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Drug addiction is not social evil: Hanoi PEPFAR advisor

TUOI TRE NEWS

Updated : 04/12/2016 14:56 GMT + 7

“Recognizing that substance abuse disorders and addiction are diseases and not moral failings, social ills or evils is critically important in trying to educate the public,”  Kenneth W. Robertson, substance abuse treatment advisor for the Substance Abuse and Mental Health Services Administration’s PEPFAR Office in Hanoi, told Tuoi Tre News in a recent interview through email.

How do you see the current state of drug addiction in general, and crystal meth use in particular, in Vietnam? Is it concerning?
   
Heroin has been the drug of focus for a number of years in Vietnam but methamphetamine use certainly seems by all indications to be growing in popularity in Vietnam. You can read in the newspapers about the increasing number of arrests for distributing methamphetamine in the country. Just a month ago there was a huge methamphetamine “bust” of almost $1 billion in value in Australia and the drug was meant for distribution throughout Southeast Asia. 

I recently visited a community outpatient treatment center in Ho Chi Minh City and talked with patients. Previously, most patients in this clinic were there for the treatment of heroin addiction, but during this visit, two of the eight patients I talked to were there because of methamphetamine use. So, yes, I and others do believe that methamphetamine use is growing quickly and becoming a “drug of choice” for many Vietnamese addicts.

In your opinion, what is the reason for the increased use of crystal meth in Vietnam in recent years?

There has actually been a long history of methamphetamine use in southern and eastern Asia for the past two decades, but as I mentioned it has increased in areas like Vietnam, where heroin and other opioids have been the “drug of choice.” 

I cannot really say for sure why there is a surge of methamphetamine use without talking to more health providers, social workers, counselors or undertaking more study.

There could be a number of reasons including the ready availability of the drug now, the low cost of methamphetamine, the opportunity to do a different drug than heroin/opium, or a misbelief that methamphetamine is not as harmful as other drugs like heroin. We do know that methamphetamine is a stimulant and will keep you alert/awake, so its use is sometimes associated with students or young people who are staying up all night whether to study or to party, or with people who need to stay alert or awake for long hours while working or in the population of men having sex with men, or just people who want to have a “high” for a longer period of time.

How dangerous is crystal meth to humans, physically and mentally?

Methamphetamine use is much more severe than other types of amphetamines or synthetics like Ecstasy. Methamphetamine, especially crystal meth or “ice” use can lead to a serious dependence on the substance, which is very difficult to break and can take much longer to treat than other substances. 

People who are dependent on methamphetamine often suffer multiple relapses in their recovery, which means they return to use of the drug even after stopping or being in treatment. There are often symptoms such as paranoia and aggressive behavior as well as risks of heart attack or stroke. Because the drug is often injected there are increased risks of HIV infection just as with heroin and opioids. Because methamphetamine can also heighten sexual drive there is the increased threat of transmission of HIV and sexually transmitted diseases when safe sex is not practiced.
 
In addition, because there are many ways to use methamphetamine including injection, smoking, snorting, and swallowing there are different levels of health risks. Many younger people use the drug ‘recreationally’ and do not inject it. Once a person begins to inject methamphetamine, the potential for more serious physical and mental harm increases.   

Kenneth W. Robertson

What are the solutions to stop, or at least limit the number of young people addicted, in your opinion?

There are many actions that can be taken that include a wide range of education, prevention, treatment, recovery support and help groups. A vigorous program of education on substance abuse in schools and in the home is a starting point. But it is critical that factual information be presented on the use of substances, their effects and the possible negative health and social consequences that can occur. 

Parents need to sit down with their children even at early ages and have an honest and open discussion about drugs. To do this parents need to educate themselves first and be open and non-judgmental, especially if they discover that a child or young adult is engaged in substance use. Assisting the child or young adult to get into treatment should be the first priority and not putting guilt on the person. We know that trying to simply scare people, especially younger people, is not effective and can, in fact, make them more curious about drugs.       

Public education campaigns including public awareness through education seminars, posters placed in public areas or on public transportation serve as another form of awareness. 

Recognizing that substance abuse disorders and addiction are diseases and not moral failings, social ills or evils is critically important in trying to educate the public. Treating addiction as a brain disease that can be addressed without shaming individuals or punishing them by locking them away should be seen as a principle in how to deal with this issue. Without treatment, the chances of recovery and a successful return to family, friends and communities are much lower.

If a person goes into treatment, it is then very important for family and friends and the community to support that person in the recovery journey. One of the primary reasons that people deny that they have a “drug problem” is that they are afraid of the reactions they will receive, such as ridicule, shame, guilt, anger, aggression or shunning or banning them from their vital family and community connections. 

Dealing with drug addiction is said to be not only a medical but also a social issue, as many people come to drugs because of a lack of care from family and education from school. How should these issues be solved?

Substance abuse and addiction are medical issues, but they are also social ones because of all the consequences: physical and mental health, public health, isolation from family, loss of education and/or jobs, and costs to society including medical, criminal justice, social service and other costs. The best way to treat the individual suffering from substance abuse disorders or addiction is to try to address all of these issues. 

In the United States, one of the models of substance abuse treatment involves a full array of services that surround the individual. We call these recovery support services because you utilize all the government, community, and family services and connections available. A good caseworker is trained in how to contact and obtain all available services for the individual and their family. One way to think of recovery support is to picture an oxen cart wheel with the patient being at the hub or center of the wheel and all the spokes around the wheel as the support services, with the case manager as the rim that holds the wheel together. I hope that is translatable to Vietnam.   

Vietnam has advanced a long way in changing the way it views and addresses drug issues. There has been a transformation from the view of HIV and drug use as social evils to the medical model where these are diseases to be treated with a combination of medicines and counseling and treatment services. The number of people on methadone [treatment] in Vietnam has increased dramatically in the past eight years as the number of people in compulsory centers has decreased.

Most of these efforts have come as the result of the lengthy partnership between your government and our government as a result of PEPFAR [the American President's Emergency Plan For AIDS Relief]. In Vietnam, one of the main sources of HIV exposure is injectable drug use, so we have focused much of our efforts on treatment of both HIV through anti-retroviral treatments/medications and heroin use through methadone and substance use treatment models. 

Fighting substance use and addiction is a long, frustrating journey for every nation. It requires patience and a belief that individuals can recover and return to their home, family, community and nation. Vietnam like other nations has a long way to go but is on the right path. 

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