In Hong Kong, drug addiction among young adults has become an increasingly prevalent issue, with many turning to drug use as a means of coping with stress, mood-related problems, and boredom. Ironically, most of the young adults struggling with drug problems had not sought professional help or other forms of social support in dealing with problems resulting from taking drugs. Currently, most drug rehabilitation services in Hong Kong focus on reducing drug use and providing psychoeducation on drug-related mental health issues. Although these traditional forms of drug abuse treatment were found empirically efficacious, frontline workers are confronted with the issue of non-compliance and, more importantly, drop-out from programs especially among young adult drug abusers. There is an imminent need for synergizing innovation to revamp Hong Kong's drug rehabilitation service, and young adult drug abusers need professional assistance that is appealing to them to help them cope.
Sponsored by the Beat Drugs Fund, a project called "From Addiction to Creation: Project on Using Creative Arts for Drug Use Prevention and Young Adult Drug Users Empowerment (CAPE)" which aimed to integrate creative arts with drug rehabilitation services in Hong Kong was organized by the Centre on Behavioral Health, The University of Hong Kong between June 2019 and January 2024. To conclude the project, Project "CAPE" art exhibition cum closing ceremony and press conference was held today (18 January 2024) to showcase artwork of drug rehabilitees, conduct project sharing and disseminate the results of research on the impact of the project.
The most common forms of creative components adopted in drug rehabilitation programs are visual arts, music, movement, drama, and play. These art-inspired drug rehabilitation programs have been applied to a wide range of drug abusers of different sociodemographic backgrounds, with encouraging results. The objectives of this project were to integrate creative arts into drug rehabilitation services in Hong Kong, and explore its effectiveness, acceptability and practicality among young adult drug abusers and caseworkers. Additionally, this project aimed to promote social change by using the arts to provide support for individuals struggling with drug addiction.
The four-and-a-half-year CAPE project consisted of four main components: (1) Carry out multimedia community education and inclusion activities (for example, exhibitions, creative competitions, website and publications) to raise young adults' awareness of drug issues, strengthen their understanding of common drug harms, and reduce stigma on drug treatment in the society and support rehabilitees re-connecting to society. (2) Conduct train-the-trainer workshop for frontline staff to equip them with the skills to incorporate arts into the drug rehabilitation services. (3) Provide creative arts-based rehabilitation services, implement and adopt innovation-based rehabilitation services in response to the different needs of drug rehabilitees. (4) Carry out project evaluation, evaluate the effectiveness of the project in a scientific way using random sampling, and make use of creative arts as an intervention approach for local drug rehabilitation services.
During the four-and-a-half-year period, the project conducted a four-day training workshop for frontline staff. The training content was specially designed for the workshop by expressive arts therapists from the Centre on Behavioral Health, The University of Hong Kong. Through the training and supervisions, 30 frontline professionals from more than 20 different social welfare agencies were equipped with the basic principles, skills, experience and mindset to integrate creative arts into drug rehabilitation services. After the training, these frontline professionals also launched the "Creative arts drug rehabilitation program" in drug treatment institutions and provided 8-week programme of creative arts-based rehabilitation services to 175 drug rehabilitees. The project also organized an anti-drug creative art competition called "Say 'Yes' to Arts!", two public creative art exhibitions of the competition's artworks, and an exhibition of the artworks of drug rehabilitees, benefited 11,608 people in the society. These community education and inclusion projects were uploaded to the project's website for public display and received more than 44,000 views.
The program evaluation study assessed the potential benefits of the two major program components: (1) the creative arts intervention program for drug rehabilitees, and (2) the Train-the-Trainer program for frontline professionals. Evaluation for the creative arts intervention program adopted a mixed-methods, randomized controlled study design, with two assessment time points (T0 and T1) using both quantitative and qualitative methods of inquiry. For this research initiative, a total of 260 drug rehabilitees were included in the evaluation in Hong Kong and quantitative data were collected on two separate time points: baseline (T0) and 8-week follow-up (T1); amongst them 132 were young adult participants aged between 21 and 35. In the focus group interview, we interviewed 30 young adult drug rehabilitees at the end of the program completion. For the Train-the-Trainer program, a total of 30 caseworkers filled in an exit poll survey upon completion of the 4-day training and 10 of them were invited to take part in the focus group interview. All data were collected between June 2019 and May 2023.
Results of the randomized-controlled study yielded emerging evidence to suggest the effectiveness of the creative arts interventions in enhancing positive affect in rehabilitees (aged between 21 and 35) who participated in the creative arts intervention, compared with the treatment-as-usual condition. Findings also showed potential gains in alleviating anxiety, reducing self-defeating tendency, enhancing drug-related coping through stopping unpleasant emotional thinking, adopting problem-focused coping, as well as improving drug avoidance self-efficacy. Further exploration might be needed to understand the value of the intervention program in reducing depressive symptoms, negative affect, and improving self-soothing tendency. Similar findings were also reported in the aggregate data with participants ranging from 21 to 60, yielding additional information to support the potential benefits and effectiveness of the creative arts intervention in improving psychosocial wellbeing of drug rehabilitees. Focus group interviews with rehabilitees attending the program revealed additional gains reported by the participants, including improved mood management, enhanced social relationships, and cultivation of self-awareness, self-confidence, and psychological flexibility. Participants regarded the non-verbal expression, embodiment and concretization of experience, as well as creativity; artistic pleasure is the key element underlying their positive changes; emphasis was placed on the facilitation skills of the facilitator to instil hope and common humanity, and facilitate interpersonal learning.
Evaluation of the train-the-trainer program showed that the training program was regarded as practical, insightful, and satisfying by frontline professionals who participated in the training. While the trainees regarded that the training was helpful in enhancing their knowledge competence, practice competence, and self-competence in delivering creative arts intervention to their service users, they expressed enthusiasm for further training to enhance their skills in this area and to work around the environment challenges they encountered in implementing creative arts interventions in the drug rehabilitation setting.
In summary, creative arts intervention is a culturally relevant, emerging evidence, and person-centred approach to drug rehabilitation in Hong Kong. The creative arts intervention is well-received by both the service users, and frontline professionals in the field – both parties found the application of creative arts in rehabilitation service effective, meaningful, and satisfying. Findings from the present study also revealed that creative arts did not only benefit young adults drug rehabilitees, but also those who are older in age. Frontline professionals shared their passion for further training, and their support to the furtherance of creative arts interventions as an alternative to traditional form of drug rehabilitation. Further research efforts and training resources will contribute to the course and the holistic wellbeing of those who are struggling with the issues of addiction.
Please visit the HKU Centre on Behavioral Health website at https://cbh.hku.hk/ to know more on the project.
Project "CAPE" art books will be distributed to the public free of charge.
