Saturday, September 26, 2009
Heroin addiction treatment: is forced rehabilitation the way?
Drug Free Australia's Gary Christian is again asserting that harm minimisation measures such as heroin trials or methadone maintenance just keep people addicted to drugs, and Sweden's harsh regime of forced rehabilitation is the answer. His reasoning is that Sweden also has very low rates of drug use, and a 1997 study showed 96% support by the Swedes for forced rehabilitation. It's a seductive thought -- just catch 'em, lock 'em up until they are over the withdrawals and let 'em go to become model citizens, problem solved!
As usual though, Gary Christian ignores several key points made by others in the debate -- could it be that Sweden's Lutheran majority with its temperance tradition is the main cause of both the harsh drug laws and the low usage rate? Prohibitionists always present the former as being the cause of the latter. Maybe not? Drug usage rates in nearby European countries with much more liberal approaches to drugs are as low or lower than Sweden's. This clearly indicates that the harsh approach is not the only way.
Also I wonder if forced rehabilitation (which I understand to mean involuntary incarceration) is very successful. What are the recidivism rates? Mike Ashton, writing in 2007 about outcomes from residential rehabilitation programs aiming at abstinence (the most expensive form of treatment), said:
"Despite the investment made in their rehabilitation, perhaps just 1 in 7 were enabled to sustain abstinence out in the real world and some (conceivably, every single one) of these will have had to enter methadone or other community-based treatment programmes to avoid continued relapse. Of the heroin users among them, within a fortnight of leaving residential care half had returned to the drug. (Gossop M. et al. “Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses." Addiction: 2002, 97, p. 1259–1267)
Added to this is the increased death rate as people with newly low tolerances accidentally overdose. And how many 'abstinent' success stories simply switch to alcohol abuse but are counted as 'cured' by prohibitionists with their double-standard regarding licit and illicit drugs?
And If Sweden is the shining success story it is claimed to be, someone had better explain it to several of their neighbours who must be really ignorant if prohibitionists are right: To quote from Alex Wodak in The Age the other day:
"In 1997, a large Swiss study concluded that for this minority of entrenched heroin users who had never benefited from repeated episodes of diverse treatments or prison, giving them heroin as part of their treatment provided huge benefits, with few side effects. Their physical and mental health improved considerably. Consumption of street drugs decreased. Crime, measured three different ways, decreased substantially. The treatment was much more expensive than the standard methadone treatment, but for every Swiss franc the program cost, there were gains of two Swiss francs.
"Rigorous scientific studies were then also conducted in the Netherlands, Spain, Germany and Canada. All showed similar results. All were published in reputable journals. This month, the results of a British study were released. Again, the results were similar to the previous studies. In each, heroin was self-administered under stringent supervision. Abundant, high-quality psychological and social support was provided.
"After a decade of heroin-assisted treatment in Switzerland, the treatment is still only provided to a steady 5 per cent of those seeking help.
"This small minority of severely dependent drug users is so important because they account for a disproportionate share of the drug-related crime.
"In a national referendum last year in Switzerland, 68 per cent supported retaining heroin-assisted treatment as a last resort. The Netherlands now also provides the treatment. Earlier this year, 63 per cent of members of the German parliament voted to allow heroin-assisted treatment. All major political parties in Denmark recently supported the treatment."
Could it be that 96% of Swedes are wrong? Or that their solution might be right for their country but not others? These shades of grey have no place in DFA's black-and-white world of harsh judgement. But they exist, Mr Christian, whether you ignore them or not.