Not just abstinence, but a better life : understanding the quality of life of psychotropic drug abusers in Hong Kong

Abstract

Drug abuse—and the problems associated with it—often adversely influence the quality of life (QoL) of psychotropic drug abusers (PDAs). Given the chronic and relapsing nature of drug abuse, improved life quality is a crucial recovery-oriented goal for treatment and rehabilitation (T&R) services, alongside abstinence and relapse prevention. However, wellness measurements for people with addiction problems remain underdeveloped, and specific QoL measures that can adequately represent PDAs’ real life experiences have received limited consideration. Related studies often consider QoL from an overall perspective that lacks in-depth exploration of underlying components and correlates. This thesis adopts a needs-based perspective towards conceptualizing the QoL of PDAs, revisiting key concepts and their significance in terms of need satisfaction across six domains: autonomy, competence, relatedness, physical, safety, and abstinence. Based on this conceptual framework, the thesis aimed to 1) conceptualize the perceived dimensions and priorities of QoL for PDAs, 2) develop and validate a specific measurement tool for this population, named the Needs-Based Quality of Life (NBQoL) Scale, and 3) identify variations of needs-based QoL among different demographic groups and the drug use patterns of PDAs. Study 1 used a qualitative design, collecting interview data from 22 PDAs receiving T&R services and 29 service providers. To achieve the first objective, a thematic analysis was conducted, revealing a shared understanding that QoL dimensions extends beyond health to six dimensions, among which empowerment and connection are prioritized. However, divergent views emerged regarding the priorities of material conditions, emotional well-being, and physical health. Aligning with scale development objectives, interviews with PDAs were analyzed to revise the item pool derived from prior literature and existing instruments. The revised item pool was then tested for content validity by expert judgment, establishing a final item pool with 37 items. Study 2 was a quantitative study with 329 PDAs. To address objective two, exploratory factor analysis was conducted to reduce the number of items generated in Study 1, and confirmatory factor analysis was used to confirm the factor structure. The finalized scale containing 25 items with six factors was then validated; it showed satisfactory reliability (internal consistency: Cronbach’s alpha ≥ 0.69; average split-half reliability: 0.84) and validity (concurrent and construct validity). Furthermore, an analysis of variance revealed demographic differences in NBQoL; specifically, adults had higher scores in the domain of drug abstinence needs compared to adolescents and young adults. Study 3 explored the relationships between drug use patterns and various NBQoL domains, revealing significant correlations between the timing of the last drug use, use frequency, polydrug use, and dependence severity. Additionally, regression analysis indicated a positive correlation between the duration of drug abstinence and overall QoL. Although dependence severity had a negative impact on both the overall NBQoL and psychological needs domains, it was positively correlated with the drug abstinence domain. In conclusion, this thesis provides T&R service providers with a robust, valid instrument to effectively measure and understand PDAs’ diverse QoL dimensions. By considering QoL priorities, variations, and associated factors, T&R services can be administered more cost-effectively, with the ultimate aim to enhance the QoL of PDAs.