Quality of Life in Asia 11 Yuet Wah Cheung Nicole Wai-ting Cheung Psychoactive Drug Abuse in Hong Kong Life Satisfaction and Drug Use Quality of Life in Asia Volume 11 Series editors Alex C. Michalos, University of Northern British Columbia, British Columbia, Canada Daniel T.L. Shek, The Hong Kong Polytechnic University, Hunghom, Hong Kong, China Doh Chull Shin, University of California, Irvine, California, USA Ming-Chang Tsai, Academia Sinica, Taipei, Taiwan This series, the first of its kind, examine both the objective and subjective dimensions of life quality in Asia, especially East Asia. It unravels and compares the contours, dynamics and patterns of building nations, offering innovative works that discuss basic and applied research, emphasizing inter- and multi-disciplinary approaches to the various domains of life quality. Thus, the series appeals to a variety of fields in humanities, social sciences and other professional disciplines. Asia is the largest, most populous continent on Earth, and it is home to the world’s most dynamic region, East Asia. In the past three decades, East Asia has been the most successful region in the world in expanding its economies and integrating them into the global economy, offering lessons on how poor countries, even with limited natural resources, can achieve rapid economic development. Yet while scholars and policymakers have focused on why East Asia has prospered, little has been written on how its economic expansion has affected the quality of life of its citizens. The series publish several volumes a year, either single or multipleauthored monographs or collections of essays. More information about this series at http://www.springer.com/series/8416 Yuet Wah Cheung • Nicole Wai-ting Cheung Psychoactive Drug Abuse in Hong Kong Life Satisfaction and Drug Use Yuet Wah Cheung Nicole Wai-ting Cheung Department of Sociology Department of Sociology Hong Kong Shue Yan University The Chinese University of Hong Kong Hong Kong, China Hong Kong, China ISSN 2211-0550 ISSN 2211-0569 (electronic) Quality of Life in Asia ISBN 978-981-10-6152-3 ISBN 978-981-10-6154-7 (eBook) DOI 10.1007/978-981-10-6154-7 Library of Congress Control Number: 2017949180 © Springer Nature Singapore Pte Ltd. 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Preface This book is an in-depth analysis of the data of the “Longitudinal Survey of Psychoactive Drug Abusers in Hong Kong” (LSPDA). Conducted during 2009– 2012 and funded by the Beat Drugs Fund established by the government, the 3-year longitudinal study was the first of its kind in Hong Kong, tackling the alleged social problem of soaring prevalence of psychoactive drug use in young people since the mid-1990s (for the report of the study, see Cheung Y.W. (2012). A longitudinal survey of psychoactive drug abusers in Hong Kong. Report submitted to Narcotics Division, Government of the Hong Kong SAR.). Ketamine stood out as the most popular psychoactive drug since 2000. This had caught youth drug workers, medi- cal and legal professionals, teachers, parents, community leaders, and government officials by surprise, as ketamine was not a widely used drug worldwide and at that time little was known about the drug’s pharmacological properties other than its use as an anaesthesia in animal surgical operations. Medical research on the physical and mental harm of ketamine abuse had to quickly begin in the early 2000s in order to acquire more knowledge of the proper- ties of ketamine, badly needed for the design of appropriate treatment and preven- tion strategies. However, large-scale social scientific studies of the characteristics of ketamine users and factors influencing their ketamine use were seriously lacking. LSPDA filled this research gap by studying a sample of ketamine users recruited from youth outreach agencies and treatment programmes. This book offers a com- prehensive analysis of the data of LSPDA, focusing on the socio-demographic and psychosocial correlates of ketamine use in young psychoactive drug users. Practical implications for treatment and prevention efforts are also discussed. Incidentally, the senior author had conducted a longitudinal study of drug abus- ers in Hong Kong some 10 years before LSPDA. That study was entitled “Longitudinal Study of Chronic Drug Abusers in Hong Kong” (LSCDA), conducted from 2000 to 2003 and also funded by the Beat Drugs Fund (for the report, see Cheung Y.W. (2003). A longitudinal study of chronic drug abusers in Hong Kong. Report submitted to Narcotics Division, Government of the Hong Kong SAR; for the subsequent book, see Cheung Y.W. (2009). A brighter side: Protective and risk factors in the rehabilitation of chronic drug abusers in Hong Kong. Hong Kong: v vi Preface Chinese University Press.). At that time, although young people’s psychoactive drug use had begun to pop up, the majority of drug abusers were still adults addicted to heroin, the conventional drug of choice in Hong Kong for many decades. A large number of socio-demographic and psychosocial variables were introduced in the study to gauge the protective and risk factors of post-treatment drug use among chronic heroin abusers. This earlier longitudinal study (LSCDA) addressed an older generation of users of heroin; 10 years later, LSPDA examined the younger genera- tion of users of ketamine and other psychoactive drugs. These two landmark studies echoed each other, and together they captured the major changes in drug abuse pat- terns and their psychosocial correlates across the two generations. Among the psychosocial variables used in the two longitudinal studies to explain continuation/discontinuation of drug use, one of them—life satisfaction—was included in both studies. Life satisfaction was found to be significantly related to drug use in both studies, after controlling for other psychosocial variables. This is perhaps the first evidence showing the importance of life satisfaction in affecting drug use among drug abusers of both generations in Hong Kong. It is a tempting invitation to a more elaborate exploration of the role of quality of life in the preva- lence of young people’s psychoactive drug use, as well as the design of relevant treatment strategies. This has become the major objective of this book, which is based on LSPDA. In the multivariate analysis, the effect of life satisfaction on the continuation/discontinuation of drug use of psychoactive drug users is compared with those of other important psychosocial variables, such as permissiveness to drug use (derived from the normalization of recreational drug use perspective), self- esteem, depression, stressful life events, experience of discrimination, and sense of uncertainty about the future. Gender differences in how life satisfaction and other psychosocial variables had influenced drug use are also examined. In addition, a chapter is devoted to the discussion of the role of subjective well-being in the treat- ment and rehabilitation of psychoactive drug addiction. It is hoped that this unique analysis will serve as a springboard for more fruitful research on this topic in the future. We owe the idea of publishing this book to Professor Daniel T.L. Shek of Hong Kong Polytechnic University, who saw the potential of an in-depth analysis of the data of LSPDA in contributing to the scanty literature of life satisfaction and drug use/drug treatment in Hong Kong. Without his encouragement and patience, we would not have finished the manuscript. Dr. Celia X. Chen and Ms. Cherry Y.T. Choi had provided us with valuable assistance in data analysis. The Narcotics Division kindly gave us the permission to use the data of LSPDA. We would also like to express our great appreciation to those treatment and rehabilitation agencies that had actively participated in the survey for 3 years, without which this study would not have been successfully conducted. Hong Kong, China Yuet Wah Cheung Nicole Wai-ting Cheung Contents 1 Changes of the Drug Scene in Hong Kong .............................................. 1 From Heroin to Psychoactive Drugs........................................................... 1 Social Change and Young People’s Drug Use in Hong Kong ............................................................................................. 6 1950s–1980s ........................................................................................... 6 1990s–2010s ........................................................................................... 8 Neutralization of Recreational Drug Use ............................................... 10 Summary ..................................................................................................... 11 References .................................................................................................. 12 2 A Longitudinal Survey of Psychoactive Drug Abusers in Hong Kong ............................................................................................. 15 The Study and Method ............................................................................... 16 Independent Variables ................................................................................. 20 Socio-demographic Variables ................................................................. 20 Psychosocial Variables ........................................................................... 20 Dependent Variable ..................................................................................... 23 Characteristics of the Sample ..................................................................... 24 Selection of Subjects for Analysis .............................................................. 29 Pooled Data and Regression ....................................................................... 30 References .................................................................................................. 31 3 Socio-demographic and Psychosocial Correlates of Drug Use ............. 33 Bivariate Associations ................................................................................ 33 Explaining Continuation/Discontinuation of Drug Use with Psychosocial Variables ....................................................................... 36 Drug Use in Last 30 Days as Outcome Variable .................................... 36 Permissiveness to Regular Drug Use as Outcome Variable ................... 39 Permissiveness to Occasional Drug Use as Outcome Variable .............. 41 Life Satisfaction as Outcome Variable ................................................... 44 vii viii Contents Self-Esteem as Outcome Variable .......................................................... 44 Depression as Outcome Variable ............................................................ 49 Summary and Discussion ........................................................................... 52 References .................................................................................................. 55 4 G ender Differences in Psychosocial Correlates of Drug Use ................ 57 Gender Differences in How Psychosocial Variables Affected Drug Use in the Last 30 Days ..................................................................... 58 Gender Differences in How Psychosocial Variables Affected Permissiveness to Regular Drug Use .......................................................... 60 Gender Differences in How Psychosocial Variables Affected Permissiveness to Occasional Drug Use..................................................... 61 Gender Differences in How Psychosocial Variables Affected Life Satisfaction .......................................................................................... 63 Gender Differences in How Psychosocial Variables Affected Self-Esteem ................................................................................................. 65 Gender Differences in How Psychosocial Variables Affected Depression .................................................................................................. 65 Gender Differences: A Summary ............................................................... 68 Discussion ................................................................................................... 68 References .................................................................................................. 72 5 Probing into the Role of Subjective Well-Being in the Rehabilitation of Psychoactive Drug Abusers .............................. 75 Life Satisfaction .......................................................................................... 76 How Can the Level of Life Satisfaction of Drug Abusers Be Raised? .................................................................................................. 77 Depression .................................................................................................. 79 Subjective Well-Being as Outcome of Treatment and Rehabilitation ........ 80 References .................................................................................................. 82 6 S ummary and Discussion ......................................................................... 85 The Study .................................................................................................... 85 Socio-demographic and Psychosocial Correlates of Continuation of Drug Use ...................................................................... 86 Permissiveness to Drug Use ................................................................... 88 Life Satisfaction and Depression ........................................................... 92 Self-Esteem ............................................................................................ 92 Drug Use at Previous Time Point ........................................................... 93 Short-Term Effects of Psychosocial Variables ....................................... 93 Epilogue ...................................................................................................... 94 Limitations of the Study ............................................................................. 96 References .................................................................................................. 97 Contents ix Appendices ....................................................................................................... 99 Appendix One: A Closer Look at the Sample ............................................ 99 Drop-Out Group at T2 ........................................................................... 100 Drop-Out Group at T3 ........................................................................... 100 Drop-Out Group at T4 ........................................................................... 102 Drop-Out Group at T5 ........................................................................... 104 Drop-Out Group at T6 ........................................................................... 105 Biases Due to Drop-Outs ....................................................................... 105 Appendix Two: Bivariate Relationships for Selection of Variables into Regression Models Testing Gender Differences ................................. 107 Index ................................................................................................................. 121 The original version of the Index was revised. The version supplied here includes final author corrections.