The International Journal of Psychosocial Rehabilitation

Has Malaysia’s Drug Rehabilitation Effort been Effective?



James F. Scorzelli, Ph.D.

Professor
Health Sciences, NEU

 

Citation:
Scorzelli JF   (2009). Has Malaysia’s Drug Rehabilitation Effort been Effective?
.   International Journal of Psychosocial Rehabilitation. 13(2), 21-24


Abstract
The review of
Malaysia’s intensive drug rehabilitation program indicates that it is not working in that the country recidivism rate is still over 50%.  Furthermore, methamphetamine and ecstasy has recently been introduced in the country, and this has worsen the country’s drug problem.  The author provides the reasons for this failed rehabilitation effort.
Key words:  heroin, marijuana,
Malaysia, death penalty, recividism


 Introduction
  Malaysia, a country in Southeast Asia, has a population of 24,821,286 million people, and gained its independence from Great Britain in 1957 (Central Intelligence Agency, 2007)).  It is a racially mixed country in that 55% of the population are Malays, 32% Chinese, and 8% Indians (Central Intelligence Agency, 2007).  Malaysia is an Islamic country, and all the Malays are Muslims.  Even though most of the population of the country is forbidden from drinking alcohol, Malaysia is the tenth largest consumer of alcohol in the world (Arokiasamy, 1995).   This high consummation pertains to the non-Malays in that 34% of them are viewed as heavy drinkers. (Arokiasamy, 1995).   Of these two groups, alcohol dependence appears to relate more to the Indians because of poverty and the easy assess to alcohol (Arokiasamy, 1995).  In fact, the average consummation of alcohol by Indians is 14 liters a year, and the average age of alcohol dependence is 22 years (Arokiasamy, 1995).  Regardless of this data, the country does not view alcohol as a problem, and except for a few AA groups in the large cities, there is really no treatment services available for this client population.
 
  In 1983, Malaysia declared its drug problem a national emergency, and enacted severe enforcement sanctions.  That is, anyone convicted of trafficking (based on the amount of the drug in the person’s possession when he or she is arrested) was sentenced to death.  This pertained to 15 grams of heroin and 200 grams of cannabis.  Further, if a person was arrested for possession, he or she would be sent to a governmental rehabilitation center for two years.  The individual was also registered as a drug offender with the government.  At that time, the drugs of abuse were heroin, opium and cannabis.  Malaysia has a policy of “cold turkey” detoxification for a person addicted to an opiate.  Specifically, a person is placed in small cell for a week where he or she goes through withdrawal.  Once the withdrawal ends, the person is medically examined and sent to a rehabilitation center.  The only exception to the “cold turkey” detoxification” is if the individual is 55 years of age or older or has medical complications.  If this is the case, he or she is admitted to a hospital, and goes through withdrawal with medication.   Presently, there are 29 governmental rehabilitation centers in Malaysia, of which one is for women.  It should be noted that 97.3% of the persons incarcerated for drug possession in the country are male, between the ages of 22 to 29 (Ministry of Home Affairs, 2005).
 
  Once discharged from the rehabilitation center, the person has one year of probation where he or she has two urine tests a month.  If the test is positive, the person is required to go for counseling.  Even though the test is positive, the drug abuser would not be sent back to a rehabilitation center, and this would only occur if he or she is arrested again for possession.  As stated, at the beginning of the country’s stringent enforcement policy, the drugs of abuse were heroin, opium and cannabis, with most offenders using heroin intravenously (66.3%) (Ministry of Home Affairs, 2005).  Based on governmental studies, the reasons given for drug abuse pertained to peer pressure and poverty (Scorzelli, 1989). 

The problem of heroin abuse in Malaysia is further complicated because of HIV and Hepatitis C.  Because of the high incidence of IV heroin usage, the country has a large number of people infected with HIV.  In a survey of 300,241 registered drug users from 1988 to 2006, it was found that 18.49% were infected with HIV (UNICEF, 2007).  In another study by the National Institute of Drug Abuse (2006), 177 male heroin users who were being treated in a rehabilitation center were medically examined.  Of this group, 19.2%. had HIV, 89.9% Hepatitis C, and 15.7% had tuberculosis.  Also, only 8% of these men said that they used a condom.  
 
  Treatment Program
  The treatment provided by the rehabilitation center is based on the model of the therapeutic community.  The therapeutic community is a hierarchical model with treatment stages that reflect increased level of personal and social responsibility.  There is peer influence that is mediated through a variety of group processes. The treatment stages in the rehabilitation centers in Malaysia are identified by the color of the inmate’s shirt.  The lowest or first level is a red shirt, and the inmate can progress to a yellow, green and white shirt.  The inmate remains a red shirt until he or she has been at the center for four months.  The yellow shirt involves eight months, and this is followed by another eight months as a green shirt.  When the inmate wears a white shirt, he or she has only four months to serve at the rehabilitation center.   If an inmate tries to escape, he or she is given a blue shirt to wear.  In a way, a blue shirt stigmatizes the person since he or she is at the lowest level in the rehabilitation center.  At the beginning of the person’s commitment to a rehabilitation center, he or she is involved in paramilitary drills and callisthenics for several hours a day, and for Muslims, religious instruction daily by an Imam.  Those inmates who are not Muslims  have religious services once a week.  As the inmate progresses to higher levels, he or she has less physical activity, and receive counseling (individual, group and family) and vocational training.  With respect to the latter, most of the inmates are either un or under-employed when they are arrested (Scorzelli, 1989).  However, the vocational training provided does not involve areas of high technology, but consist of such things as, rattan making, shoe repair, mushroom farming, brick laying, welding, small engine repair.  Therefore, there is little employment status or career mobility when the inmate is released.
 
  In 1986, the government started to keep records of recidivism, and using 1986 as the baseline, recidivism in the country is over 50%.  In a recent study by UNICEF (2007), there were 22,811 registered drug users in 2006, and 12,430 (54.5%) were repeat offenders.  Although the reason for this high recidivism is not known, some believe it is due to the treatment provided to the inmates (Office of Home Affairs, 2005).  This pertains both to the low level of vocational training, and the qualifications of the counselors and religious instructors.  That is, many of the counselors are not professionally trained, and they and the religious instructors often have little knowledge about drug abuse.  In addition, the one year probationary period is poorly managed, and many discharged inmates simply vanish and never participate in the process.   In contrast to this, is the other view that relapse is part of the disease of drug addiction, and since recidivism is based on drug usage since 1986, the rate would be high (a person could relapsed after 10 years of sobriety and would still be included in the statistics).
 
  New Drugs of Abuse
  Within the last five years, Malaysia’s drug problem has worsen with the introduction of methamphetamine (referred to as sybu) and ecstasy. The death penalty remains for both of these drugs if a person is apprehended with 50 or more grams of the drug(s).  According the government, sybu comes from the Philippines and ecstasy from Thailand (Office of Drugs and Crime, 2003).  Reasons given for the introduction of these new drugs concern the fear of contracting HIV from IV heroio use (Ministry of Home Affairs, 2005).  Although heroin is still the drug of choice, there are reports that 60% of the inmates at a rehabilitation center in Sabah are methamphetamine abusers (Ministry of Home Affairs, 2005).  To complicate the situation more, there have been reports of ketamine and cocaine abuse.  In terms of cocaine, the drug is still a rarity in the region.

These recent changes in the drug usage in Malaysia has resulted in some treatment changes.  First of all, methadone maintenance was introduced a few years ago.  Yet, this treatment is only for those persons who volunteer and have not been arrested for drug abuse.  Those arrested still go through cold turkey detoxification.  Secondly, there has been the development of over 60 private treatment facilities.  Again, these are only for those persons who volunteer for treatment and have not been arrested, or for those who have been discharged from a rehabilitation center.   Many of these facilities have a religious orientation (Islam or Christian), and like the governmental rehabilitation centers, are based on the therapeutic community model.  There is no data yet on the success of the methadone maintenance program or the effectiveness of the private treatment facilities.   
 
  Changing the Current System
  To change the current situation in Malaysia, it is the belief of the author that there has to be a change in the nature of the vocational training, and the treatment approach.  As indicated by the literature (Dongus, 2005; Greenwood,, Woods, Guydish, & Bein, 2001; Huvvard, Craddock, & Anderson, 2003; McLellan, et al., 1999; Sindelar, Jofre-Bonet, French, & McLellan, 2004) there is a relationship between viable employment and drug treatment success.  Work appears to be a reinforcing factor in helping a recovering drug abuser maintain his or her sobriety.  Based on the importance of viable employment in the rehabilitation of the client who abuses drugs  the vocational training provided at the rehabilitation centers need to change.  Specifically, training as computer programmers or electronic technicians may provide a better incentive then rattan making for inmates to remain drug free upon their discharge.  Furthermore, the implementation of a transitional or supported employment model would also be helpful.  White shirted inmates who appear committed to stop their drug usage could be identified and sent to large corporations to work while they are still incarcerated. 

This on-the-job training would help make them aware of the world of work, and the opportunities that are available in the private sector.  Also, there is no reason while outstanding candidates could not be hired by corporations prior to their discharge.   Lastly, the development of self-employment options for the inmates could also make the employment options upon the inmate’s release more viable.  In terms of further education, there may be a problem because of the country’s educational system.  Modelled after the United Kingdom, a student is required to take a series of tests, beginning at age 12.  If he or she fails this standardized test, he or she can only attend school until 15 years of age.  The second exam is given at 15 years of age, and if a person fails the examination, he or she must leave school at 17 years of age.  The last examination, which is for college admission, is offered when the student is 17 years of age, and if he or she fails, his or her education ends.  Nevertheless, there is a possibility that there may be some inmates who have progressed far enough to take some college classes.  Therefore it is felt that changing the nature of training and providing an opportunity for transitional employment would be important factors in helping a person maintain a drug free life style.  
 
  In terms of treatment services, it is possible that a more intensive treatment model is needed.  One such intensive program is the matrix treatment model.  The matrix model was developed as a response to the cocaine epidemic of the 1980’s.  The goals of the matrix model are to achieve the following:  cease drug use, retain the client in treatment, help the client learn about issues that are critical to addiction and relapse, receive direction and support from a trained therapist, receive education for family members affected by addiction, have the client become familiar with self-help groups, and receive monitoring by urine and breath analysis (Rawson, et al., 1995).  The components of the model involve therapist support, group/individual counselling, 12-steps, relapse prevention and education, family education, and monitoring whether the person has used drugs (Rawson, et. al, 1995).  An important part of the program involves the training and treatment manuals that describes a protocol for evaluating the effectiveness of the intervention.  In fact, the National Institute of Drug Abuse (2006) indicated that 5,000 cocaine and 1,000 methamphetamine addicts have participated in this treatment model.  Further, research has indicated that there has been a significant decrease in drug abuse among the participants (National Institute of Drug Abuse, 2006).   An important factor in implementing this model is that the counsellors be professional trained, preferably with a master’s degree.  As of present, most of the counsellors in the treatment centers do not have a master’s degree.  Because of this need, many of the universities in Malaysia are developing graduate programs in drug counselling. 

  Based on a review by the author, Malaysia’s attempt to curtail its drug problem does not appear to be working.  The reasons for this failure appear to pertain to low level of vocational training provided to the inmates, as well as the diluted treatment services that they receive.   Fortunately, the government has acknowledged these problems, and are attempting to change the services received at the rehabilitation centers.

References

Arokiasamy, C. C. (1995).  Malysia.  In Heath, D.B. (ed.), International Handbook on Alcohol and Culture.  Westport, Ct.Greenwood Press.

Central Intelligence Agency. (2007).   The World Factbook 2007.  Washington, D. C.:  author.

Dongus, M. (2005).  Review of integrated treatment for dual disorders.  A guide to effective practice.  The Canadian Journal of Psychiatry, 50, 299-300.

Gendeh, B. S.,
Ferguson, B. J., Johnson, J. T., & Kapadia, S. (1998).  Drug abuse in Malaysia.  Medical Journal of Malaysia, 53, 435-438.

Greenwood, G. L., Wiisdam W, HJ., Guydish, J., & Bein, E. (2001).  Relapse outcomes in a randomized trial of residential and day drug abuse treatment.  Journal of Substance Abuse Treatment, 20, 15-23.

Hubbard, R. L., Craddock, S. G., & Anderson, J. (2003).  Overview of 5-year follow-up outcomes in drug abuse treatment outcome studies (DATOS).  Journal of Substance Abuse Treatment, 25, 125-134.

McLellan, A. T., Hagan, T. A., Levine, M., Meyers, K., Gould,
I., Bencivengo, M., Durrell, J., & Jaffe, J. (1999).  Does clinical case management improve outcome addiction treatment.  Drug and Alcohol Dependence, 55, 91-103.

Ministry of Home Affairs (2005).  Treatment of the drug addict in
MalaysiaKuala Lumpur, Malaysia:  author

National Institute on Drug Abuse (2006).  Addiction research news:  Malyasia.  News Scan, Betheseda, Md.;  author.

Rashid,
Abdul, Md. (2006).  Psychosocial factors in drug abuse in Malaysia.  Journal Psikologi Malaysia, 15, 53-58

Scorzelli, J. F. (1989).  Assessing the effectivness of
Malaysia’s drug prevention education and rehabilitation system.  Journal of Substance Abuse Treatment, 5, 253-262.

Sindelar, J., Jofre-Bonet, M., French, M. T., & McLellan, A. T. (2004).  Cost effectiveness analysis of addiction treatment:  Paradoxes of multiple outcomes.  Drug and Alcohol Dependence, 73, 41-50.

UNICEF. (2007).  International day against drug abuse: 
Malaysia., New York:  author.  





Copyright © 2009 Southern Development Group, SA. All Rights Reserved.  
A Private Non-Profit Agency for the good of all, 
published in the UK & Honduras