Editorial - Development and Evaluation of a Drug Prevention Program in Hong Kong
Authors: Daniel T.L. Shek, Rachel C.F. Sun and Joav Merrick
Abstract: A survey of the websites of several international organizations (e.g., Office on Drugs and Crime of the United Nations, International Narcotics Control Board, National Institute of Drug Abuse in the United States, and European Monitoring Center for Drugs and Drug Addiction) shows that illicit drug use is a growing global problem. With the influence of post-modern thoughts and changing youth sub-culture, adolescent substance abuse is also an acute global problem which has captured the attention of policy-makers, youth workers and the general public. As an international city, adolescent substance abuse is also a growing concern in Hong Kong (1-2). With reference to the substance abuse figures reported to the Central Registry of Drug Abuse (CDRA) maintained by the Narcotics Division of the Government of the Hong Kong Special Administrative Region, several phenomena regarding adolescent substance abuse can be observed. First, there were several peaks in adolescent substance in the past two decades: the first peak was in mid-1990s which was mainly due to easy access to tranquilizers, which were not tightly controlled by legislations; the second peak was in early 2000s which was closely related to the rave party culture and ecstasy; the third peak was in the recent two years, which is mainly related to abuse of ketamine in schools. In fact, these peaks mirrored the global trend of abusing non-opiate psychotropic substances and the growing belief among young people that psychotropic substance abuse is non-addictive and it is a trendy choice of life. Second, the drugs abused by young people under the age of 21 years were mainly psychotropic substances, particularly ketamine. Actually, ketamine abuse in Hong Kong could be regarded as quite unique, because this drug is not commonly abused in other parts of the world. Third, with the return of Hong Kong to China in 1997, traveling between Hong Kong and Shenzhen in mainland China has become very popular, hence creating the problem of cross-border adolescent substance abuse. Actually, with the use of electronic home-return permits, adolescents can easily go back to Shenzhen to abuse drugs without leaving any trace in their travel documents. Hence, it is extremely difficult for parents to know whether their children have returned to Shenzhen. As a result, the problem of “cross-border adolescent drug abuse” has become a recurrent issue in Hong Kong in the past decade. Fourth, as the Hong Kong police force has stepped up action against adolescent substance abuse in rave parties, the venues of drug abuse among young people has become more “hidden” in nature. Actually, some research studies showed that adolescents abused drugs in their homes, an emerging trend that deserves our attention. In short, the adolescent substance abuse in Hong Kong has become very complicated, with greater difficulty involved in detecting those abusing drugs. In the recent school survey conducted by the Narcotics Division, Government of the Hong Kong Special Administrative Region, it was found that drug abuse was more prevalent than those reported in previous studies (3). For example, among 112 secondary schools under study, there were 111 schools in which there were students ever abusing drugs. There was also a trend of lowering of age of abusing drugs. The findings also highlight the “hidden” nature of abusing psychotropic substances in adolescent substance abusers in Hong Kong. While the school surveys conducted by the Narcotics Division are illuminating, it should be noted that they are not regularly conducted, hence suggesting the need to conduct more research in this area. In addition, there are very few longitudinal studies in this field. With the growing problem of substance abuse among young people in Hong Kong, many people, including scientists, helping professionals and policy-makers have asked a common question: how can we prevent substance abuse in young people? In response to this question, scientists and practitioners in the West have developed structured drug prevention programs focusing on the weakening of risk factors and strengthening of protective factors in substance abuse in young people (4). Typically, successful programs focus on promoting life skills and psychosocial competencies in adolescents. Unfortunately, while many structured drug prevention programs targeting adolescents have been developed in the West, relatively fewer validated drug prevention programs exist in different Chinese contexts (5). Within the context of prevention, it is always a strenuous task to show that prevention programs of substance abuse really work. In the literature on program evaluation, there are numerous examples showing that programs based on good will and passion may not be ineffective programs. One example is the Project D.A.R.E. (Drug Abuse Resistance Education) Program. This program was founded in 1983 in Los Angeles and it was implemented in 75% of the school districts in the U.S.A. and in more than 43 countries around the world to help young people to resist pressure and to live drug and violence free lives. Unfortunately, several longitudinal studies have repeatedly showed that the program did not work. As pointed out by Rosenbaum and Hanson (6), “…can this popular school-based program prevent drug use at the stages in adolescent development when drugs become available and are widely used, namely, during the high school years? Unfortunately, the answer to the question is ‘no’ ” (p. 404). Obviously, popularity and enthusiasm alone do not guarantee program success. To demonstrate that a substance abuse prevention program really works, we need to demonstrate that the participants have changed after joining the program and that the changes are not due to other extraneous variables but only the treatment effect. This requirement implies that experimental design with random assignment of participants or quasi-experimental design with statistical adjustment of the pre-treatment differences between the experimental and control group must be used. In addition, we need to assess the effects of the program over time, which means longitudinal data must be collected. Besides, with the gradual integration of different evaluation strategies based on the principles of pragmatism and triangulation, there is a quest to evaluate substance abuse prevention program based on different strategies. The Project Astro is a drug prevention designed for young people in Hong Kong. To provide a comprehensive evaluation of the project, the researchers utilized four approaches of evaluation (objective outcome evaluation, subjective outcome evaluation, qualitative evaluation and evaluation based on repertory grid tests) that permit triangulation of evaluation findings based on different methods. To evaluate the program in a rigorous manner, the following features are intrinsic to the experimental evaluation study of the Astro program: adoption of a non-equivalent group design, use of advanced statistical analyses to adjust pretest differences between the experimental group and control group, collection of longitudinal data, and use of validated instruments. Evidence-based practice is still very primitive in the fields of youth work and adolescent prevention in Hong Kong and there are many obstacles involved. Of course, one good way to promote evidence-based practice is to develop programs that are supported by rigorous evaluation. Fundamentally, youth workers and practitioners in the field of substance abuse must be able to differentiate the following types of intervention programs: a) ineffective or harmful intervention; b) intervention unlikely to be beneficial; c) intervention with unknown effectiveness; d) intervention with both benefits and adverse effects; e) intervention likely to be beneficial; and f) intervention is effective reflected by clear evidence. It is our humble wish that the Project Astro can demonstrate how adolescent prevention and positive youth development programs can possibly be developed in different Chinese contexts. In conjunction with other positive youth development programs (7-9), it is expected that the literature on adolescent prevention programs will expand in future.