Enhancing Psychological Well-being of Ex-drug Addicted Individuals

in Semarang with Evidence-based Community Counseling

Rudi Haryadi

, Mulawarman

, and Dwi Yuwono Puji Sugiharto

Guidance and Counseling Program, Faculty of Teacher and Training Education, Universitas Islam Kalimantan

Muhammad Arsyad Al-Banjari, South Kalimantan Province, Indonesia

Guidance and Counseling Program, Faculty of Education, Universitas Negeri Semarang, Central Java Province,

Indonesia.

Keywords: psychological well-being; ex-drug-addicted individuals; evidence-based practice; community counseling;

evidence-based community counseling.

Abstract: Psychological well-being basically needs to be owned and developed by individuals to achieve happiness.

For ex-drug-addicted people, maintaining psychological well-being will reduce the potential for relapse.

Various best evidences collected to find effective treatment for ex-drug-addicted individuals. An evidence-

based community counseling then generated and delivered to some ex-drug addicted individuals in

Semarang. The treatment includes 8 sessions (90 – 120 mins. for each) of preventive-oriented and delivered

in 4 weeks. At least 20 ex-drug-addicted participants in Semarang involved to this experiment.

Psychological well-being of ex-drug-addicted individuals measured by Ryff’s 54-item PWB Scale (r =

0.752). It is found that evidence-based community counseling is proven effective to enhance ex-drug-

addicted individuals’ psychological well-being (z = -2006; p = 0.045). The conclusion is evidence-based

community counseling could be an alternative treatment for using to enhance psychological well-being of

ex-drug addicted individual. However, this study had some bias, such as small number of sample, simple

research design, and validity of the treatment itself. Further research need to do to make the results could be

generalized for broader populations.

1 INTRODUCTION

Although it can be said to be free from addiction, ex-

drug addicts are still shadowed by the fear of

relapse. Approximately 80 to 90 percent of ex-

addicts experience relapse (Schwartz, et al., 2008).

This can occur due to various factors. For example,

if individuals are in a negative social environment

where they are in contact with people who use

alcohol or other drugs, they are about two and a half

times more likely to relapse using alcohol or drugs

(Chong & Lopez, 2008). Therefore, in the

complexity of current life, maintaining

psychological well-being is very important to protect

a person from factors that can negatively affect

physical and mental health (Hidalgo, Bravo,

Martinez, Pretel, Postigo, & Rabaddan, 2010: 78).

Especially for an ex-drug addict who wants to

survive in abstinence.

Psychological well-being (PWB) is a concept

related to what an individual feels about activities in

daily life and leads to the disclosure of personal

feelings about what is felt by individuals as a result

of his life experiences (Ryff, 1989; Ryff, 2014).

Psychological well-being can be reflected through

philosophical questions such as: (1) the extent to

which a person feels their life has meaning, purpose

and direction; (2) do they see themselves living

according to their own personal beliefs; (3) the

extent to which they utilize their personal talents and

potential; (4) how well they manage their life

situation; (5) how significant are their connections in

relationships with others, and (6) what knowledge

and acceptance do they have about themselves

(Ryff, 2014). Someone who is psychologically

prosperous will have immunity from stress and other

negative tendencies.

Related to this, there has been found a link

between the low psychological well-being of a

person and the tendency to use drugs. Although it is

not yet known whether the low psychological well-

being affects individuals to tend to use drugs, or

180

Haryadi, R., Mulawarman, . and Sugiharto, D.

Enhancing Psychological Well-being of Ex-drug Addicted Individuals in Semarang with Evidence-based Community Counseling.

DOI: 10.5220/0009018500002297

In Proceedings of the Borneo International Conference on Education and Social Sciences (BICESS 2018), pages 180-185

ISBN: 978-989-758-470-1

precisely the use of drugs is what makes a person's

psychological well-being to be low (Visser &

Routledge, 2007). But what can be clearly known is

the stressful life events associated with aggression

that can lead to peer alienation and lead to an

increase in the possibility of drug use (King &

Chassin, 2008). In contrast, a study of 40 drug

addicts in East Tehran showed that those who had

long been in abstinence had a higher average

psychological well-being score (Dogaheh, et al.,

2013). This confirms the assumption that people

who have high psychological well-being can

maintain an abstinence period without experiencing

a recurrence.

Even though psychological well-being offers

important things to prevent relapse, the factual

conditions in Semarang show that the

implementation of assistance efforts for ex-drug

addicts has not facilitated this much. Generally

therapeutic community in the field has not been

standardized (Ginting, Priyanti, Hilderia, &

Andriansyah, 2014). In many places, available forms

of community counseling are often ineffective, not

supported by scientific evidence, and sometimes not

in line with human rights and involuntary principles

(UNODC, 2016).

An empirically proven model is needed to

provide effective assistance. This model must be

structured with involvement by people who receive

intervention, integrated by explicit knowledge from

those who provide intervention, in the context of

available resources (Leen, Bell, & McQuillan,

2014). Because human behavior is strongly

influenced by the context in which the individual is

located, then to provide assistance to people in this

group, counselors need to work within the scope of

community counseling. Community counseling can

be interpreted as a comprehensive assistance

framework based on multicultural competence and

oriented to social justice (Lewis, Lewis, Daniels, &

D'Andrea, 2011). Counselors in the community

sphere use strategies that facilitate the development

of mental health both individual clients and the

surrounding community. . Furthermore, support

within the community can also have a good impact

on drug addicts. As mentioned that family, respected

authority, and commitment are found to be

protective factors that can reduce the likelihood of

relapse (Giordano, Clarke, & Furter, 2014).

In addition, the ideal interventions to be carried

out need to be supported by rigorous empirical

studies. Especially for subjects who have special

characteristics and there are still not many valid

models to be implemented for them, practices that

refer to the best evidence promise better

effectiveness. Moreover, in the last few decades,

counselors have been encouraged to turn to

evidence-based interventions (Hays, 2010). An

evidence-based community counseling model is then

designed and tested to improve the psychological

well-being of ex-drug addicts. This model is a group

intervention that is oriented to the prevention of

relapse and the development of skills to maintain

abstinence for ex-drug addicts. Intervention with

group format was chosen because it has been proven

effective to improve psychological well-being in

drug addicts (Suresh & Sachin, 2014). Counseling in

group formats was also found to be effective in

reducing marijuana and alcohol use among

participants who received peer support, and gained

strength in social behavior (Mason, et al., 2015).

Good evidence from previous research provides

efficacy about how potential group interventions are

colored by community touches and tested practices

for improving psychological well-being in ex-drug

addicts. However, in order to obtain stronger

empirical evidence regarding the combination of

these interventions, further testing is needed.

2 METHODOLOGY

This study uses between groups experimental

design. Twenty people were selected in clusters

from a total of 40 ex-drug addict clients in 2 post-

rehabilitation institutions in Semarang. Treatment

tests focus on clients in one institution due to

considerations of time visibility and permits that are

more likely. The selected sample has met the criteria

as: (1) having good cognitive function; (2) willing to

be a research subject; and (3) get permission from

the institution. The sample was then divided into

experimental groups and control groups. Evidence-

based community counseling was given to 10 people

in the experimental group, while in 10 people the

control group was given treatment as usual. The

research design can be seen in table 1.

Table 1. Research Design

Pretest Treatment Posttest

O1 X O3

O2 O4

Note: O1, O3 = Experiment group; O2, O4 = Control

Group

2.1 The Treatment

The experimented treatment is evidence-based

community counseling. This is a prevention and

Enhancing Psychological Well-being of Ex-drug Addicted Individuals in Semarang with Evidence-based Community Counseling

181

individual development oriented intervention model

given to ex-drug addict clients in the city of

Semarang. This intervention consists of 8 sessions

with duration per session for 90 – 120 minutes. The

session is divided into 1 opening session, 4 main

sessions, and 1 closing session. The session and its

content in more detail can be seen in table 2. The

entire session is completed after 4 weeks of

treatment, each week is filled with 2 sessions with a

distance of about 3 to 4 days between sessions. The

instrument for measuring psychological well-being

is given at the beginning of the first session and after

the last session.

Table 2. Evidence-Based Community Counseling Model

Session Intervention Duration

1 Initial Session (IS.00) 2 x 50 mins.

2 Growth Group I Session

(GG.01)

 Topic: Life Goals

1 x 90 mins.

3 Discussion Session (DS.00)

 Topic: Stigma of

Ex-Drug Addicted People

2 x 60 mins.

4 Support Group I Session

(SG.01)

1 x 90 mins.

5 Growth Group II Session

(GG.02)

 Topic: Self-Growth

1 x 90 mins.

6 Education Session (ES.00)

 Topic: Cognitive-

Behavior Relapse

Prevention

2 x 60 mins.

7 Support Group II Session

(SG.02)

1 x 90 mins.

8 Termination Session (TS.00) 2 x 50 mins.

2.2 Instruments and Analysis

The psychological well-being of subjects was

measured using the Ryff PWB scale of 54 items,

which assessed six indicators: (1) self-acceptance;

(2) positive relationships with others; (3) autonomy;

(4) environmental mastery; (5) the purpose of life;

and (6) personal growth. This scale uses the Likert

format with a score range of 1 to 6. This scale has

been tested for reliability in a population similar to

the sample and the results were found to be in good

category (r = 0.752). PWB scale is given as pretest

and posttest. Non-parametric test then carried out on

the results of the calculation of scores obtained in

both groups to find out the differences and confirm

whether evidence-based community counseling is

more effective in improving psychological well-

being in individual ex-drug addicts compared to

treatment as usual.

3 RESULTS AND DISCUSSION

The results in this study found a change in scores at

the level of psychological well-being of subjects

from before being given treatment until after being

treated with evidence-based community counseling.

Psychological welfare scores of subjects in the

experimental group experienced a greater increase

than in the control group. The data shown in table 3

shows the changes in psychological welfare scores

in each group after being treated. The average score

of the experimental group changed to higher (pre =

207.1; post = 221.3), while the average in the control

group tended to experience a slight decrease (pre =

209.3; post = 207.4). Change in score does not only

occur in the mean in general, but also occurs in all

subjects in it. This difference shows that evidence-

based community counseling models have a more

positive impact on improving psychological well-

being compared to interventions in general.

In addition to the results of pretest and posttest

measurements on each subject in each group, this

study also identified changes in the scores of each

component in psychological well-being. The

difference in scores is seen in the mean of each

component. Table 4 shows the data exposure in

question. Data shows that each component of

psychological well-being changes from pretest to

posttest, both in the experimental group and in the

control group. But a striking change occurred in the

experimental group where all of the components

experienced a greater change than in the control

group. The biggest changes occur in the components

of self-acceptance (pre = 31; post = 35.9),

environmental mastery (pre = 33.8; post = 36.5), and

positive relationships with others (pre = 32.8; post =

35.1).

Descriptively, this shows that the evident-based

community counseling model given to the

experimental group proved to be more effective than

the treatment as usual given to the control group in

improving the psychological well-being of the

subjects. In addition, the results of hypothesis testing

also show results that are not much different. In the

5% error level, the mann-whitney test results

showed a significant difference between the scores

of the experimental group and the control group (Z =

-2006; p = 0.045). In summary, the results of testing

hypotheses can be seen in table 5.

BICESS 2018 - Borneo International Conference On Education And Social

182

Table 3. Differences Between Each Groups

Experiment Group Control Group

Subject

Pretest Posttest

Subject

Pretest Posttest

Score C Score C Score C Score C

E1 184 M 210 M C1 220 H 217 H

E2 216 H 224 H C2 195 M 197 M

E3 195 M 233 H C3 222 H 223 H

E4 220 H 228 H C4 186 M 188 M

E5 233 H 246 H C5 211 M 214 M

E6 211 M 224 H C6 207 M 198 M

E7 198 M 203 M C7 244 H 232 H

E8 158 L 170 M C8 211 M 214 M

E9 236 H 243 H C9 190 M 193 M

E10 220 H 232 H C10 207 M 198 M

Mean 207,1 M 221,3 H Mean 209,3 M 207,4 M

Note: C = Category: L = Low; M = Medium; H = High

Table 4. Pretest dan Posttest Data for Each Psychological Well-Being Component

Component

Eksperimen (n=10) Kontrol (n=10)

Pre. C Post. C Pre. C Post. C

Self-acceptance 31 M 35,9 M 35,5 M 34,7 M

Positive relations with others 32,8 M 35,1 M 33,8 M 33,8 M

Autonomy 34,3 M 34,9 M 34 M 33,9 M

Environmental mastery 33,8 M 36,5 H 34,6 M 33,9 M

Purpose of life 37,1 H 38,7 H 37,8 H 37,8 H

Personal growth 38,1 H 40,2 H 33,6 H 33,3 M

Note: C = Category: H = High; M = Medium

Table 5. Significance Differences of Control and Experiment Group

Data Group N Mean Mann-Whitney U Z p

Pretest

Experiment 10

208,2 48.500 -0,144 0,909*

Control 10

Posttest

Experiment 10

214,35 23.500 -2,006 0,045**

Control 10

Note. *p > 0,05; **p < 0,05

This finding basically confirms the superiority of

evidence-based community counseling compared to

conventional interventions. Because an intervention

based on evidence will clarify the effects of a

treatment so that its use in practice results in a belief

in better effectiveness (Konstam, Cook, Tomek,

Mahdavi, Gracia, & Bayne, 2015). Besides that the

integration between research findings and practice

will provide a deep understanding of an intervention.

This alignment can help develop professional

confidence (Beidas & Kendall, 2010). Professional

self-confidence in question is trust in using

interventions found through empirical decision-

making processes. The results of this study have at

least temporarily provided empirical evidence that

the model used in a positive impact on improving

the psychological well-being of ex-drug addicts.

In technical cases, when compared to the

counseling model that is generally applied in the

field, this Evidence-Based Community Counseling

model has a standard time in the implementation of

each session. This may affect the effectiveness of the

intervention. It was stated in a study that the

implementation of community therapy was found to

be often ineffective due to internal factors such as

non-standardization of the time of intervention

implementation (Ginting, Priyanti, Hilderia, &

Andriansyah, 2014).

Another reason that can explain the effectiveness

of the model is related to the approach used in the

model. CBT has been used extensively to influence

various variables. The use of CBT in counseling and

psychotherapy has reliably been able to be used in a

variety of different cultural settings and contexts

(Beck, 2011). Several systematic studies have shown

the reliability of CBT in being the best intervention

for ex-drug addicts (Klimas, et al., 2014), or for

increasing psychological well-being (Heijden,

Enhancing Psychological Well-being of Ex-drug Addicted Individuals in Semarang with Evidence-based Community Counseling

183

Abrahams, & Sinclair, 2017). With the high level of

trust in CBT, the effectiveness of the intervention is

certainly no doubt.

Other studies have suggested that to provide

effective results in improving psychological well-

being, interventions with narrative or behavioral

approaches appear promising (Ruini, Masoni,

Otolini, & Ferrari, 2014; Weiss, Westerhof, &

Bohlmeijer, 2016). Through this trial of the

Evidence-Based Community Counseling model, it

was found that the cognitive-behavioral approach

also had a significant impact on improving

psychological well-being, especially for ex-drug

addicts. These results certainly provide support for

similar studies that use cognitive-behavioral

approaches to improve psychological well-being

(Yazdanbakhsh, Merzai, Dehghan, & Mahmoudi,

2016).

However, methodologically the number of

samples used in the prototype model trial can be said

to be too small. Limitations of time and resources

make testing done limited in one community. In

addition hypothesis testing is carried out using non-

parametric statistical methods which do not require

the assumption of normal distribution. This makes

the test results obtained despite being proven to be

empirically effective, still cannot be generalized to a

wider population. Therefore, it is necessary to have

more samples to be able to generalize the findings.

Furthermore, confidence in the treatment effects

that appear in the results of the trial of this model

may not escape bias, given that some internal

validity is poorly maintained. Internal validity refers

to how reliable the effect of a treatment is to

influence a variable (Creswell, 2015). Some things

like implementation that are not standardized

between each session, the implementation of one or

two sessions that are interrupted by the community

authority, and the duration of several sessions that

are not adhered to may cause bias in the test results.

It is important for future researchers to be able to

control this internal validity before testing the model

to get a more optimal measurement result.

4 CONCLUSIONS

In the end, the findings of this study stated that the

evidence-based community counseling was a better

model for improving psychological well-being in

individual ex-drug addicts compared to general

treatment. As evidenced by the comparison with

treatment as usual, psychological well-being in

experimental subjects experienced a significant

increase in measurements after treatment. Thus, the

evidence-based community counseling might be

considered as an alternative for efforts to help ex-

drug addicts to improve their psychological well-

being.

However, these results contain several biases

such as too few samples, controls on less stringent

treatment, and various other internal validity

problems. In addition, some things have not been

clearly ascertained in this research, as it is still

unknown whether positive changes in the score of

psychological well-being can last longer or are only

temporary, and whether whether psychological well-

being increases really correlates with the longer

period of abstinence an ex-drug addict. Therefore,

further research is needed to ensure this, of course

with more rigorous research methods.

ACKNOWLEDGEMENTS

The invaluable contribution from the Post-Graduate

Program of Universitas Negeri Semarang (UNNES),

Central Java Province, Indonesia is respectfully

acknowledged (https://www.unnes.ac.id/). We

would like to gratefully acknowledge funding from

the DIPA UNNES through the post-graduate thesis

grant.

REFERENCES

Beck, J. S. 2011. Cognitive Behavior Therapy: Basics and

Beyond. New York, NY: The Guilford Press.

Beidas, S. R., & Kendall, P. C. 2010. Training Therapists

in Evidence-Based Practice: A Critical Review of

Studies From a Systems-Contextual Perspective.

Clinical Psychology: Science and Practice, 17, 1-30.

Chong, J., & Lopez, D. 2008. Predictors of Relapse for

American Indian Women After Substance Abuse

Treatment. Journal of The National Center, 14 (3), 24-

47.

Creswell, J. W. 2015. Riset Pendidikan: Perencanaan.

Pelaksanaan, dan Evaluasi Riset Kualitatif &

Kuantitatif (5th ed.). (H. P. Soetjipto, & S. M.

Soetjipto, Trans.) Yogyakarta: Pustaka Pelajar.

Dogaheh, E. R., Jafari, F., Sadeghpour, A., Mirzaei, S.,

Maddahi, M. E., Hosseinkhanzadeh, A. A., et al.

(2013). Psychological Well-Being and Quality of

Sleep in Addicts under Methadone Maintenance

Treatment. Research Papers, 1 (2), 71-75.

Ginting, E. Y., Priyanti, E., Hilderia, D., & Andriansyah,

D. 2014. Pengaruh Pelaksanaan Metode Therapeutic

Community Terhadap Kesembuhan Pecandu Narkoba

di Sibolangit Center. Jurnal Pendidikan Antropologi,

1-12.

Giordano, A. L., Clarke, P. B., & Furter, R. T. (2014).

Predicting Substance Abuse Relapse: The Role of

BICESS 2018 - Borneo International Conference On Education And Social

184

Social Interest and Social Bonding. Journal of

Addiction and Counseling , 35, 114-127.

Hays, D. (2010). Introduction to Counseling Outcome

Research and Evaluation. Counseling Outcome

Research and Evaluation , 1, 1–7.

Heijden, I. v.-d., Abrahams, N., & Sinclair, D. 2017.

Psychosocial group interventions to improve

psychological well-being in adults living with HIV.

Hoboken, NJ: John Wiley & Sons, Ltd.

Hidalgo, J. L.-T., Bravo, B. N., Martinez, I. P., Pretel, F.

A., Postigo, J. M., & Rabaddan, F. E. 2010.

Psychological Well-Being Assessment Tool and

Related Factor. In I. E. Wells, Psychological Well-

Being (pp. 77-113). New York: Nova Science

Publishers, Inc.

King, K. M., & Chassin, L. 2008. Adolescent Stressors,

Psychopathology, and Young Adult Substance

Dependence: A Prospective Study. Journal of Studies

on Alcohol and Drugs , 69 (5), 629-638.

Klimas, J., Tobin, H., Field, C.-A., O’Gorman, C. S.,

Glynn, L. G., Keenan, E., et al. 2014. Psychosocial

interventions to reduce alcohol consumption in

concurrent problemalcohol and illicit drug users.

Hoboken, NJ: JohnWiley & Sons, Ltd.

Konstam, V., Cook, A., Tomek, S., Mahdavi, E., Gracia,

R., & Bayne, A. H. 2015. Evidence-Based Practice,

Work Engagement and Professional Expertise of

Counselors. The Professional Counselor, 5 (1), 67-80.

Leen, B., Bell, M., & McQuillan, P. 2014. Evidence-Based

Practice: a Practice Manual. USA: Health Service

Executive.

Lewis, J. A., Lewis, M. D., Daniels, J. A., & D'Andrea, M.

J. (2011). Community Counseling: A Multicultural-

Social Justice Perspective (4th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

Mason, M., Light, J., Campbell, L., Keyser-Marcus, L.,

Crewe, S., Way, T., et al. (2015). Peer Network

Counseling with Urban Adolescents: A Randomized

Controlled Trial with Moderate Substance Users.

Journal of Substance Abuse Treatment , 58, 16-24.

Ruini, C., Masoni, L., Otolini, F., & Ferrari, S. 2014.

Positive Narrative Group Psychotherapy: The Use of

Traditional Fairy Tales to Enhance Psychological

Well-Being and Growth. Psychology of Well-Being, 4

(13), 1-9.

Ryff, C. D. 1989. Happiness is Everything, or Is It?

Explorations on the Meaning of Psychological Well-

being. Journal of Personality and Social Psychology,

69, 719-727.

Ryff, C. D. 2014. Psychological Well-Being Revisited:

Advanced in the Science and Practice of Eudaimonia.

Psychoterapy and Psychosmoatics, 83, 10-28.

Schwartz, R. P., Kelly, S. M., O’Grady, K. E., Mitchell, S.

G., Peterson, J. A., Reisinger, H. S., et al. 2008.

Attitudes toward buprenorphine and methadone

among opioid-dependent individuals.

American

Journal of Addicton, 17, 396–401.

Suresh, V., & Sachin, S. (2014). Effectiveness of group

therapy on psychological wellbeing among alcoholic

dependents at selected De-addiction Centre in

Ahmedabad. IOSR Journal of Nursing and Health

Science , 3 (5), 35-39.

UNODC. 2016. International Standards for The

Treatment of Drug Use Disorders. Vienna, Italy:

Commission on Narcotic Drugs, WHO.

Visser, M., & Routledge, L.-A. 2007. Substance Abuse

and Psychological Well-Being of South African

Adolescence. South African Journal of Psychology, 37

(3), 595-615.

Yazdanbakhsh, K., Merzai, S., Dehghan, F., & Mahmoudi,

S. (2016). The effectiveness of matrix treatment in

psychological well-being of stimulants substance

abusers. The Social Sciences, 11 (1), 6079-6093.

Enhancing Psychological Well-being of Ex-drug Addicted Individuals in Semarang with Evidence-based Community Counseling

185