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Lessons from the East

By Rowena Young. Source: Global Thinking

Rowena Young argues that we must learn from Asia if our drug policies are to stand a chance of success.

Issue 05, Summer 2001

Drugs policy in the western world stands out as a story of continuing, almost unmitigated, failure. While other problems – from unemployment to youth crime – have proved amenable to serious debate and imaginative solutions, drugs policy sometimes appears frozen – a victim of an unhealthy cocktail of acute public anxiety, simple nostrums, tabloid bile, and political opportunism.

Yet drugs policy could be about to become interesting. The Anglo-American tradition of drug policy that has shaped the response of industrialised nations for a century now stands at an impasse. On one side stand the advocates of a continuing war on drugs. For them psychoactive substances are intrinsically a bad thing. Almost no price – in money or civil liberties – is too high to pay to stop the traffic of drugs or their sale by immoral dealers to misguided consumers. On the other side stand the advocates of treating drug addiction as a disease, a problem of health rather than law enforcement, who pour scorn on the prospects of curbing availability of drugs and point out that no society in human history has abjured all use of psychotropic substances. Their argument is that – as with alcohol - the best we can do is to provide help to those individuals who cannot control their own use.

Neither camp has much to be proud of. Running in parallel, these twin strategies have failed to prevent a steady upward trajectory of the number of problematic drug users. The most recent figures show, if anything, that the situation is becoming more acute. In 1998, nearly three and a half thousand people died from drug-related deaths in Britain, a rise of 19 per cent in four years, and only the latest in an ever increasing death toll. Seventy per cent more problematic drug users have presented themselves for treatment in the last five years for which figures are available, and the largest ever cohort of 20 to 24 year olds (55%) now report having used illicit substances at some point in their lives.

The prohibitionists have a particularly bleak track record: there is not a single piece of evidence to show their interventions work. Given enough investment of resources seizures can grow impressively, but the quantities of illicit drugs hitting the streets show an unerring ability to keep pace – at an estimated ratio of about ten kilos reaching the streets for each one that is seized. In the US the oscillations in drug use and related crime have more to do with demographic factors, shifting fashions for particular drugs and generational cycles of attraction and revulsion. The one certainty is that drugs policy itself has had little if any positive effect. Moreover, although governments are beginning to be more selective, to date the patterns of police behaviour and arrests have given purveyors of hard drugs the easiest ride. More than 90 per cent of drug offences in the UK, for example, are for possession and three quarters of those involve cannabis. Both here and in the US the war on drugs has been a resounding failure. Rarely in the history of wars have so many achieved so little at such a high cost.

The treatment world does at least have sound foundations. The National Treatment Outcomes Research Study which was conducted through the Nineties and is the largest ever of its kind in the UK, concluded that 'treatment works', though its authors were quick to stress this headline comes with many caveats and is no cause for complacency. By its nature, treatment – advice, counselling, prescribing and alternative therapies - succeeds in attracting those whose drug use poses the greatest health and social problem. Recreational users by contrast rarely perceive themselves to have a problem.

Treatment can reduce harmful behaviour, improve physical and emotional health, and cut drug-related crime. But its ability to transform the features of a person's life that led to dependent drug use is doubtful – it's not uncommon to find clients who've been round the treatment loop a dozen times, and typically around two thirds of treatment fails – if you count abstinence from uncontrolled use as your goal. Just as important for the future, the treatment providers have also made no in-roads on the cohort at risk of debilitating use. An honest end of term report card might read: 'could do better'.

European drug co-ordinators know they sit on one of the most dysfunctional areas of government policy and many are developing interesting new approaches which are taking them ever further away from the American tradition. The Swiss are taking the idea of addiction-as-illness to its logical conclusion and experimenting with large scale heroin prescribing for users to inject in authorised shooting galleries. Unthinkable in the UK in the current climate, public referenda in the cantons to be affected by the trials returned a two thirds majority in favour of the initiative. By contrast, the Portuguese government is proposing bringing addicts in from the cold with a far-reaching decriminalisation of drugs, including heroin. In the UK such radical moves remain off the agenda; instead we have settled for a more conservative 'balanced approach', which essentially involves matching higher spending on law enforcement with higher spending on treatment.

The advent of a more open approach to policy in Europe is to be welcomed. But it still represents little more than tinkering, founded on a fundamentally limited conception of the problem. At root, problematic drug use and serious supply are still treated by clinicians and criminologists respectively as symptoms of personal pathology. This is despite the fact that since the 1980s, the profile of dependent drug users in the UK has taken a profound shift and now correlates overwhelmingly with the socially excluded on the sharp end of growing socio-economic inequalities. Many of the consumers of what is, after all, the world's third largest industry do not suffer much damage to their lives, or chronic addiction. But for those whose lives are damaged, all serious analyses of the epidemiology of their use suggest that a wider public health approach which encompasses the full range of tools of social policy is more likely to work than punitive legislation and isolated arrests.

The good news is that there are clues to a happier way forward. They can be found by looking not to the west but to the south. In Asia a new generation of more holistic, enterprising models of drug treatment (brought together in the Forum network) are attempting to address the structural issues, as well as the personal ones, that lie behind their clients' difficulties. Their central insight is that sustainable progress depends on dealing with all of the different factors – ranging from the physiological to the social - that can cause addiction. Specifically that means helping drug users to find new networks of support; providing them with skills and jobs, and revitalising the communities they come from as well as helping them to fight physical and emotional dependence.

Where this is done effectively there is a double dividend – on the one hand reducing the risk of relapse, and on the other stemming the flow of new users. For projects working in areas of cultivation there is a third dividend too, as poor farmers find alternative sources of income and thus cut the supply to the cities and international drug rings.

Perhaps the most distinctive feature of these new organisations – such as Nai Zindagi in Pakistan, Mukti Sadan in India, or Pink Triangle in Malaysia, is that they see themselves as economic enterprises, as well as social or health ones. By creating jobs for their clients they have also found a way to generate income for themselves – through everything from reconditioning cars and building environmentally friendly houses, to selling condoms to sex workers and running light industry. As a result they are highly cost effective - particularly if the long run costs and benefits are taken into account.

Some of these lessons are beginning to be learnt in Europe. The UK government has just launched a programme of job creation for drug dependents. Outfits like the Merchant's Quay Project in Dublin and Kaleidoscope in London combine treatment with education, jobs and resettlement, and the more thoughtful policy experts are starting to acknowledge that this is one field where holistic approaches are a necessity rather than a luxury.

Sadly, the prosperous north has rarely been good at learning lessons from the south, with isolated exceptions like the Grameen Bank which has now been copied in cities all over the western world. However much the US model fails, and however many billions continue to be squandered, there is always a long queue of experts, pundits and commentators eager to advocate its virtues. When it comes to drugs, even the most highly educated sometimes appear happy to leave their critical faculties behind and cling to the child's view of the world as a simple battle between the good guys and bad guys.

Ends

Rowena Young is Development Director at Kaleidoscope, the only one-stop drug treatment agency in the UK. Her publication, From war to work: drug treatment, enterprise and social inclusion, will be published later this year. Email: r.young@can-online.org.uk