Mental Health among Substance Users Receiving Compulsory Treatment

Abstract

The burden of disease attributable to mental and substance use disorders is evident worldwide. In 2010, mental and substance use disorders accounted for 183.9 million disability-adjusted life years (DALYs). In Thailand, capacity building and promoting quality of life among substance users is one of the strategies under the Narcotics Addict Rehabilitation Act, B.E. 2545 (A.D. 2002). The drug addict rehabilitation centers were established to help users get back to their normal lives. This cross-sectional analytical study aimed to investigate mental health status and factors associated with mental health status among substance users who were receiving compulsory treatment at Latlumkhaew Drug Addict Rehabilitation Center, Pathum Thani Province, Thailand.

The study was approved by the Ethics Committee of Thammasat University (COA No. 050/2562). 129 participants were randomly recruited from the center between June and July 2019. A standardized questionnaire was developed with the validity index of Item-Objective Congruence (IOC) ranging from 0.67-1.00, and the reliability index Cronbach’s alpha coefficient ranging from 0.72-0.93. The study investigated variables in five areas: perception on physical health, self-esteem, perception on family relationships, relationship to the community (Drug Addict Rehabilitation Center) and social support. Mental health status was measured by using General Health Questionnaire-30 (Thai GHQ-30), which was developed by the Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand. The internal consistency, sensitivity and specificity of this instrument were 0.91, 81.3%, and 88.2% respectively. Written informed consent was obtained from all participants who had the right to deny answering any questions at any time without giving their reasons. Data were analyzed by using descriptive statistics and binary logistic regression analysis. Associations with p<0.05 were regarded as significant.

Just over half of the participants were female (51.9%). The mean age was 34.3 years old (SD 7.9, min=18, max= 52 days). Most of them had finished primary school level or lower (66.7%) and were single or divorced (59.7%). 76.7% used Methamphetamine and other drugs, while the remainder (23.3%) used Methamphetamine only. 51.9% of the sample was in Latlumkhaew Drug Addict Rehabilitation Center for the first time and 26.4% had received treatment more than once. The mean duration of stay in the center was 71.4 days (SD 52.6, min=7, max= 201 days). The results revealed that 37.2% of the participants’ mental health state was abnormal, 51.9% showed moderate perception of their physical health, and 62.8% perceived poor family relationships. Moreover, 60.5% had good community relationships at the rehabilitation center but 52.7% received low social support. Analysis of factors associated with mental health status by using multivariate analysis showed that experience of drugs used in the past (adjusted OR 3.39, 95% CI 1.19 - 9.61, p=0.022) and perceived communication or visits from family members (adjusted OR 2.49, 95% CI 1.11 - 5.55, p=0.026) were significantly associated with mental health status. However, perceived physical health (adjusted OR 2.06, 95% CI 0.93 - 4.55, p=0.075) and perceived support by staff (adjusted OR 2.40, 95% CI 0.94 - 6.16, p=0.068) were not associated with mental health status.

This study showed a higher rate of abnormal mental health among substance users compared with other drug addict rehabilitation centers in Thailand, which can be explained by the strict control of compulsory treatment in this setting.  This strict control of compulsory treatment may affect mental health among substance users, as indicated by this study. It suggests that a surveillance system on mental health among substance users in a rehabilitation center is essential in order to monitor their mental health and provide support.  Factors which should be considered in the development of drug treatment processes are: drugs used in the past, family members involved in treatment processes, perception of physical health, and the support of staff, which may help to decrease mental health problems during compulsory drug addiction treatment.