex, while women reported transactional sex in their interviews. Based on research findings, we suggest policymakers strengthen safer-sex educational programs. Policymakers should also enhance prevention methods targeting meth use among women who may engage in transactional sex.

Compulsory treatment of drug use in Southeast Asian countries

BackgroundSeveral Southeast Asian countries have implemented compulsory drug detention centres in which people who use or are suspected of using drugs, mainly amphetamine-type stimulants, are confined without their consent and in most cases without due process and clinical evaluation of their substance use disorder.Given these facilities’ lack of access to evidence-based drug dependence treatment, and the human rights implications of peoples’ arbitrary detention under the pretext of “treatment”, international organizations have called for their closure. The aim of this study was to estimate recent numbers of compulsory drug treatment centres and of people in these centres in the region. MethodsWe conducted an analysis of cross-sectional governmental data collected from seven countries in the region with compulsory drug detention centres, namely Cambodia, China, Lao PDR, Malaysia, the Philippines, Thailand and Viet Nam. We computed descriptive data provided by government representatives for the period between 2012 and 2014. ResultsThe total number of people in compulsory detention centres overall decreased by only 4% between 2012 and 2014. In 2014, over 450,000 people were detained in 948 facilities in the seven countries. While only two countries decreased the number of compulsory detention centres, most countries increased the number of people detained. ConclusionsIn spite of international calls for the closure of compulsory detention centres, the number of facilities and detained people remained high in the seven countries included in the analysis. These officially reported figures are concerning regarding access to effective drug dependence treatment and given the potential for additional human rights abuses within compulsory detention centers.Further concerted policy and advocacy efforts should support transition of treatment for people with drug dependence towards human rights-based and evidence-based drug dependence treatment. Expansion of existing drug and HIV services in the community rather than compulsory treatment modalities will effectively address the region’s drug and HIV burden.

Chinese Drug Users’ Abstinence Intentions: The Role of Perceived Social Support

This study investigated the relationship between Chinese drug users’ perceived social support and their intentions for choosing abstinence. Both bivariate and multivariate analyses were performed with 3,239 drug users, especially heroin (427) and methamphetamine (890) users. All participants were from multiple Chinese compulsory drug treatment institutions. Perceived support from friends was the factor that showed a strongest positive relationship with Chinese drug users’ abstinence intentions. The positive influence from family support on the willingness to seek and choose abstinence was not as great as scholars have suggested, which challenges previous research findings. Methamphetamine users had a significantly lower chance of pursuing abstinence, but their abstinence intentions were positively related to perceived support from friends. Comparatively, all types of perceived social support had no significant influence on heroin users’ abstinence intentions. This study highlights that, as China’s methamphetamine-addicted population rapidly expands, tailored treatment, especially facilitating positive peer support, is urgently needed.

Rehabilitation policy for drug addicted offenders in China: current trends, patterns, and practice implications

ABSTRACTDrug use in China is both associated with criminal behaviour and regarded as social deviance. Drug addicted offenders can either be assigned criminal punishment or compulsory drug treatment, depending on the severity of the crimes they have committed. Compulsory drug treatment is in many ways similar to imprisonment in China. However, both compulsory drug treatment and imprisonment fail to prevent drug relapse. The authorities have implemented methadone maintenance treatment and non-medical social work interventions, although they are still in their infancy. More efforts should be made to deliver post-institutionalization programmes to help ex-inmates stay away from drugs and crime.

The social work services in screening process of compulsory treatment interventions in addicts in Iran: A content analysis study

Compulsory treatment has had a detrimental impact on drug abuse treatment policies and programs in Iran. Physicians are currently required to conduct initial treatment screening. Social workers are a part of the treatment team but have no authority to initiate a compulsory drug treatment plan. For this reason, the present article investigates social work service participation in the process of compulsory drug treatment. The study methodology is content analysis. Nine social workers participated in seven focus group discussions. Overall, 110 codes were extracted from the sessions and were categorized into five main themes: interview and initial assessment; referral; investigation of ineligibility criteria; report to judicial authority; and follow‐up and advocacy. The results of this research suggest amending executive bylaws based on a social work approach to the screening process for compulsory drug treatment.