Linking Heroin Users in China to Drug Treatment and Other Resources in the Community
Injection drug use contributes to approximately 40% of all HIV/AIDS cases in China. The country has traditionally taken a penal approach toward illicit drug users. Convicted drug users are sentenced to prison-like compulsory rehabilitation facilities. However, relapse rates after rehabilitation have been reported as high as 80% to 95%. In response to high rates of HIV/AIDS among injection drug users and the inefficiency of the punitive approach, China has recently adopted a community recovery strategy. This study introduces and investigates the effects of a Recovery Management Intervention (RMI, adapted from the Transitional Case Management Model, which is well tested in the United States with drug offenders) on Chinese drug users released from compulsory rehabilitation in regard to their utilization of community resources and recovery outcomes.
Data were drawn from a larger scale study, which randomly assigned 100 heroin users released from compulsory rehabilitation centers to the community in Shanghai, China into either a Standard Care group (N=50) or a RMI group (N=50). All study procedures, including screening of eligibility for study participation, informed consent, baseline and 3-month follow-up surveys, and the RMI were carried out by trained local social workers from the Shanghai Zi-Qiang Social Services at private rooms in participating Zi-Qiang sites. The following measurements were applied at baseline and 3-month follow-up: 1) participants’ motivation for treatment, such as treatment readiness and desire for help; 2) confidence to stay abstinent, such as self-esteem, self-efficacy, and perceived social support; 3) service utilization, including numbers of services received and objectives completed with social workers and other community agencies; and 4) recovery outcomes, measured by recidivism and employment rates. Structural equation modeling path models were fitted to detect whether RMI contributed to participants’ motivation for treatment, confidence to stay drug abstinent, service utilization, and recovery outcomes. All analyses were done in EQS 6.2.
RMI participants received more assessment and referral services from their social workers and utilized more community resources such as health services, social security, housing assistance, employment training, and methadone maintenance treatment. This difference in service utilization then led to the differences between the two groups in recidivism and employment rates. RMI participants showed significantly lower arrest rate (0 vs. 6%) but higher employment rate (33% vs. 2%) at 3-month compared to their standard care group counterparts. Path analyses concluded that controlling for the effect of site difference between 2 Zi-Qiang branches, RMI indicated a significant positive influence on participants’ service utilization and subsequently their recovery outcomes. Motivation for treatment and confidence to stay abstinent had no effects on service utilization and recovery outcomes.
Conclusions and Implications:
The positive relationship between RMI and participants service utilization and recovery outcomes strongly suggest that RMI is a promising strategy that can assist drug users to reintegrate in the community in China. Further larger scale trial of the RMI is needed in China before it can be extensively applied in China.