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.
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