© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
DOCTOR FOR SOCIETY
Expect the unexpected: an interview with Dr Ben Kin-leung Cheung
Suki Ho1; Christie Wong2
1 Year 4, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
2 Year 3, Faculty of Medicine, The University of Hong Kong, Hong Kong
“The young man jumped the next day while on leave from hospital. He never returned,” Dr Cheung recalled an encounter during his time at Kwai Chung Hospital, after a patient had committed suicide. “When his mother arrived on the ward, I was very worried. However, she told me that it wasn’t my fault. Instead we should blame those selling illicit drugs. This cause of death is totally preventable, and I needed to help victims of drug abuse.”
Dr Ben Kin-leung Cheung, a highly respected leader in the field of psychiatry, is also Chairman of the Action Committee Against Narcotics (ACAN). The ACAN is a non-statutory advisory body that aims to advise the government on policies and measures regarding substance abuse. It acts as a bridge between the general public and the government in the fight against narcotics. Dr Cheung was involved in the rehabilitation of drug addicts when working with the Hospital Authority, and has continued his fight against drug addiction since moving into private practice.
After graduating in 1987, Dr Cheung started working in the field of general adult psychiatry. Similar to many, during his early career he did not like drug abusers—the never-ending admissions, rudeness without any gratitude to doctors, and sometimes threats. They lied, they shouted, they hit you. One lady would fake a recurrent wound infection and ask for antibiotics that she could trade for cocaine; a gentleman refused treatment and then scratched Dr Cheung’s car to show his discontent. One can imagine Dr Cheung’s general impression of drug abusers.
Yet the case of a particular young drug abuser changed Dr Cheung’s opinion. “I used to believe that it was their choice to take drugs, and they should bear the consequences.” It was not until the patient committed suicide that Dr Cheung started to put himself in the drug abusers’ place. In the case of this patient, “He brought joy and energy to the ward. His mental state improved rapidly once he stopped taking illicit drugs, and I allowed him home leave. He never came back. Even after so many years, I still remember the smile on his face when he was sitting on his bed, playing guitar.” His life was not supposed to end like this. Had it not been for the moment of weakness when he resumed drug abuse, he might still be alive today, living life to the full. “Substance-induced psychiatric morbidity is a totally preventable illness. If a person recovers, a door opens. They can turn their life around.”
Dr Cheung joined ACAN in 2008 and became Chairman in 2014. Now Dr Cheung is on the panel of ACAN, and has the opportunity to advise on government policies, and to coordinate agencies to fight drug abuse at a community level. After training in Canada and the United States, he realised it was inefficient to work case by case. Dr Cheung began to build up a service model that could be passed on to others. In response to an epidemic of youth substance abuse in 2008, Dr Cheung was the first to develop an innovative body check-up programme that applied motivational theories to engage psychotropic substance abusers early on. Motivational interviewing is a counselling approach developed by Professor William R Miller. Its original study aimed to give stage-targeting intervention to alcoholics. Dr Cheung adapted and applied the approach to drug addicts. A free body check-up is offered to them. Information that is of concern—such as skin age, exercise tolerance, liver function, cognitive function—is provided confidentially, with reference to non-drug abusers. “This plants a seed in their mind, the idea that they can improve their health and the motivation to do so. Once they have the determination to succeed, health institutions can offer help. The drug victims will then try to reduce the drug dose, eventually quitting. They can progress to the next stage, choosing a new future.” This model is widely adopted in Hong Kong by different health care professionals and allied health workers, and benefits a large number of clients with documented favourable outcomes.
Dr Cheung then started to think about how to help those victims of drug abuse. He placed more focus on the increasing cases of substance-induced psychosis that leads to tragedies such as suicide and mental impairment. He established that many drug abusers did not choose to start taking drugs, and nobody wanted to die from them. “Drug abusers have often had a difficult past or poor environment that led them to take illicit drugs. They are victims of their past. They may not have intended to become an addict, they just can’t stop.” Since then, Dr Cheung has placed more emphasis on the treatment and rehabilitation of drug abusers. He set up cluster-based detoxification cubicles in hospital wards under the Hospital Authority. The detox units provide a homely environment with daily necessities and entertainment, giving the drug abusers a feeling of a home. He mentioned that the process of detoxification should never be harsh; a comfortable environment will decrease resistance to treatment and help motivate individuals to seek help. From audit data, the complete detoxification rate confirmed by urine toxicology upon discharge is around 90%, which is a very encouraging number. “However in the field of addiction, quit rate is not the sole determinant of treatment outcome. We also used a set of indicators that include abstinence, employment, recidivism, casualty department attendance, hospitalisation, and retention rate to measure treatment outcome.” The detox cubicles help drug abusers break away from the clutches of illicit drugs and significantly improve their future prospects.
The next step is to help victims see a future and give them hope. “Often they do not care about their future and hate to think about their pitiful past. The only thing they value is today. It is crucial to encourage them to reflect on the past and think about their future.” Finding a meaning to life can give strength. Art therapy is recommended by Dr Cheung, allowing them to express their thoughts. “A patient once drew a picture of a toilet, the scene of her previous drug taking, to sum up her past. She acknowledged her past, drew a line under it, and began to think of a change for her future.” The drawings of patients can directly reflect their mind and mood. Throughout different stages of art therapy, the drawings changed. “When we first met, this patient drew a moody-looking sky with raindrops. After a few sessions of counselling, his drawing transitioned into one of a sunny day, and finally a rainbow.” Dr Cheung was motivated by the recovery of drug addicts, and he decided to study abroad, finding new ways to help them.
In response to the current situation in Hong Kong, Dr Cheung is determined to tackle two challenges. Firstly, there is an increasing number of drug abusers in young adulthood aged 21 to 35 years. Dr Cheung suggests that more support is needed by this age-group, for instance, vocational training, job opportunities, and family support. He has proposed to the government that they adjust resource deployment in existing services accordingly, and address service gaps. He also proposed short-term services to residential drug treatment service institutes for addicts with gainful employment or family members to care for, so as to lower the threshold of when young addicts seek help.
Secondly, ‘ice’ has taken over ketamine as the most popular psychotropic substance of abuse. Dr Cheung is concerned that ‘ice’ is associated with much greater psychiatric morbidity. He proposed that the government should enhance relevant training for antidrug workers in the management of complications and increase collaboration between social workers and medical professionals.
“Never underestimate yourself and always follow your dream.” The inspiration for Dr Cheung to devote his time to helping drug addicts was the passion to help valuable young lives. “You may not have gone where you intended to go, but you will end up getting to where you are needed most.” Dr Cheung said that even if you have never expected to work in certain areas, never say never. You will then be able to find out the meaning of walking such a path. We should not let passion fade away, but hold on to it and have the courage to act.
It rained cats and dogs yesterday. The sun shines through clouds today. A rainbow will appear tomorrow.
Driven into a corner. Back on the road, ‘the straight and narrow’. The road broadens again.
With great pleasure, I want to share my feelings and thoughts with you. Are you willing to listen?
We are grateful for your constant support and encouragement during those dark days. My heart is filled with sunshine now.
That night of fireworks reminded me of my childhood that was also dazzling and vibrant. I reflected on this and determined to turn over a new leaf.