The New Straits Times, May 6, 2001
By Professor Dzulkifli Abdul Razak
Drug abuse and addiction has long been a major public health problem in this country and the Asean region. By virtue of the complexity and pervasive consequences of the problem, the recent statement by the Deputy Home Minister that the problem is showing a decreasing trend is indeed a major departure from the previous years for Malaysia.
According to him, "The number of drug addicts detected nationwide has declined by 13.5 per cent from 35,359 in 1999 to 30,000 last year".
This seems to be encouraging, especially because before 2015, a deadline set by Asean, the region is supposed to be drugfree. To achieve this public participation is an important consideration.
Moreover, according to the director of US National Institute on Drug Abuse in a booklet entitled Principles of Drug Addiction Treatment (1999), three decades of scientific research and clinical practice have yielded a variety of effective approaches to treatment.
To begin with, there are now extensive data indicating that "drug addiction treatment is as effective as treatments for most other chronic medical conditions".
But unfortunately "many people equate addiction with simply using drugs and therefore expect that addiction should be cured quickly, and if it is not, treatment is a failure". In part, this is because of unrealistic expectations.
Many seem to forget that "drug addiction" is a complex condition characterised by compulsive, at times, uncontrollable drug craving and seeking.
In many cases, addiction becomes chronic, with relapses possible even after periods of abstinence. Since addiction has so many dimensions and disrupts so many aspects of an individual's life, treatment for this condition is never simple.
The path to addiction begins with the act of taking drugs. Over time, a person's ability to choose not to take drugs can be compromised. Drug seeking becomes compulsive, in large part the result of the effects of prolonged use on brain functioning and, thus, on behaviour.
Today there are many treatments available depending on the specific addictive drugs. Treatment must be provided in an integrated way, especially when patients also experience mental disorders which often occur simultaneously.
Thus, the choice of treatments vary depending on the characteristics of the patients. It also depends on the different settings, using a variety of behavioural and pharmacological approaches.
Research has revealed a set of "overarching principles" that characterise the most effective treatments.
Among some of the principles that ought to be understood are the following: * No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to ultimate success.
* Treatment needs to be readily available. Because individuals who are addicted to drugs may be uncertain about entering treatment, taking advantage of opportunities when they are ready for treatment is crucial.
* Potential treatment applications can be lost if treatment is not immediately available or not readily accessible.
* Effective treatment attends to multiple needs of the individual, not just his or her drug use. It must address the individual's drug use and any associated medical, psychological,social, vocational, and legal problems. Research indicates that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.
* Medical detoxification is only the first stage and by itself does little to change long-term drug use. It safely manages the acute physical symptoms of withdrawal associated with stopping drug use. While detoxification alone is rarely sufficient for long-term abstinence, for some individuals it is a strongly indicated precursor to effective treatment.
* Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of interventions.
Generally, therefore, drug addiction treatment is less expensive compared to situations where the addicts are not treated or simply being incarcerated. Treatment is regarded as cost-effective in reducing drug use and its associated health and social costs.
In short, treatment of addiction can be as successful as treatment of other chronic diseases, such as diabetes, hypertension.
The measures of effectiveness typically include levels of criminal behaviour, family functioning, employability, and medical condition. Given the current decreasing trend, such measures must be carefully tracked so that we all look forward to a drug-free Malaysia, if not Asean.
