Roles and Collaborative Practices of Drug Rehabilitation Social Workers and Community Drug Control Officers in Community-Based Drug Rehabilitation in China: A Qualitative Study

Abstract

Community-based drug rehabilitation (CBDR) in China involves multiple types of frontline workers, yet little empirical research has examined how these workers carry out their respective roles and collaborate in practice. This study explored the roles, collaborative practices, and role boundaries of drug rehabilitation social workers (DRSWs) and community drug control officers (CDCOs) in CBDR in Guangzhou, China. Semi-structured in-depth interviews were conducted with 23 DRSWs and 9 CDCOs across two sequential phases, and data were analyzed using reflexive thematic analysis. The findings revealed that DRSWs primarily performed professional rehabilitation services alongside administrative assistance, while CDCOs focused on administrative management, support for enforcement-related procedures, and upward resource advocacy. Five areas of collaboration were identified, characterized by a spontaneous complementary division of labor. However, role boundary ambiguity was also observed at three interconnected levels: DRSWs’ administrative workload had expanded beyond an assisting capacity, some CDCOs described care-giving practices that approached the professional domain of social work, and workers reported that persons with drug use histories (PWUDs) often had difficulty distinguishing between the two roles. These findings highlight the need for clearer role definitions and institutionalized coordination mechanisms in CBDR.

1. Introduction

The total number of current registered drug users in China has declined in recent years, falling from 1.124 million at the end of 2022 to 747,000 at the end of 2024 (Office of National Narcotics Control Commission 2023, 2024, 2025). Despite this decline, drug use remains a serious public concern.

To manage and support this population, China has established an official drug treatment system that includes compulsory detoxification, community-based detoxification, and community-based drug rehabilitation (CBDR). CBDR is the final stage that most persons with drug use histories (PWUDs) are required to complete (Yang and Giummarra 2021). It aims to help PWUDs reduce harm, restore social functioning, and reintegrate into society through ongoing supervision, behavioral regulation, supportive assistance, and the repair of social relationships within natural community settings (Yang and Giummarra 2021; Wang et al. 2025). However, social reintegration is rarely smooth. Beyond drug dependence itself, PWUDs frequently face practical obstacles, including social stigma, strained family relationships, employment difficulties, limited access to resources, and poor coordination of cross-departmental service referrals (Islam et al. 2023; Ou 2024).

In response, China has introduced laws and policies on drug control, professional social work, and the government procurement of social services (Standing Committee of the National People’s Congress 2015; Office of National Narcotics Control Commission et al. 2017; Ministry of Finance of the People’s Republic of China 2020; General Office of the CPC Central Committee and General Office of the State Council 2024). These have collectively established a multi-level institutional framework for CBDR. At the national level, the National Narcotics Control Commission sets policy direction and coordinates inter-ministerial drug control work. Provincial and municipal narcotics control commissions are responsible for implementation within their jurisdictions. At the grassroots level, the day-to-day operation of CBDR involves multiple agencies with distinct functions.

Public security organs occupy a central position in this governance structure. They are involved in enforcement-related procedures, including decisions on community-based rehabilitation, testing requirements, responses to violations, and the investigation of drug-related offenses. Sub-district drug control offices and related grassroots units coordinate routine management, prevention education, follow-up work, and everyday collaboration among frontline personnel (State Council of the People’s Republic of China 2011; Song and Jiang 2025). Local governments at or above the county level have also increasingly used government procurement of social services to introduce professional social work into CBDR. Through this mechanism, social work service organizations are contracted to provide rehabilitation and welfare-related services to PWUDs while working alongside existing grassroots administrative staff (Office of National Narcotics Control Commission et al. 2017; Enjuto Martinez et al. 2023). This arrangement has produced a dual-track frontline workforce in which community drug control officers (CDCOs; the authors’ English rendering of 社区禁毒专干, shequ jindu zhuangan) and drug rehabilitation social workers (DRSWs) operate in the same community-based service settings and serve the same population, but do so under separate lines of accountability and with different professional mandates.

CDCOs are typically recruited and managed by county-level, township, or sub-district governments. They serve as dedicated grassroots personnel responsible for administrative management, anti-drug publicity and education, home visits, urine-testing coordination, risk assessment, information system maintenance, and community transition arrangements following release from compulsory rehabilitation facilities (State Council of the People’s Republic of China 2011; Central Committee of the Communist Party of China and State Council of the People’s Republic of China 2014). DRSWs, by contrast, are professionally qualified social workers employed by social work service organizations contracted through government procurement. Their primary responsibilities include rehabilitation services, welfare and assistance services, anti-drug education, and assistance with administrative tasks related to drug control (Office of National Narcotics Control Commission et al. 2017).

Although the two groups often work alongside each other and serve overlapping caseloads, they are not in a formal hierarchical or line-management relationship. Their operational interdependence is most apparent in tasks such as home visits, information sharing, service referral, follow-up work, and community transition. In institutional design, CDCOs focus on administrative management and support for enforcement-related procedures, whereas DRSWs focus on professional rehabilitation services and welfare assistance. However, in grassroots practice, these boundaries are often less clear. The government procurement system may also create practical dependence, as DRSWs’ organizations rely on contract renewal by local authorities within the same administrative environment in which CDCOs are embedded (Enjuto Martinez et al. 2023; Xie and Pantea 2019). In the absence of clear guidelines for everyday collaboration, the functions of CDCOs and DRSWs may overlap or even become conflated in some local contexts, further blurring their role boundaries (Zhang et al. 2022; Zhang and Jiang 2025; Zhao et al. 2024).

A growing body of research has examined CBDR in China, but existing studies tend to approach the system from within a single disciplinary or institutional lens. Legal and policy analyses have traced the development of China’s drug rehabilitation framework and identified structural tensions between its punitive and rehabilitative orientations (Liu et al. 2023; Wang et al. 2025; Jiang and Song 2025). Studies on DRSWs have documented challenges such as professional de-legitimization, administrative absorption, and role strain, but primarily from the perspective of social workers themselves, without examining how these challenges are shaped by the presence and practices of CDCOs (Huang et al. 2021; Xie and Pantea 2019; Li and Song 2022). Research on CDCOs remains scarce, with few empirical studies examining their frontline roles and collaborative practices. To date, CDCOs and DRSWs have rarely been examined together, despite the fact that their daily work is closely intertwined in practice.

The dual-track arrangement of CDCOs and DRSWs has no direct equivalent in the international literature. However, several adjacent fields have examined closely related challenges, particularly how different categories of frontline workers define their roles, negotiate task boundaries, and coordinate in practice. Research on interprofessional collaboration and task sharing in health and social care has shown that when workers from different backgrounds share the same service environment, role ambiguity and boundary disputes may emerge, particularly in the absence of formalized coordination mechanisms. Unclear role boundaries may also limit the effectiveness of task redistribution among different categories of workers (Reeves et al. 2010; Bark et al. 2023; Joshi et al. 2014; Tesema et al. 2025). Studies on social work in multidisciplinary settings have shown that social workers’ roles may become diluted or subordinated within organizational environments dominated by other professional or administrative logics (Cootes et al. 2022). Yet these dynamics have not been investigated within the specific institutional configuration of China’s CBDR system.

This study therefore examined how CDCOs and DRSWs enact their respective roles in everyday CBDR practice, how tasks are shared between the two groups, and how role boundaries are maintained or blurred in grassroot service settings.

2. Methods

This study adopted a qualitative approach to explore the roles and collaborative practices of DRSWs and CDCOs in CBDR in Guangzhou, China. Grounded in a critical realist ontology and a contextualist epistemology (Pilgrim 2014; Braun and Clarke 2022), the analysis treated participants’ accounts as situated descriptions of lived and professional experience while also examining the institutional conditions that shaped those experiences. An experiential orientation was adopted, prioritizing faithful representation of participants’ accounts over external evaluation of their practices. The concepts of role ambiguity, task sharing, and boundary negotiation informed interpretation but did not predetermine coding.

2.1. Study Design

This qualitative study employed a two-phase sequential design (see Figure 1). Phase 1 focused on DRSWs, and Phase 2 focused on CDCOs. Semi-structured in-depth interviews were conducted with both groups. Different interview guides were used in the two phases to reflect the distinct institutional roles and professional backgrounds of the two groups, although the overarching research questions remained consistent.

The decision to interview DRSWs before CDCOs, rather than conducting both sets of interviews simultaneously, was driven by both the structural characteristics of the two groups and the methodological needs of the study. DRSWs operate at the intersection of professional service and administrative assistance, meaning that their daily practice intersects with multiple dimensions of the CBDR system, including direct interaction with CDCOs. Their accounts were therefore well suited to generating an initial map of collaborative touchpoints and areas of tension between the two roles.

Rather than serving as a means of verifying DRSWs’ accounts, Phase 1 sensitized the research team to areas of collaboration and boundary ambiguity that had emerged from frontline practice, allowing the Phase 2 interview guide to include more empirically grounded questions about CDCOs’ own experiences. The Phase 2 guide also retained open-ended questions about CDCOs’ responsibilities, work routines, role perceptions, and collaborative practices. The CDCO data were analyzed separately, and CDCO themes were developed on their own terms before any cross-group comparison was conducted.

2.2. Location and Sampling

Guangzhou was selected as the research site for two reasons. First, Guangdong Province has the largest number of individuals with a recorded history of drug use in China, exceeding 800,000 and accounting for approximately one-sixth of the national total (Zhou et al. 2024). Guangzhou, as the provincial capital, has a comparatively high concentration of registered PWUDs, with drug-related offenses consistently ranking among the highest in the province (China National Narcotics Control Committee 2020, 2022; Guangzhou People’s Procuratorate 2023). Second, Guangzhou has a relatively mature CBDR system with an established practice of government procurement of social work services (Liu et al. 2022; Mo et al. 2024; Song and Jiang 2025), providing access to both CDCOs and DRSWs as active frontline participants.

Purposive sampling was used to recruit participants in both phases. In Phase 1, DRSWs were recruited based on the following inclusion criteria: (1) holding the National Social Worker Qualification Certificate; (2) having at least one year of frontline practice experience in CBDR; (3) having practical experience of collaborating with CDCOs in daily work; and (4) currently working in Guangzhou. A total of 23 DRSWs were interviewed.

In Phase 2, CDCOs were recruited based on the following criteria: (1) being officially appointed by county-level or township governments as designated CBDR workers; (2) having at least one year of frontline practice experience in CBDR; (3) having practical experience of collaborating with DRSWs; and (4) currently working in Guangzhou. A total of 9 CDCOs were interviewed.

Participants in both phases were drawn from CBDR stations across five administrative districts of Guangzhou (Nansha, Panyu, Huangpu, Baiyun, and Tianhe), covering both central urban and peripheral areas. The DRSWs and CDCOs were recruited independently and were not necessarily working within the same teams. The aim was not to reconstruct paired worker relationships or specific case-level interactions, but to compare how the two categories of frontline workers understood and enacted their roles within the same municipal CBDR system.

In both phases, the adequacy of the dataset was assessed through the logic of information power (Malterud et al. 2016). The research team considered the specificity of the sample, the relevance of participants’ frontline experience to the research questions, the quality and depth of the interview accounts, and the extent to which the data supported meaningful analysis of role enactment, collaboration, and boundary ambiguity. For DRSWs, the interviews generated detailed accounts of professional service provision, administrative assistance, and everyday collaboration with CDCOs. Later interviews largely elaborated and refined these patterns rather than opening substantially new lines of interpretation. For CDCOs, although the sample was smaller, participants had direct experience of grassroots CBDR work and provided focused accounts of administrative management, support for enforcement-related procedures, resource coordination, and collaboration with DRSWs. On this basis, the research team judged that the data in both phases held sufficient information power to support the study’s comparative and interpretive aims.

2.3. Data Collection

Data were collected through semi-structured in-depth interviews in both phases. The Phase 1 interview guide was developed by the first author based on a literature review and preliminary fieldwork, and was reviewed by the other authors. The guide explored DRSWs’ perceptions of their professional roles and core responsibilities, their typical work routines and service processes, and their practical experiences of working alongside CDCOs. Sample questions included: “What specific tasks do you mainly undertake when following up with PWUDs?” and “How do you usually coordinate with CDCOs when dealing with emergencies or linking resources?”

The Phase 2 interview guide was revised in three specific ways based on Phase 1 findings. First, Phase 1 interviews revealed that DRSWs frequently described a pattern in which their administrative assistance to CDCOs had gradually expanded into routine responsibility. The Phase 2 guide therefore included questions asking CDCOs directly about their expectations of DRSWs’ involvement in administrative tasks and how they perceived the division of labor. Second, DRSWs described a spontaneous “hard-soft” division of labor during joint home visits, in which CDCOs handled compliance-related tasks while DRSWs handled emotional support. The Phase 2 guide incorporated questions asking CDCOs to describe their own experience of joint visits and whether they recognized this pattern. Third, several DRSWs reported that PWUDs often could not distinguish between the two roles. The Phase 2 guide added a question asking CDCOs whether they had observed similar confusion among PWUDs and how they understood the distinction between their own role and that of DRSWs. Beyond these targeted revisions, the guide also explored CDCOs’ perceptions of their job responsibilities and daily work priorities more broadly. Sample questions included: “What are your main responsibilities in managing PWUDs in the community?” and “In your daily work, how do you and DRSWs divide tasks when working with the same client?”

The first author conducted all interviews between November 2024 and August 2025. Phase 1 interviews took place from November 2024 to April 2025, and Phase 2 interviews from May to August 2025. All interviews were conducted in Mandarin Chinese, lasted between 45 and 90 min, and were audio-recorded with participants’ written consent. All recordings were transcribed verbatim by the first author. The extended data collection period was a result of the sequential design, in which Phase 2 could only begin after Phase 1 data had been preliminarily analyzed. No major policy changes or institutional restructuring affecting CBDR in Guangzhou occurred during this period.

2.4. Data Analysis

The data from each phase were analyzed separately. Although the Phase 2 interview guide incorporated targeted questions informed by Phase 1 findings, the thematic analysis of the CDCO data was conducted independently, and themes specific to the CDCO group were developed on their own terms rather than being confined to the framework established in Phase 1. We followed Braun and Clarke’s reflexive thematic analysis approach (Braun and Clarke 2021, 2022), which suited our aim of identifying patterns in each group’s data while staying close to the specific contexts of grassroots practice. All transcripts were imported into NVivo 14. The first and fifth authors coded each transcript independently. A single text segment could receive more than one code when its meaning was not straightforward. Once coding was complete, the two coders compared their work and identified points of divergence. These were discussed with the full research team, with each coder explaining their interpretive rationale until a shared understanding was reached. Themes were not finalized until the full team had reached agreement.

After themes for each phase had been established separately, the research team looked across both sets of findings to identify tasks on which DRSWs and CDCOs appeared to work together. Demographic and professional background information for all participants was recorded alongside the interview data to provide additional context for interpretation.

2.5. Researcher Reflexivity

The first author was trained in social work and previously worked as a drug rehabilitation social worker at one of the participating service organizations in Guangzhou. This background had implications for the research process. Familiarity with the CBDR system and its day-to-day operation allowed the first author to gain access to participants with relative ease, establish rapport during interviews, and develop a grounded understanding of the terminology and practices described by both DRSWs and CDCOs. At the same time, this insider position introduced the risk of treating certain practices as self-evident or of unconsciously privileging the perspective of DRSWs over that of CDCOs. To manage this, the first author adopted an explicitly researcher-oriented stance during all interviews, and made a deliberate effort to approach CDCOs’ accounts with the same openness and curiosity as those of DRSWs, treating both groups’ descriptions as equally valid representations of their experience.

Several steps were taken throughout the research process to guard against the influence of prior assumptions. During data collection, the first author used reflective journaling after each interview to record initial impressions and note any moments where personal experience may have shaped the direction of questioning. During analysis, the independent coding by the fifth author, an associate professor in social work with extensive research experience in this field but no prior involvement with the participating organizations, served as a check on the first author’s interpretive tendencies. Points of disagreement between the two coders were discussed openly with the full research team, and themes were only finalized through collective deliberation. While it is neither possible nor desirable to eliminate the researcher’s influence entirely within a reflexive thematic analysis framework, these measures were intended to ensure that the findings reflect the participants’ accounts rather than the first author’s prior professional experience.

2.6. Ethical Considerations

Ethical approval for this study was obtained from the Ethics Committee of Universiti Kebangsaan Malaysia (COA No: JEP-2024-679). Prior to each interview, the first author explained the study’s purpose, procedures, and participants’ rights in detail, and obtained written informed consent. Participants were informed that they could withdraw at any time without consequence. All recordings and transcripts were stored in encrypted files, and participants’ identifying information was replaced with pseudonyms to protect confidentiality.

3. Findings

The study included a total of 32 grassroots drug control workers, comprising 23 DRSWs and 9 CDCOs.

Table 1. Demographic Distribution.

Demographics	Drug Rehabilitation Social Workers (n = 23)	Community Drug Control Officers (n = 9)
Mean age (years)	39.1	53.6
Mean years of experience	5.6	11.4
Gender
Male	30.4%	77.8%
Female	69.6%	22.2%
Education level
Senior high school or below	-	11.1%
College diploma	69.6%	77.8%
Bachelor’s degree	26.1%	11.1%
Postgraduate or above	4.3%	-
Professional qualification
Assistant social worker	82.6%	-
Intermediate social worker	17.4%	-

presents the demographic characteristics of participants interviewed in each phase.

Table 2. Individual Participant Profiles.

Participant ID	Gender	Age	Education Level	Professional Qualification	Years of Experience	District
Drug rehabilitation social workers (n = 23)
DRSW-01	Male	46	College diploma	Assistant social worker	7	A
DRSW-02	Male	35	Bachelor’s degree	Assistant social worker	4	B
DRSW-03	Female	37	College diploma	Assistant social worker	5	A
DRSW-04	Female	51	College diploma	Intermediate social worker	10	C
DRSW-05	Female	33	College diploma	Assistant social worker	4	B
DRSW-06	Male	45	Bachelor’s degree	Assistant social worker	3	D
DRSW-07	Female	39	College diploma	Assistant social worker	6	A
DRSW-08	Female	36	College diploma	Assistant social worker	4	E
DRSW-09	Male	42	College diploma	Assistant social worker	7	C
DRSW-10	Female	29	Bachelor’s degree	Assistant social worker	3	B
DRSW-11	Female	43	College diploma	Assistant social worker	8	D
DRSW-12	Female	39	College diploma	Assistant social worker	9	A
DRSW-13	Male	44	Bachelor’s degree	Intermediate social worker	7	E
DRSW-14	Female	37	College diploma	Assistant social worker	5	C
DRSW-15	Female	38	College diploma	Assistant social worker	4	B
DRSW-16	Female	24	College diploma	Assistant social worker	3	D
DRSW-17	Female	44	Bachelor’s degree	Assistant social worker	5	A
DRSW-18	Female	41	College diploma	Assistant social worker	8	E
DRSW-19	Female	35	College diploma	Assistant social worker	4	C
DRSW-20	Male	48	Bachelor’s degree	Intermediate social worker	7	B
DRSW-21	Female	36	Postgraduate or above	Intermediate social worker	5	D
DRSW-22	Female	38	College diploma	Assistant social worker	6	E
DRSW-23	Male	39	College diploma	Assistant social worker	4	C
Community drug control officers (n = 9)
CDCO-01	Male	55	College diploma	-	9	A
CDCO-02	Male	48	College diploma	-	12	C
CDCO-03	Female	58	College diploma	-	10	C
CDCO-04	Male	47	Bachelor’s degree	-	8	D
CDCO-05	Male	56	College diploma	-	13	E
CDCO-06	Male	50	College diploma	-	11	A
CDCO-07	Female	53	College diploma	-	12	B
CDCO-08	Male	59	Senior high school or below	-	16	E
CDCO-09	Male	56	College diploma	-	12	D

Note: District identifiers were anonymized to protect participant confidentiality.

presents the individual profiles of all participants. The findings are organized into three sections: key roles of DRSWs (Section 3.2), key roles of CDCOs (Section 3.3), and collaborative tasks and role boundaries between the two groups (Section 3.4).

3.1. Participant Characteristics

The two groups differed noticeably in age, tenure, gender composition, educational background, and professional qualifications. The mean age of DRSWs was 39.1 years, compared with 53.6 years for CDCOs. CDCOs had considerably longer tenure in their current positions, averaging 11.4 years, while DRSWs averaged 5.6 years. DRSWs were predominantly female (69.6%), whereas CDCOs were predominantly male (77.8%). Regarding educational background, the majority of DRSWs (69.6%) held a college diploma, 26.1% held a bachelor’s degree, and 4.3% held a postgraduate degree. Among CDCOs, 77.8% held a college diploma, 11.1% held a bachelor’s degree, and 11.1% had completed only senior secondary education or below. In terms of professional qualifications, 82.6% of DRSWs held the Assistant Social Worker certificate and 17.4% held the Intermediate Social Worker certificate. None of the CDCOs held any professional social work qualification.

3.2. Key Roles of DRSWs

Interviews with DRSWs revealed three key roles in CBDR: the professional service role, the “assisting” role in administrative governance, and contributors to community-based drug prevention education. Figure 2 maps these roles and their associated tasks. DRSWs’ professional service work operated across individual, family, and social levels, while their daily responsibilities also encompassed substantial administrative and educational tasks.

3.2.1. Theme 1: The Professional Service Role

All DRSWs interviewed described their role in CBDR as that of a professional service provider. Drawing on professional social work approaches, including psychosocial support, motivational engagement, cognitive-behavioral intervention, family psychoeducation, and resource linkage, they offered services aimed at supporting the personal recovery and social reintegration of PWUDs. These services operated at three levels: the individual level, the family level, and the social level.

Individual Level

At the individual level, DRSWs primarily provided psychosocial support and guidance, motivational engagement, cognitive-behavioral intervention, and relapse prevention follow-up.

DRSWs described psychosocial support and guidance as a process of building and sustaining professional trust with PWUDs through emotional acceptance, empathic responses, and sustained emotional support. Participants widely regarded this trust as an essential foundation for PWUD’s willingness to engage with subsequent rehabilitation services. Several DRSWs noted that PWUDs often approached them with strong resistance, tending to see social workers as agents of control rather than sources of support. One DRSW described this:

“When they first meet us, most of them are reluctant, even angry. For a long time, they assume we are there to supervise them, like the relationship between a prison guard and an inmate. Lecturing them only deepens their mistrust. So what do we do? Our profession tells us to accept and empathize.”

(DRSW-07)

Motivational engagement involved the use of techniques such as motivational interviewing to help PWUDs shift from passive compliance to active change. Participants observed that most PWUDs initially entered rehabilitation under external pressure, and were highly susceptible to relapse once that pressure was removed. One DRSW responded:

“Ask them why they want to quit drugs, and most will say it is because they are afraid of being arrested or sent to compulsory detention. Under those circumstances, the moment external supervision ends, relapse is almost inevitable. My job is to help them find something inside themselves that makes them want to change.”

(DRSW-02)

Another DRSW described a specific technique for stimulating internal motivation:

“I often ask them one question: if one day you were completely free from drugs, what is the one thing you would most want to do? I want to use that kind of question to help them find a reason that feels worth enduring the pain of change.”

(DRSW-08)

DRSWs also helped PWUDs identify irrational beliefs associated with their drug use and develop alternative coping strategies. Participants noted that PWUDs commonly held cognitive distortions that rationalized their substance use, such as denying that the substance they used was a drug, insisting they were not addicted, or believing that drugs had medicinal value. One DRSW explained:

“These misconceptions allow them to justify their drug use, so correcting these cognitive distortions is something we have to do on a daily basis.”

(DRSW-12)

Once such beliefs had been identified, DRSWs and their clients worked together to find alternative ways of responding to situations that had previously triggered drug use. Another DRSW gave a concrete example of this process:

“One client insisted that methamphetamine was not a real drug and said he only used it to stay alert. I did not argue with him directly. Instead, I asked him: ‘If it is just something to keep you awake, why did it make you go three days without sleep and lose 20 jin [about 10 kg]?’ After that, we listed what he had lost because of it.”

(DRSW-17)

Relapse prevention follow-up was another core service that DRSWs provided at the individual level. Participants generally viewed relapse as a normal part of the rehabilitation process rather than a sign of failure. In their routine follow-up work, DRSWs helped PWUDs identify high-risk situations that might trigger relapse and established immediate contact mechanisms for moments of crisis. One DRSW described this approach:

“During regular follow-ups, I go through the high-risk triggers with them: holiday gatherings with old friends, payday when they suddenly have cash, a major argument with family. I keep asking them: ‘If one day you really cannot hold on anymore, can you at least send me a message before you act on it?’ Our follow-up is not about watching whether they slip up. It is about being a safety net when they are close to breaking point.”

(DRSW-15)

Beyond these core areas, participants also mentioned other work at the individual level, such as helping PWUDs develop phased rehabilitation plans, conducting regular assessments of recovery progress, and referring them to psychiatric or counseling services when needed.

Family Level

At the family level, the most frequently described areas of intervention included psychological support for family members, psychoeducation on addiction, trust rebuilding, and communication mediation in fractured relationships.

Several participants noted that family members of PWUDs often suffered from prolonged psychological distress and emotional exhaustion, and that DRSWs needed to attend to their emotional needs alongside those of the clients themselves. One DRSW put it this way:

“We are not just social workers for the clients. We are social workers for their families too. Family members carry deep resentment after years of repeated drug use. We have to truly feel what they are going through. Only through genuine empathy can we actually enter their family world.”

(DRSW-07)

Another DRSW elaborated on how this support was delivered in practice:

“The thing family members say to us most often is ‘I have given up hope.’ At that point, you cannot rush into discussing a rehabilitation plan. You first need to make them feel that their pain has been seen. I tell them: ‘You have been carrying this alone for years. That must have been incredibly hard.’ Some of them start crying when they hear that, because no one has ever said it to them before.”

(DRSW-03)

Participants also pointed out that family members’ misunderstanding of the nature of addiction was often the main obstacle to repairing family relationships. Most family members attributed drug use to moral failure, and DRSWs needed to use psychoeducation to help them develop a more informed understanding of addiction. One DRSW noted:

“We regularly provide families with education on the mechanisms of addiction. The goal is to help them see the person who uses drugs not as a ‘destroyer’ but as someone who is also a victim.”

(DRSW-12)

Another DRSW gave an example of how this was communicated in practice:

“Reasoning with family members in abstract terms does not work. You have to use language they can understand. I tell them: ‘Blaming him for having no conscience is useless, because the drug has already hijacked his brain. Just like a patient with pneumonia cannot stop coughing through willpower alone, he cannot quit just because you scold him.’ Once their understanding shifts, their attitude may begin to shift too.”

(DRSW-18)

Trust rebuilding between PWUDs and their family members was another frequently mentioned area of family-level intervention. Participants noted that the gap between the two sides’ expectations around trust was a major source of family conflict. DRSWs addressed this primarily through expectation management with both parties. One DRSW explained:

“We need to get both sides on the same page. The client wants the family to trust them, but the family watches them like they are guarding against a thief. The moment the client steps out the door, the family assumes they are going to use drugs. Unless this dynamic is addressed, family functioning cannot be restored.”

(DRSW-20)

When direct communication between family members had broken down entirely, DRSWs took on the role of intermediary, relaying each side’s concerns to the other to create an opening for emotional reconnection. Participants described this as a careful, indirect process of bringing estranged family members closer without forcing confrontation. One DRSW recounted a case:

“A father and son were living under the same roof and had not spoken a single word to each other for nearly a year. So when I was with the son, I casually mentioned that his father had secretly asked me whether his stomach problem was getting better. Then I went to the father and told him that his son had received his first paycheck and wanted to buy him a carton of cigarettes but felt too awkward to give it to him directly.”

(DRSW-23)

Participants additionally reported other family-level work, such as involving family members in the development of rehabilitation plans, identifying and addressing codependency patterns, and referring family members to professional counseling services when needed.

Social Level

At the social level, the most frequently described areas of intervention included employment support, accompanied healthcare access, social assistance navigation, and community reintegration activities.

Employment was the structural barrier that participants mentioned most consistently. PWUDs with drug-related records commonly faced social exclusion in the job market, and DRSWs’ primary role in this area was to link clients with resources that could facilitate re-employment. Several participants described building long-term relationships with local businesses to expand employment channels, while others mentioned connecting clients with community members who could offer vocational skills training in areas such as baking, appliance repair, or pet grooming. One DRSW put it this way:

“I often have to go door-to-door to visit nearby businesses, looking for employers willing to offer job opportunities to our clients. Initially, they are almost always unwilling to hire people with criminal records, so we have to repeatedly persuade them. Sometimes, we even have to humble ourselves just to seek their cooperation.”

(DRSW-09)

Healthcare access presented another considerable challenge. Some PWUDs had co-occurring conditions such as hepatitis C, HIV, or mental health disorders, yet avoided seeking medical care out of fear of being stigmatized in clinical settings. DRSWs responded by accompanying clients to their appointments. One DRSW responded:

“They worry about the looks people give them if a doctor sees the needle marks on their arms, or if their record shows up in the system. So, whenever we have the time, we try our best to accompany them, just to make sure they don’t get discriminated against.”

(DRSW-22)

In the area of social assistance, DRSWs helped PWUDs apply for temporary relief, minimum living allowances, and other welfare entitlements. Participants noted that rigid eligibility criteria frequently did not align with clients’ actual circumstances, which meant DRSWs had to negotiate repeatedly with local administrative departments on their behalf. One DRSW recounted:

“Some of them are only in their thirties. According to the policy, they fall under ‘people with working capacity,’ so it’s basically impossible to get Dibao (minimum living allowance) approved. But the reality is, after years of drug use, their brains are damaged, they just can’t work a normal job. So that’s when we must help out. We help them get their medical records, get the hardship certificates, and then we have to run to the sub-district office over and over again to apply for temporary relief.”

(DRSW-20)

Beyond these specific areas of need, DRSWs also organized community activities aimed at helping PWUDs rebuild social connections and develop a more positive sense of identity. Several participants emphasized that PWUDs were often deeply isolated within their communities, and that this isolation was in itself a significant risk factor for relapse. DRSWs’ approach was to create opportunities for clients to participate in community life without being labeled. One DRSW explained:

“In the community, they are practically invisible. Their families would rather hide them away. We never organize anything called a ‘drug rehabilitation forum’ because that would be putting them on public display. Instead, we invite them to volunteer: joining a neighborhood cleanup, delivering dumplings to elderly people living alone, or helping direct traffic at an intersection. Real social reintegration is not about forcing society to accept them. It is about creating opportunities for them to feel that they still matter.”

(DRSW-05)

Other social-level tasks mentioned by participants included assisting PWUDs with identity documents and household registration procedures, connecting them with vocational training programs, and coordinating community volunteers to provide daily companionship.

3.2.2. Theme 2: The “Assisting” Role in Administrative Governance

In addition to their professional service role, DRSWs were also involved in a range of administrative tasks as part of the daily operation of CBDR. The most frequently mentioned areas of assistance included door-to-door inspections and information verification, case file establishment and maintenance, urine testing notification and coordination, community transition for persons released from compulsory rehabilitation facilities, and the signing and monitoring of community rehabilitation agreements.

In the area of door-to-door inspections, several participants noted that DRSWs were required to assist grassroots government agencies and public security departments in verifying and updating the personal information of registered PWUDs in their jurisdictions. One DRSW described this:

“Every month we have to go out on inspection rounds, visiting households one by one to check whether the registered PWUD in our area still live at the same address, what their current status is, and whether they have moved elsewhere. All of this has to be entered into the system. Nothing can be left out.”

(DRSW-04)

DRSWs also assisted with the establishment and maintenance of individual case files for each PWUD. One DRSW responded:

“Every client has a file box with their basic info, drug use history, and rehab progress. From setting up the files to keeping them updated, it all falls on us. Honestly, just dealing with this stuff takes up a massive amount of our time. Especially when supervisors or government leaders come down for an inspection, we have to work overtime to check and re-check all these documents just to make sure there are no mistakes.”

(DRSW-13)

Urine testing notification and coordination was another administrative task in which DRSWs were regularly involved. The testing itself was carried out by public security departments, but the work of notifying PWUDs to attend on time and arranging the schedule often fell to DRSWs. One DRSW described this:

“We don’t actually have the authority to do urine tests on the clients ourselves. But for some reason, it’s our job to notify them to come in for testing. Sometimes we can’t even reach them on the phone, so we have to go out and look for them in person.”

(DRSW-06)

Community transition following release from compulsory rehabilitation facilities was another important area of administrative assistance. DRSWs helped facilitate the signing of community rehabilitation agreements and assisted with subsequent management and service arrangements. One DRSW responded:

“After someone is released from a compulsory rehabilitation facility, they are required to report to the sub-district office and sign a community rehabilitation agreement within a set period. We find out about their situation in advance, go to meet them on the day of release, help them complete the paperwork, and explain what they need to do going forward.”

(DRSW-10)

Other administrative tasks mentioned by participants included reporting information as part of community grid management, attending joint meetings and work briefings organized by drug control departments, and assisting with emergency situations involving PWUDs.

3.2.3. Theme 3: Contributors to Community-Based Drug Prevention Education

DRSWs played a contributing role in drug prevention education within the CBDR system. The most frequently described activities included community drug awareness campaigns targeting local residents, school-based prevention education for young people, and anti-stigma advocacy directed at communities where PWUDs live.

Several participants noted that DRSWs regularly assisted grassroots drug control departments in organizing awareness campaigns in the community. These typically involved setting up information booths, distributing educational materials, displaying exhibition boards, and running quiz activities, with increased frequency around key dates such as the International Day Against Drug Abuse on 26 June. Some participants also described using new media channels to reach a wider audience. One DRSW described this work:

“The sub-district drug control office will ask us to help them with public awareness tasks. For example, we have to set up a booth and put out some mock drugs and drug identification materials on it. These tasks get a lot heavier on special dates like the World Drug Day.”

(DRSW-04)

Another DRSW described the use of social media for prevention education:

“Young people are all on their phones these days, so traditional leaflets do not reach them very well. We produce short videos and post them on community WeChat groups and public accounts, mainly about how to identify new types of drugs and the dangers of addiction. Once we made a one-minute clip called ‘Recognizing Disguised Drugs,’ and it spread quickly in parent chat groups. A lot of parents shared it and said it was very practical.”

(DRSW-16)

In school-based prevention education, some participants described entering local primary and secondary schools to deliver anti-drug lectures and interactive sessions. DRSWs primarily took on the roles of content design and classroom delivery in these activities. One DRSW responded:

“Every semester we go to primary and secondary schools in our area to give anti-drug education talks. You cannot just read from a textbook when speaking to students. You have to use language they can relate to. I usually bring replica drug models and use real cases to explain the harm drugs cause.”

(DRSW-11)

Beyond knowledge dissemination, some participants also described incorporating anti-stigma advocacy into their prevention education work. In campaigns targeting community residents and students, DRSWs sought to promote a more inclusive understanding of PWUDs in order to reduce stigma and social exclusion at the community level. One DRSW noted:

“When we do awareness work, we do not just talk about how dangerous drugs are. We also talk about how hard it is for people in rehabilitation. We want community residents to understand that these people are not bad people. They are trying to change, and they need society to give them a chance.”

(DRSW-14)

Participants additionally mentioned other prevention education activities, such as assisting in the production of anti-drug publicity materials, supporting drug control departments in delivering training sessions for businesses and community organizations, and organizing PWUDs to share their personal recovery experiences as peer educators.

3.3. Key Roles of CDCOs

Interviews with CDCOs revealed three key roles in CBDR: frontline execution of administrative management and support for enforcement-related procedures, primary responsibility for community-based drug prevention education, and upward coordination and advocacy for institutional resources. Figure 3 maps these roles and their associated tasks. While CDCOs’ core duties centered on administrative management, their accounts also revealed care-oriented practices during routine interactions with PWUDs.

3.3.1. Theme 1: Frontline Executors of Administrative Management and Law Enforcement Support

All CDCOs interviewed identified administrative management and law enforcement support as the core of their work. As dedicated staff recruited and managed by township governments or sub-district offices, CDCOs carried out a substantial volume of administrative tasks in the day-to-day operation of CBDR. The most frequently described tasks included inspection and tracking of registered PWUDs, information system maintenance, organization and implementation of urine and hair testing, management of community rehabilitation agreements, and law enforcement assistance in cooperation with public security departments.

In the area of inspection and tracking, CDCOs were responsible for conducting regular visits to registered PWUDs in their jurisdictions to verify residential status, employment situation, and social contacts, and for tracking those who had moved away. One CDCO described this:

“We have dozens of people to manage in our jurisdiction. We visit each one at least once a month. Who has moved, who has left for work, who seems off lately. We need to know all of this. Some of them refuse to cooperate. They do not answer the phone, they do not open the door. So we have to go back again and again. Sometimes it takes several trips before we can even see them.”

(CDCO-09)

Information system maintenance occupied a significant portion of CDCOs’ daily work. Participants described being required to enter the information collected during inspections into the drug control information management system without delay, and to ensure that the data on PWUDs in their jurisdictions remained accurate and up to date. One CDCO responded:

“The daily monitoring of drug users is all based on this management system. Since it is open to the national police network, we have to constantly update the data in real time and make sure everything is completely accurate. For example, we have to upload details like when a user comes in to report, when they take a hair test, and exactly what the results are.”

(CDCO-04)

The organization and implementation of urine and hair testing was another core responsibility. CDCOs were directly in charge of scheduling these tests and carrying them out. One CDCO recounted:

“Everyone has a different date they need to come in for testing. Some need to be tested today, and others are scheduled for tomorrow. We handle everything from verifying their IDs, to supervising them on-site while they provide the sample, to labeling and sealing the samples, and finally inputting every single test result into the management system. We go through this entire routine almost every day.”

(CDCO-02)

CDCOs were also responsible for the signing, monitoring, and evaluation of community rehabilitation agreements. Participants noted that whether or not PWUDs complied with these agreements directly shaped the management measures applied to them afterward. One CDCO explained:

“The community rehabilitation agreement is not just a piece of paper to sign and forget about. For these three years, if they step out of line, if they relapse and get caught, or if they miss urine tests three times, I do not care how much they cry. I submit the request to the public security bureau to send them to two years of compulsory rehabilitation. We are the ones holding the ruler. If you do not show them the sword hanging over their heads, they have no sense of accountability.”

(CDCO-06)

In terms of law enforcement assistance, CDCOs cooperated with local police stations in investigating drug-related leads, managing PWUDs, and carrying out specialized anti-drug operations. Several participants stressed that although CDCOs did not have law enforcement authority, their cooperation with public security departments was very close in practice. One CDCO noted:

“We do not have law enforcement power, but our coordination with the police station is very tight. For example, when a suspected drug user is newly identified in the area, the police station will ask us to go together to verify the situation. Sometimes when they carry out targeted raids, we participate from start to finish. And when someone goes off the grid or out of control, we assist the police in tracking them down and bringing them back.”

(CDCO-03)

Other administrative tasks mentioned by CDCOs included assisting with the supervision of narcotic and psychotropic drug use in their jurisdictions, supporting investigations into illegal drug cultivation, and completing various statistical reports and data submissions required by higher-level drug control departments.

It is also worth noting that several CDCOs, while describing their administrative and enforcement-related duties, mentioned paying attention to the practical living conditions of PWUDs and offering help where they could. One CDCO put it this way:

“You cannot just manage them without helping them. When I visit someone and see that their fridge is empty or they are still wearing thin clothes in winter, I am not going to just turn around and leave. I will ask around at the sub-district office about whether there is any temporary assistance they can apply for, or help them find out who is hiring. Strictly speaking, not all of this falls within my job description. But you are dealing with a real person. You cannot just look the other way.”

(CDCO-08)

3.3.2. Theme 2: Primary Drivers of Community-Based Drug Prevention Education

CDCOs played a leading role in organizing and driving drug prevention education at the community level. Participants generally regarded prevention education as one of their main responsibilities, and described taking the lead in event planning, resource allocation, and on-site implementation.

Several participants described the process of organizing routine awareness campaigns in their communities. One CDCO offered an account of this work:

“Drug prevention publicity is our biggest event every year. 26 June for the International Day Against Drug Abuse, 1 December for World AIDS Day, the start of the school year, around Chinese New Year. We have to organize activities at all of these. From writing the plan, booking the venue, and preparing materials to running the event on the day, we take the lead on all of it. Social workers and volunteers come to help, but the overall coordination is on us.”

(CDCO-01)

In school-based drug prevention education, CDCOs also took on a coordinating role. Participants noted that it was typically the CDCOs who liaised with schools and arranged the visits, while the actual teaching might be carried out by CDCOs themselves, DRSWs, or police officers depending on availability. One CDCO responded:

“Every semester we have to arrange anti-drug education classes in the schools. I am the one who contacts the school, sets the date and grade level, and prepares the teaching materials. Sometimes I deliver the talk myself, sometimes I ask a social worker to do it, and when possible, we invite a police officer from the local station, which tends to have a stronger impact.”

(CDCO-05)

Some participants also described developing locally adapted approaches to prevention education. One CDCO described this:

“Just handing out flyers and hanging banners has very limited effect. People do not even look at them. So now we try things that feel more relevant to local life, like screening anti-drug films in the village square, weaving drug prevention messages into local folk opera, or running prize quizzes at the entrance to the farmers’ market. The key is getting people to stop, watch, and actually take it in.”

(CDCO-07)

Other prevention education work mentioned by participants included organizing businesses and rental property landlords in the jurisdiction to sign anti-drug responsibility pledges, assisting drug control offices in building drug education centers and public display boards, and posting drug prevention information in community WeChat groups and public accounts.

3.3.3. Theme 3: Upward Coordinators and Advocates for Institutional Resources

CDCOs also served as advocates for resources and attention from higher levels of government. Participants noted that the operation of CBDR at the grassroots level was heavily dependent on the degree of priority placed on drug control by local government leaders and the level of resources allocated. As the persons directly responsible for drug control affairs at the grassroots level, CDCOs needed to secure support from above through multiple channels.

Several participants described actively reporting the practical needs of grassroots drug control work to higher-level departments. One CDCO gave an account of this:

“The people above do not necessarily understand the difficulties we face at the grassroots level. How many people we have to manage, whether we have enough staff, whether the budget is sufficient. If we do not raise these issues ourselves, nobody up there is going to know. Every time I go to a meeting, I lay out the real situation. I put the roster on the table and do the math right in front of the leaders: how much the urine test kits cost, how much travel money I advanced out of my own pocket to go after someone. You have to push for it, or this job simply cannot be done.”

(CDCO-02)

In terms of resource coordination, CDCOs also needed to communicate across different government departments to secure cooperation and support from civil affairs, human resources and social security, and public health authorities. One CDCO responded:

“Drug rehabilitation is not something a single department can handle on its own. If a client needs to apply for Dibao, you have to go to the Civil Affairs Bureau. If they need vocational training, you go to the Human Resources Bureau. If there are mental health issues, you go to the Health Commission. A lot of the time, I just have to run around between these different departments trying to coordinate resources.”

(CDCO-04)

Some participants also highlighted the critical importance of securing attention from local government leaders. One CDCO reflected:

“If the leaders take drug control work seriously, the funding comes through, we get enough staff, and things just run smoothly. If they don’t care, it is really hard to get anything done. So, we must also learn how to ‘manage up’ and show them actual results to make the leadership realize why this work is so important.”

(CDCO-09)

Other resource-related tasks mentioned by participants included applying for dedicated drug control funding and equipment, advocating for the inclusion of drug control performance in local government annual assessments, and coordinating with local businesses and social organizations to participate in anti-drug public welfare programs.

3.4. Collaborative Tasks and Role Boundaries Between DRSWs and CDCOs

3.4.1. Collaborative Tasks

Analysis across both phases revealed that DRSWs and CDCOs jointly participated in a number of tasks in the daily operation of CBDR. Based on the accounts of both groups, collaboration was primarily observed in five areas: joint home visits, information sharing and case communication, coordinated community transition following release from compulsory rehabilitation facilities, joint drug prevention education, and coordinated emergency response. Figure 4 summarizes these collaborative tasks. Across these areas, collaboration was characterized by a spontaneous complementary division of labor: CDCOs typically handled administrative and enforcement-related aspects, while DRSWs addressed psychosocial, relational, and supportive service dimensions.

Joint home visits were the most frequently mentioned form of collaboration by both groups of participants. One CDCO described this:

“When we go on home visits, I usually go with the social worker. I am responsible for verifying basic information and checking for any violations, and the social worker is responsible for chatting with the client about how things have been going and how they are feeling. The division of labor happens naturally. I handle the ‘hard’ part, and the social worker handles the ‘soft’ part.”

(CDCO-03)

One DRSW described the same process from her own perspective:

“The advantage of going with the CDCO is that some clients are afraid of the CDCO and will not open the door, but they are willing to talk to me. I knock on the door first and get them to open up, and then the CDCO comes in to do his part. On the other hand, there are situations where it is not safe for me to go alone, for example when a client is emotionally unstable. Having the CDCO there makes me feel much more at ease.”

(DRSW-08)

Information sharing and case communication was another important area of collaboration between the two groups. One DRSW explained:

“The CDCOs have the ‘hard data’: urine test results, check-in records, whether someone has left the area. We have the ‘soft information’: how someone has been feeling lately, whether their family relationships are stable, whether there are early signs of relapse. Put these two pieces together, and you get the full picture of a person. That is why we regularly sit down with the CDCOs to update each other.”

(DRSW-12)

One CDCO corroborated this practice:

“A client was perfectly cooperative in front of me, and his urine test came back completely clean. But the social worker told me he is actually going through a divorce right now and feeling really low. So looking at the whole picture, there is definitely a huge risk of relapse here. We would never pick up on that just by looking at the data without the social worker telling us.”

(CDCO-04)

Community transition following release from compulsory rehabilitation facilities was another area where the two groups coordinated closely. One CDCO described the division of tasks:

“When a client is released from a compulsory drug treatment facility, I handle all the procedural work. We take the lead on everything from signing agreements and entering data into the system to scheduling their very first urine and hair tests. But when it comes to their mental state, whether their family is willing to take them back, and how to plan their actual recovery steps, the social workers take over.”

(CDCO-06)

One DRSW added her perspective on the same process:

“During the handover, we actually go into the compulsory rehab center beforehand to look at how they behaved inside and check their psychological evaluations. Then we talk to the family to see if they are willing to take them back. We are also right there on the day they are released, but my role is very different from CDCO. The CDCO is there to lay down the rules. My job is to talk with the clients about their future plans and figure out what kind of support they are going to need moving forward.”

(DRSW-10)

Drug prevention education was another task in which both groups participated. CDCOs typically took the lead in planning and coordination, while DRSWs focused more on content design and on-site delivery. One CDCO noted:

“When we run large-scale awareness events, I am the one who writes the plan, arranges the venue, organizes the materials, and coordinates the staff. But when it comes to designing exhibition boards, putting together quiz activities, and interacting with the public on the day, the social workers are better at that than we are.”

(CDCO-01)

When PWUDs encountered emergency situations, DRSWs and CDCOs typically responded together. One DRSW recounted:

“When there is an emergency, the CDCO and I are usually both on the scene. For example, last time one of our clients suddenly went unreachable for two days. The CDCO immediately went to the places the client was known to frequent, and I contacted his family at the same time to find out what had happened. It turned out he had had a fight with his family and taken off. We found him together. The CDCO talked to him about the rules he had broken, and I did the emotional follow-up.”

(DRSW-17)

Participants from both groups also mentioned other areas of collaboration, such as attending joint meetings and case conferences organized by drug control departments, coordinating within the community grid management system, and jointly providing support to the families of PWUDs.

3.4.2. Role Boundaries

While the collaborative tasks described above reflected a broadly functional division of labor, participants from both groups also identified areas where role boundaries were unclear in practice.

Several DRSWs observed that their involvement in administrative tasks had gradually expanded beyond assisting capacity. They noted that tasks originally understood as “helping out” had, over time, become routine expectations. One DRSW described this shift:

“At the beginning, I was just helping the CDCO with a few things here and there, like making phone calls to remind clients about urine tests. But gradually, more and more of these tasks ended up on my plate. Now I handle case files, enter data into the system, and even go on inspection rounds on my own. It is hard to say no, because the CDCO is short-staffed and there is nobody else to do it. But every hour I spend on paperwork is an hour I am not spending on actual casework.”

(DRSW-12)

CDCOs, for their part, acknowledged that their work sometimes extended into areas that might be considered part of the social workers’ professional domain. Beyond the practical assistance described in Theme 1, some CDCOs described engaging in what they called informal emotional support during routine interactions with PWUDs. One CDCO reflected:

“I know the emotional side is supposed to be the social worker’s job. But when I am sitting in someone’s living room and they start telling me about their problems, what am I supposed to do, tell them to wait for the social worker? I just listen. Sometimes I give them advice based on my own life experience. It is not professional counseling, but it is what I can do in that moment.”

(CDCO-03)

Both groups also noted that PWUDs themselves often could not distinguish between the two roles. Several participants reported that PWUDs tended to view both DRSWs and CDCOs as “people sent by the government” and did not differentiate between their respective functions. One DRSW observed:

“Most of our clients have no idea what the difference is between a social worker and a CDCO. To them, we are all ‘the people from the street office.’ When I try to explain that I am here to help rather than to supervise, they do not really believe it, because they have seen me show up alongside the CDCO so many times.”

(DRSW-18)

4. Discussion

The findings of this study reveal that task sharing between CDCOs and DRSWs produced a spontaneous complementary division of labor. Yet where their responsibilities overlapped in everyday practice, role boundaries shifted and blurred, and role ambiguity became visible. These patterns were shaped by structural conditions rather than simply by individual choices. To our knowledge, no previous empirical study has examined CDCOs and DRSWs together; this study therefore provides a novel account of how two institutionally distinct categories of frontline workers interact within China’s CBDR system.

The breadth of DRSWs’ professional service role, spanning individual, family, and social levels, is consistent with existing literature on social work practice in addiction recovery (Huang et al. 2021; Xie and Pantea 2019; Li and Song 2022). At the same time, however, the study revealed a notable tension: DRSWs were also carrying out a substantial amount of administrative work in an “assisting” capacity, including door-to-door inspections, case file maintenance, and urine testing coordination. This phenomenon is not unique to drug rehabilitation in China. Previous research has shown that social workers embedded in grassroots governance systems commonly face pressure toward administrative absorption, with their professional autonomy constrained by organizational environments and institutional logics (Xie and Pantea 2019; Cootes et al. 2022). The present findings suggest that this tension takes on a particular form in the Chinese CBDR context. The 2017 inter-ministerial policy document, while clearly defining DRSWs’ professional service responsibilities, also lists “assisting with administrative tasks related to drug control” as part of their duties (Office of National Narcotics Control Commission et al. 2017). This dual institutional mandate creates a structural condition in which the boundary between professional service and administrative workload is inherently difficult to maintain. As the findings on role boundaries demonstrated, what begins as occasional assistance can gradually become routine expectation, progressively reducing the time and space available for professional casework.

The mechanism behind this expansion appears to be structural rather than individual. CDCOs are chronically understaffed at the grassroots level, and DRSWs, as the only other frontline presence in the same workspace, become the default recipients of overflow tasks. Because DRSWs are appointed through government procurement contracts that are evaluated and renewed by the same local authorities who manage CDCOs, they have limited institutional leverage to refuse administrative requests without jeopardizing their continued engagement (Enjuto Martinez et al. 2023; Xie and Pantea 2019). This structural asymmetry is reinforced by the fundamentally different institutional positions of the two groups. CDCOs are government employees managed directly by township or sub-district administrations, while DRSWs are employed by social work service organizations that depend on government procurement contracts for their continued operation (Enjuto Martinez et al. 2023). In practice, this means that when administrative demands arise, CDCOs are positioned to delegate and DRSWs are positioned to comply, not because of any formal authority relationship between the two, but because the institutional incentive structure leaves DRSWs with little room to negotiate.

In contrast to the professional service orientation of DRSWs, CDCOs’ role was primarily centered on grassroots administrative management and support for enforcement-related procedures, consistent with the institutional arrangements set out in the Regulations on Drug Rehabilitation (State Council of the People’s Republic of China 2011). However, several CDCOs described voluntarily providing practical assistance and emotional care to PWUDs during routine visits. When CDCOs came face to face with the real living difficulties of PWUDs, a purely administrative and supervisory role was insufficient to respond to the needs in front of them and care-giving behaviors emerged as a practical supplement to their formal role. This suggests that the actual roles performed by frontline workers often extend beyond their formal institutional mandates, particularly in contexts where direct and sustained contact with vulnerable populations creates relational demands that formal role descriptions do not anticipate. That said, the care CDCOs provided should not be equated with the professional services offered by DRSWs. CDCOs’ care-giving was rooted in personal experience and emotional intuition, without the backing of systematic professional methods. DRSWs’ interventions, by contrast, were grounded in social work theory and guided by established ethical standards. CDCOs’ willingness to care has clear value, but it is not a substitute for trained professional intervention.

When the two groups worked alongside each other, the picture became more complicated than the individual role descriptions would suggest. Across both phases, five areas of joint participation were identified. The most striking pattern was a complementary division of labor that developed spontaneously during joint home visits and information sharing. Participants described this as a split between “hard” and “soft” tasks: CDCOs handled information verification and behavioral monitoring, drawing on their administrative authority, while DRSWs took on psychological assessment and emotional support, drawing on their professional training. No institutional directive prescribed this arrangement. It emerged through the accumulation of everyday practice. This finding is consistent with existing research showing that frontline workers tend to develop spontaneous task divisions based on their respective strengths, even in the absence of clear institutional guidelines (Leana et al. 2009; Tummers et al. 2015). However, the other side of this spontaneous collaboration was the blurring of role boundaries. DRSWs’ involvement in administrative tasks had, in many cases, expanded beyond an assisting capacity into something closer to full responsibility. At the same time, CDCOs’ care-giving behaviors had extended into areas that would conventionally fall within the professional domain of social workers. And PWUDs themselves tended to view both types of workers as “people sent by the government,” with little awareness of the distinction between them. These three forms of boundary blurring were not isolated from one another. It was precisely because DRSWs were heavily involved in administrative work and frequently appeared alongside CDCOs in front of clients that PWUDs found it difficult to tell the two roles apart. This confusion at the service-user level, in turn, further undermined the ability of DRSWs to establish professional working relationships based on the principle of voluntary engagement.

The coexistence of spontaneous complementarity and boundary ambiguity has important implications for how tasks are shared and shifted between different categories of frontline workers in CBDR. The pattern of functional complementarity observed in this study resembles what the international health workforce literature describes as task sharing, in which tasks are redistributed among existing workers according to their respective competencies (Joshi et al. 2014; Tesema et al. 2025). Yet this informal task sharing was also accompanied by unintended task shifting: some administrative responsibilities appeared to move from CDCOs to DRSWs, while some CDCOs described care-giving practices that would conventionally fall closer to the professional domain of social work, albeit without the same professional training and ethical framework that supports DRSW practice. Previous research has noted that the absence of clear coordination mechanisms between different categories of workers can lead to service overlap and limit the effectiveness of such arrangements (Tesema et al. 2025; Bark et al. 2023). Similarly, unclear role definitions among social workers in addiction services have been found to compromise the quality of interventions delivered (Singwane and Ramoshaba 2023). The present findings add to this literature by showing that boundary ambiguity in Guangzhou’s CBDR context is not simply a matter of task allocation, but also a systemic issue that may affect professional identity and the quality of the service relationship itself. These findings suggest that task sharing in CBDR is more likely to serve its intended purpose when supported by clearer role boundaries and coordination mechanisms.

On this basis, the study offers several practical recommendations that follow directly from the findings. Because these recommendations are based on the accounts of frontline workers in Guangzhou, they may require adaptation to other local contexts. The gradual expansion of DRSWs’ administrative workload, driven in part by the incentive structures embedded in government procurement arrangements, suggests a need for clearer institutional boundaries around DRSWs’ professional service mandate. One concrete step would be for procurement contracts to specify the proportion of working time allocated to professional casework as distinct from administrative assistance, giving DRSWs a formal basis on which to protect their core service functions. At the same time, the willingness of CDCOs to provide care to PWUDs, as reflected in their accounts of routine home visits, should not be dismissed. Rather, it should be recognized and supported through training that enables CDCOs to engage more effectively with the human dimensions of their work without blurring the boundary with professional social work intervention. The current reliance on personal relationships and informal communication between the two groups, evident in the way participants described their information-sharing practices, could be supplemented by more institutionalized mechanisms, including regular case conferences, shared information platforms, and joint service protocols. Finally, the finding that the two groups brought distinctly different skill sets to their collaborative tasks suggests that differentiated training systems should be developed. For DRSWs, training should focus on the continued development of professional skills in areas such as psychosocial support, family intervention, and resource advocacy. For CDCOs, training should focus on building foundational knowledge of drug rehabilitation and strengthening their capacity for empathic communication. The aim is not to turn CDCOs into social workers, but to ensure that both groups can draw on their respective strengths when working together.

Limitations

This study has several limitations. Both DRSWs and CDCOs were recruited from Guangzhou, Guangdong Province. Although the findings provide detailed insight into the roles and collaborative experiences of both groups of frontline workers in this setting, how far they apply to other regions may depend on differences in local policy implementation, government procurement models, and staffing arrangements, as different provinces have adopted varying approaches to the deployment and management of both groups (Liu et al. 2023). The number of CDCO participants (n = 9) was relatively small compared to DRSWs (n = 23), which may have limited the comprehensiveness of the findings related to CDCOs’ roles. Although the research team judged the data to be analytically sufficient, a larger sample would help to further enrich understanding of this group’s practical experiences.

The study relied on participants’ self-reported accounts of their own roles and work experiences. It did not include the perspectives of PWUDs and their families as service recipients, nor those of police officers or local government administrators. In particular, the finding that PWUDs could not distinguish between the two roles was based on workers’ accounts of their clients’ perceptions rather than on direct reports from PWUDs themselves. It is therefore not possible to determine whether this reflects PWUD’s actual experience or workers’ interpretation of that experience. Future research should prioritize incorporating the perspectives of PWUDs directly, alongside those of other stakeholders, to develop a more complete picture of role interaction and service outcomes in CBDR. As a qualitative study, the research was designed to explore the experiences of both types of workers in depth, rather than to measure service effectiveness. Future studies could build on these findings through larger-scale quantitative or mixed-methods research to assess the actual impact of different role configurations and collaborative models on rehabilitation outcomes.

5. Conclusions

The collaborative tasks between DRSWs and CDCOs ensured continuous coverage of both the management and service dimensions of CBDR for PWUDs and their families. DRSWs focused primarily on providing professional rehabilitation services, including psychosocial support, family intervention, and resource linkage, while CDCOs were mainly responsible for administrative management, support for enforcement-related procedures, and institutional resource coordination. Clearer role definitions are needed for both groups, taking into account their respective professional strengths and institutional positions. The professional service space of DRSWs should be protected, and the core administrative functions of CDCOs should be clearly delineated. The skills of the two groups should complement rather than duplicate each other. Establishing an institutionalized framework for collaboration and coordination would help to reduce role ambiguity and task displacement, and ultimately enable a more comprehensive and effective system of management and support for PWUDs and their families.