Kicking the habit – for good

July 4, 2010
By

A drug user is classified as an addict, and before 2002 a drug addict was a criminal. To relieve prison overcrowding, parliament passed the Drug Addict Rehabilitation Act of 2002, which decriminalised addiction.

Indeed, the prison population dropped from an all-time high of 246,000 in 2002 to 210,000 in 2003 and 166,000 in 2004. It is now about 175,000. Thai prisoners are mostly drug offenders, and the favourite drug is amphetamine, or ya ba.

This new law effectively puts addicts under the Probation Department rather than the Corrections Department. Probation guides them to rehabilitation centres where they are treated as patients, not criminals.

Some 100,000 of these “patients” are being created every year, but the country has only 1,300 rehab centres. The lack of facilities forces them to wait in prison until a place can be found for them. Addicts reside in special units run by the Corrections Department, segregated from the regular prisoners.

It is possible for them to wait for a place at home, but bail conditions are severe, involving multiple sponsors. The fee, however, is only a modest 7,000 baht.

The diagram, below right, gives some idea of the complexities involved in a bureaucratic merry-go-round that commits an abuser to treatment for three years. The court that decides a drug user’s fate has a judge, but it is not a real court.

In the capital, it sits at the Bangkok North Criminal Court on Ratchadaphisek Road. There are no lawyers in the building. The judge decides from a police report whether the accused should go for rehabilitation or be charged with possession.

The rehabilitation sub-committee in the diagram controls the drug abusers. It is a multi-disciplinary group that is headed by the chief prosecutor in each province.

It meets twice a week for at least three hours, handling 20-30 cases at a time. Its duty is to decide if the abuser is to continue treatment as a patient or be incarcerated as a criminal.

Civil liberians have voiced objections to addicts being handled by a committee, saying such cases should be handled by a court. Chanchao Chaiyamukit, head of the Probation Department, described it as a legal subterfuge to speed things up. He called it “diversion”.

To leave this circle of confusion, one must successfully complete a four-month rehabilitation programme. Another way is to escape. Escapees are breaking the law, but are seldom hunted down.

A drug user in Khlong Prem said he had been in and out of prison half-a-dozen times, with 45 day sessions each time and no scheduled rehab. After release, he declines to report to probation, but fortunately, when re-captured, the probation authorities do not seem vindictive.

Probation violations are a crime and could go on your criminal record. But, in fact, they do not. Prosecutors seem to ignore probation history if violators are later booked on a criminal charge. Police and probation databases are not closely linked, Mr Chanchao explained.

Another way to avoid the merry-go-round is to be charged with possession. The drug user makes a deal with police for possession of between 1/2 to six pills. They plead guilty, go to prison for a short time, pay a small fine and more easily obtain bail.

So, maybe criminals are better off? Their prison conditions are superior and fellow inmates more mature and gentlemanly. Drug abusers tend to be hoodlums.

But is the current system working? The government’s 550-bed Thanyarak Hospital has professional facilities. If they cannot cure you, nobody can.

There have not been any recent definitive studies, but Dr Viroj Verachai, Thanyarak’s director, gave Spectrum some figures. In the compulsory four-month ya ba programme, only 80% of males finish. The other 20% escape. Of the 80% who finish, 70% of these are still clean after six months, Dr Viroj claims.

However, this is not a conclusive study. It is collated from results of urine tests from those on probation.

However, scheduled tests can be fooled if drug users drink lots of water and abstain from drugs for at least four days before the test.

Disposable test kits are available in Bangkok for as little as 20 baht, but may not be able to detect very small amounts of drugs. But Dr Viroj claims his modern instruments can detect the most minute amounts of amphetamine.

A sadder statistic supplied by Dr Viroj is that only 30% of volunteers complete the four-month programme. These are the people who pay their own way.

Wewill probably neverknowif the system is really working. And Dr Viroj said that some of the cured start drinking heavily.

A concerned Dr Viroj added: ”They might turn to alcohol or something else to keep their head spinning. They are not happy in the real world.”

Unlike Dr Viroj, the internet is full of horror stories.

”Amphetamine is the most malignant, addictive drug known to mankind,” says Dr Michael Abrams of Broadlawn Medical Centre in Des Moines, Iowa. ”The body has enzymes that break down cocaine,” he said, ”but not amphetamine.”

The blog continues: ”Amphetamine is a tricky life-wrecker in that it hides its disastrous long-term effects with its short-term benefits. These include increased attention, decreased fatigue, increased activity, decreased appetite, euphoria and rush, increased respiration and hyperthermia.

”In the long run, some 10 distant years, it leads to addiction, psychosis, paranoia, hallucinations, mood disturbances, repetitive motor activity and stroke.”

Thanyarak’s addict hotline: 1165

In an interview with hotline supervisor Ladda Chaipichitpun, Spectrum gained some insight into popular concerns.

Ya ba users are the most frequent callers, followed by alcohol abusers.

The hotline receives 20-30 calls during working hours, handled now by two operators, but this is soon to be increased to four. The service is available 24 hours a day, but records are not kept on calls out of working hours.

Each call generally lasts for about five minutes, but some can last 15-30 minutes. The hotline also receives three or four crank calls per day.

All of the callers, each a prospective patient, calls voluntarily and they will have to pay for treatment from their own pockets. They will attend rehab with those undergoing compulsory treatment, who fall under the purview of the Probation Department.

Each new patient is invited in for consultation. The operator stresses to callers that they do not have to stay overnight, a concern many have. If they are working, they may be able to be treated as an out-patient.

Alcoholism can sometimes be treated on an out-patient basis, with patients taking medication at home. Cigarette smokers are always treated as out-patients. However, the hotline gets very few calls on this addiction.

Often a call is made by a relative or even a child concerned about their parents. Sometimes an addict will call themselves, hoping to kick the habit before a lover or their family finds out.

The few foreigners who call usually use a Thai proxy. Foreigners are treated separately to Thais, and they, of course, must also pay for the service.

The hotline does not record conversations at the moment, but will soon be able to. However, recordings will be made with the caller’s consent only.

Ms Ladda recognised that addicts cannot be reasoned with, and the best way to help them is to just talk to them frequently and slowly.

Ann completes the programme

Her name is Ann, and she lives in a city slum. She is a 35-year-old mother of two, has a part-time boyfriend and works at odd jobs. She has two bad habits  –  playing cards and taking drugs.

One evening, when Ann and a group of friends and other people were gathered outside their homes, four of the group shouted out that they were police. They showed no IDs, carried no side arms and had no handcuffs.

Ann was taken to the police station, where she failed a drug test. Within 48 hours she was off to court and then immediately taken to a women’s prison in Thanyaburi.

But Ann is not a criminal. The papers she signed were not a confession. That small courtroom, although it had a judge, had no lawyers, and was not really a court. It was simply a place to decide, from police evidence, whether Ann should be sent to rehab or charged with possession.

Fortunately for Ann, it was decided that she should be sent for rehab. But since rehab centres are overcrowded she had to spend 30 days in prison before a place could be found for her.

Ann was lucky to secure a place at Thanyarak Hospital in Pathum Thani. Some are sent for rehab at army bases or temples, but Thanyarak is a government hospital run by medical professionals, whose business is to cure you.

It was an intensive four-month programme, six days a week, with vocational training, aerobics and group therapy. And there were too many rules, Ann complained. There is minimal security, and the few girls who tried to escape were given dirty work chores as punishment.

Ann was in a group of 44, which included two people attending the rehab clinic voluntarily, paying for their treatment themselves. Each of the women had a private bed, and it was far more comfortable than prison.

Each morning, the group would hold hands and sing the Thanyarak song. Group sessions featured provocative exchanges such as:

“Who don’t you like here?”
“I don’t like her.”
“Why?”
“Because she stepped on my toe this morning.”

Visiting days began with an introductory lecture on family values, part of the cure for drug addiction and similar to Alcoholics Anonymous, but without God. Tear-jerking testimonials were given by parents and daughters with themes such as “If there is love in the family you will not turn to dope.” It was a very folksy technique.

Ann spent four months at Thanyarak Hospital before being released on probation. Was she cured? We will never know. She stopped reporting for her compulsory urine testing. She claims to be “cured”, and now only drinks a little beer. In my opinion she was not really addicted to begin with, but often the authorities do not distinguish between addicts and casual users.

Ann gave me a chance to talk to a real addict, a close friend of hers who has been using drugs for seven years. She would not say how much ya ba she smokes, but one 200 baht pill a day would amount to a crippling 6,000 baht per month.

I asked the young lady why she uses drugs, and she answered: “It makes me feel good.”