Human Rights Watch
This month, nearly 600 addicts broke out of a rehabilitation
center in the northern Vietnamese city of Haiphong.
The addicts overpowered guards at the state-run treatment facility and made a
break for it. "We were complete overwhelmed," a security guard told the
Associated Press. "Forty of us were not able to prevent them, many with canes
and bricks, from escaping."
Why were hundreds of patients fleeing treatment? Because in Vietnam,
"treatment" looks a lot more like forced labor, complete with
beatings and years of involuntary detention. Like neighboring Cambodia, China, Laos, Malaysia, and Thailand, the government
of Vietnam
has adopted a "get-tough" approach to drug treatment rather than
evidence-based treatment. In Vietnam,
more than 100 government-run facilities detain between 35,000 to 45,000 people
for extrajudicial sentences of up to four years.
Vietnamese in these treatment centers are engaged in what the
government calls "therapeutic labor": long hours at menial jobs for
below-market wages -- whatever's left, that is, after the centers deduct for
the cost of their meager food and Spartan lodging. Those who fail to meet work
quotas are beaten. Patients who violate center rules can be locked in solitary confinement.
"[T]hey beat people up, kicked the face, kicked the chest," a former
resident of a rehab center near Hanoi
told the BBC in 2008. "Later,
people were made to work very hard. They said work to forget the addiction,
work is therapeutic."
Opium cultivation and smoking are not new phenomena in Vietnam. But
with economic liberalization and increased migration since the 1980s has come
greater economic polarization and drug abuse. It is estimated that there are
more than 100,000 injecting drug users in the country today, and nearly one in
three is HIV infected.
Drug treatment hasn't kept pace with increasing abuse, and aside
from some small-scale programs, allowed by the government but largely funded by
other donors, effective treatment is virtually nonexistent. Instead, the
government emphasizes compulsory, institutionalized treatment that isn't just
inhumane, but also next to useless. Government reports have said that 70 to 80
percent of those who spend time in a center return to drug use. Other estimates
put the rate closer to 90 percent -- and when drug users do relapse, they have
no place to go, especially not to a compulsory "treatment" center.
In fact, Haiphong's
escapees probably stand a better chance on the outside, if they can stay there:
The city is one of three in Vietnam
that is piloting the use of methadone to manage opiate addiction, the preferred
approach in most developed countries. Indeed, trials of methadone maintenance
therapy were already successfully conducted in Hanoi in the mid-1990s. So why not increase
the number of slots in the Haiphong
methadone clinic and offer the escapees voluntary enrollment? The U.S.
government could help ensure that those who escaped can access services by
redirecting its funding, which currently goes to HIV-treatment programs inside
these abusive centers (though not the centers themselves), to programs based in
the community.
Indeed, were Haiphong
to expand access to the community-based drug treatment services it already
offers and add counseling, employment prospects, and housing assistance, the
city could become a model of humane and sustainable treatment. Those who were
only occasional drug users -- and who don't need drug addiction treatment in
the first place -- are more likely to find meaningful work and social support
networks in the community to avoid becoming addicted. Serious addicts and
casual users alike are likely to find better HIV prevention programs and
services in the community.
Drug rehabilitation should provide drug users with a chance to
regain control of their lives, repair broken relationships, and overcome
destructive addictions. Rehab in Vietnam ruptures the lives of drug
users, severs social support, and pretty much guarantees a return to drug use
after years of abuse. No wonder drug users are escaping.
发表评论