Addiction: a modern disease

And there is no magic bullet treatment for it.

BREAKING a habit isn’t easy. So we don’t force smokers to “just quit”, despite the fact that smoking is linked to major diseases that bleed billions of ringgit from the nation’s healthcare budget.

We don’t wrench smokers from their families and jobs, shove them against their will into a “rehabilitation” centre, preach to them about morals or make them do manual labour in the hope of curing their addiction to cancer sticks.

So why do we do this with drug users? We rob them of everything that might offer some stability or self-esteem when we force them into drug “rehabilitation” centres. Not surprisingly, the vast majority relapse within weeks after leaving these centres, known as Puspen (Pusat Pemulihan Penagihan Narkotik; formerly, Pusat Serenti).

Conversely, the results are much better when we offer voluntary treatment at the Cure and Care (C&C) clinics offered by some hospitals and doctors. C&Cs provide various treatment options, including methadone, a commonly-used drug worldwide to manage heroin addiction.

Now, a major new study shows the extraordinary disparity between compulsory and voluntary treatment.

The study found that drug users released from Puspen were much more likely to relapse, and sooner – within 31 days, compared with 352 days – than those getting voluntary treatment in C&Cs. The people in the voluntary treatment group were 84% less likely to relapse.

A month after release from Puspen, more than half of the study participants had relapsed whereas 91% in voluntary treatment remained drug-free.

A year later, only 10% of those from Puspen remained drug-free compared with half the voluntary treatment group, indicating the ineffectiveness of using Puspen to treat addiction.

The study, published this week in the leading British medical journal, The Lancet, is one of the first to starkly demonstrate the difference between compulsory and voluntary drug treatment.

We really have to ask: why do we still have 7,000 drug users forcibly held in 28 “rehabilitation” centres nationwide, and twice as many more in prison?

Numerous studies have already shown the success of C&C centres, yet the programme remains limited in this country, mostly confined to the Klang Valley, with only 1,200 participants currently. This is just a fraction of the 131,000 Malaysians registered as “addicts” in the first half of this decade by the National Anti-Drug Agency.

Hopefully, this study will provide the impetus to scale-up voluntary treatment and move away from compulsory drug detention centres – not just in Malaysia but regionwide.

“Not only does this study have major drug policy implications for Malaysia, but for much of Asia where compulsory drug detention centres and the number of people detained in them are expanding,” said Prof Dr Adeeba Kamarulzaman, an author of the study and dean of Universiti Malaya’s Faculty of Medicine.

Dr Anne Bergenstrom, from the United Nations Office on Drugs and Crime, said the study “provides solid evidence” of the need to expand voluntary treatment.

In China and South-East Asia, roughly 600,000 drug users are held annually in compulsory drug rehabilitation detention centres.

Human Rights Watch (HRW) has reported detainees in some centres have experienced torture, violence, forced labour and sexual assault. In their report Skin On The Cable, former inmates from a Cambodian centre describe how they were whipped with electric wires that tore off skin each time.

In Vietnam, inmates were made to work six days a week processing cashews, sewing garments or other work, HRW reported. “Locking people up and subjecting them to abuse is considered a more politically-expedient way to manage drug use ... than approaches such as voluntary, community-based treatment,” HRW’s Richard Pearshouse said.

In the Lancet study, the authors – also from American and Australian research institutes – concluded that, given their ineffectiveness, compulsory drug rehabilitation detention centres should be closed down. The UN called for the closure of such centres in 2012, warning of consequences such as overdose, death and infection with bloodborne viruses.

Yet some 1,000 centres remain region-wide.

In Malaysia, drug rehabilitation centres date back to a five-decadeold policy. One reason why we have plodded along with the same policy is public pressure to lock up people who use drugs, said Dr Adeeba. Drug users are often viewed “as a nuisance to society”.

There is a mistaken belief that jailing them will change them. And punish them.

In fact, she said, drug addiction is a complex and chronic medical condition.

“Whilst addressing the physical dependence, it is also important to look into the psycho-social aspects of dependence.”

There is no magic bullet treatment; rather, a variety of treatment options, such as methadone and helping secure housing, employment and family ties, all help.

Addiction is society’s modern disease. Providing the means for drug users to reenter society rather than banishing them to rehab centres and prisons should be the logical – and humane – obligation of society.

Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health.

Drug addiction is a complex and chronic medical condition.