DRUG TREATMENT CENTERS IN VIETNAM

UNCLAS SECTION 01 OF 04 HANOI 000353 SIPDIS STATE FOR EAP/BCLTV; INL/AAE E.O. 12958: N/A TAGS: SNAR PGOV SOCI VM CNARC SUBJECT: DRUG TREATMENT CENTERS IN VIETNAM REFS: A. 02 Hanoi 2980 B. 02 Hanoi 2836 ¶C. 02 Hanoi 2232 D. 02 Hanoi 2054 ¶E. 02 Hanoi 1684 F. 02 Hanoi 1611 ¶G. 02 Hanoi 1506 H. 02 Hanoi 618 ¶I. 02 Hanoi 126 J. 01 Hanoi 3280 ¶1. (U) SUMMARY: Vietnamese provincial drug treatment centers range from the most basic to relatively modern. Most suffer from a lack of physical and material resources. The addict population is a combination of those who enter voluntarily and others who are undergoing "compulsory" treatment. While the GVN appears committed to helping addicts, treatment and vocational training specified under the law and relevant regulations are often lacking due to budget constraints. Insufficient professionally trained staff also appears to be a systemic problem. During 2002, there were a number of well-publicized escapes from provincial centers. Septel will discuss community-based drug treatment. END SUMMARY. -------------- NATIONAL POLICY FRAMEWORK -------------- ¶2. (U) The GVN recognizes drug addiction as a serious problem. The "official" number of addicts of all kinds, according to the GVN, is 142,000 people. (Note: Most experts view this as significantly understated. End note.) Even according to official figures, the number has risen over 40 percent in the past two years. To address the problem, Vietnam has a network of drug treatment centers. According to the Standing Office of Drug Control (SODC), there are 73 centers at the provincial level, which have a capacity of between 50 to 3,000 addicts each. Provincial authorities support most centers, but some are supported by mass organizations, such as the Youth Union. ¶3. (U) The "National Law on Drug Prevention and Suppression," passed by the National Assembly in 2000, established the broad policy for drug treatment in its Chapter Four. The law, while relatively general, notes that the "State encourages voluntary treatment" but recognizes the need for "compulsory detoxification centers." Nguyen Hoang Mai, senior expert of the National Assembly's (NA) Social Affairs Committee, claimed that the NA never intended to pass a law that would describe drug treatment "in detail." He asserted that, as with other "general laws," implementation details would follow in the form of separate administrative decrees and circulars. ¶4. (U) Since the law's passage, the GVN has indeed issued additional directives pertaining to drug treatment. According to Dr. Tran Xuan Sac, Director of National Policy and Planning in the Ministry of Labor, Invalids, and Social Affairs' (MOLISA) Department of Social Evils Prevention, by issuing Decision 150 in late 2000, the GVN settled a "long- standing disagreement" between MOLISA and the Ministry of Health (MOH) over drug treatment. Under this Decision, the GVN designated MOLISA as responsible for organizing and managing drug treatment and MOH as responsible for medical treatment in the centers. In March 2002, the GVN issued Decree 34, which lengthened mandatory stays in provincial drug treatment centers for "hard drug" addicts to two years, up from the previous minimum of six months to one year, depending on the type of addiction (ref A). Decision 605, signed by MOLISA Minister Nguyen Thi Hang in June 2002, required MOLISA staff to develop a plan on how to provide treatment to all registered addicts and to reduce the relapse rate to 60 percent, down from the probable 90-95 percent current range (similar to other countries). ¶5. (U) Concerning treatment procedures, Interministerial Circular 31, issued in December 1999, specified a series of five steps for treatment, including (1) reception and classification; (2) detoxification; (3) education; (4) work and preparation for reintegration into society; and, (5) community-based long-term management. Circular 31 also directed drug treatment centers to develop vocational training with the goal of providing recovering addicts with "basic skills." ¶6. (U) Interministerial Circular 05, issued in February 2002, updated Circular 31 and added more specifics on the centers. According to the Circular, centers must: --receive drug addicts (and prostitutes, who are to be segregated within the complex) and provide a "safe environment" for treatment; --organize and provide treatment, rehabilitation, counseling, vocational training (either in-house or by outside contractors),and productive labor; --create opportunities within the center for putting vocational training skills into practice (Note: At Hanoi Center number 6, run by and for Hanoi People's Committee but located in nearby Ha Tay province, recovering addicts working in the tailoring shop received "small amounts of money" for their labor, according to center director Dr. Le Duy Luan. Proceeds from their products also were applied to buying items for the center library, he added. End note.); --provide remedial education for illiterate addicts; and, --facilitate the addicts' reintegration into society. The circular also stipulated that centers: -- should have trained personnel in areas including medicine, vocational training, education, and security; and, --should, in conjunction with MOLISA, regularly organize training seminars and workshops for staff to improve their professional competence. -------------- VOLUNTARY VERSUS COMPULSORY TREATMENT -------------- ¶7. (U) MOLISA's Dr. Sac said that, in addition the Drug Law, Decree 20 covered ADMISSION to drug treatment centers. According to Dr. Sac, "many" addicts seek treatment voluntarily because "their families are unable to cope" with home-based or community-based treatment. Their hope is that, by entering a drug treatment facility, they will receive "more professional" care. Addicts who voluntarily enter a center generally agree to stay one year. During embassy visits on provincial visits over the past fifteen months, addicts with whom poloffs spoke (with officials present) said that their chances for eliminating drug addiction were better in a center than at home because (1) in the center they are removed from drug-using peer groups; and (2) they have some opportunity to learn skills that can help them upon return to society. ¶8. (U) Dr. Sac further confirmed that terms for compulsory treatment are now longer -- up to two years, per Decree 34. In principle, a Provincial People's Committee Chairman has the final say on sending an addict for compulsory treatment. Dr. Sac noted, however, that in reality this decision is based on a consensus decision reached by a board consisting of provincial representatives from the Departments of Labor, Invalids and Social Affairs (DOLISA) and Health, as well as from the counternarcotics police and the National Committee for Aids, Prostitution, and Drug Control. Dr. Sac added that it is "usually, but not always" true that those who enter voluntarily have "less serious" addictions compared to those who enter on a compulsory basis. -------------- REALITIES ON THE GROUND -------------- ¶9. (U) SODC officials freely admit that the centers are often inadequate. While center directors and other officials appear genuinely interested in trying to help the addict populations, resource constraints and a lack of trained staff mean that many of the centers do not even meet the GVN's legal requirements. At the centers visited by poloffs (reftels),various directors stated their adherence to the "five step" approach specified under Circular 31, but admitted that implementation remained uneven, depending on center resources. ¶10. (U) The most impressive center visited by poloffs has been the Hanoi Center number 6. Living conditions for the addict population appeared considerably better than for students at Hanoi National University. There were also substantial vocational training facilities, including welding, motorbike repair, carpentry, and tailoring. Several addicts with whom poloffs spoke (within earshot of center and DOLISA officials) said that the skills they were learning would be helpful when they returned to their families. Poloffs also observed a recent university graduate teaching a literacy class, as well as a stand-alone PC used to teach basic computer skills. This was the only computer observed in any drug treatment center. Yen Bai province's center also appeared well above the norm, with new dorms, an island setting, and reasonable vocational training facilities. ¶11. (U) Other centers have ranged from poor to barely adequate. At the low end of the scale, Ha Giang province (in northern Vietnam) had a temporarily vacant facility that was essentially nothing more than bamboo shelters surrounded by a barbed wire fence. Quang Nam provincial center (central Vietnam) appeared understaffed and even dilapidated, with no facilities for vocational training or rehabilitation. The center director attributed the poor conditions to the lack of provincial support. Lai Chau, in northwest Vietnam, has "at least 10,000 addicts," according to the center's director, but its center has a capacity for only 70 addicts. A relatively low wall, a lack of guards, and a "strong desire for drugs" had resulted in "quite a few escapes," he admitted. Lai Chau's neighboring province, Lao Cai, is also another "drug hotspot." Its facility was larger (200 beds) and had a program of basic education and vocational training, as well as considerable land outside the facility used for farming. Sports and cultural activities also have improved the "quality of life, according to the center's director. -------------- ESCAPES - A CHRONIC PROBLEM -------------- ¶12. (U) In addition to the apparently chronic escape problem in Lai Chau, other centers have also experienced escapes. In June 2002, 369 addicts escaped from the drug treatment center in Can Tho province in southern Vietnam (ref F). According to press reports at the time, this was the third escape within seven months. In November 2002, 188 addicts escaped from the same facility, according to another press report. In addition to the Can Tho escapes, 54 addicts escaped from a Ha Tay province facility last July; in August, 42 escaped from the Binh Duong provincial center (and eight others drowned while trying to escape); and 20 escaped from the Nha Trang facility in December. According to the UN Office of Drugs and Crime (UNODC) Vietnam representative, there are "probably many other unreported escapes." ¶13. (U) Officials have offered several possible explanations for the escape problem. MOLISA's Dr. Sac opined that Decree 34, which lengthened compulsory treatment to two years, had "some impact," noting that the rate of escapes "seems to be increasing." Dr. Sac claimed that Vietnam "badly needs" more support from foreign donors to improve the centers and provide better training for staff. Dr. Sac also cited "poor management and conditions" as other factors behind escapes. Separately, the UNODC representative noted that the poor condition of many facilities, the generally untrained staff, and the lack of rehabilitation and vocational training opportunities were all factors "not only affecting the escape rate but also impacting the potential for reducing the high relapse rate." The representative lamented that "some officials" in Vietnam "still view drug treatment and detention synonymously." -------------- SOME HOPE FOR THE FUTURE? -------------- ¶14. (U) MOLISA's Dr. Sac said his ministry was committed to a goal of treatment for 100 percent of all addicts, but without a "significant increase in capacity," it would be "extremely hard" to achieve. MOLISA in February 2003 also proposed that the central government support additional drug treatment centers in "especially poor" provinces, according to a report in "Lao Dong" newspaper report. ¶15. (U) Some new facilities are under construction. According to a Vietnam News Agency report in November 2002, a new 15,000 square meter facility is being built in southern Vietnam's Binh Phuoc province. The facility should be completed by the end of April 2003 and will have the capacity to treat 2,000 addicts, according to the report. In 2002, Ho Chi Minh City opened six additional drug treatment centers, three in partnership with the city's Young Pioneers, a Communist Party mass organization. A large regional center is under construction in Nghe An, about 12 kilometers from the provincial capital of Vinh; it will include an additional 700 beds for addicts. MOLISA's Dr. Sac said that this center should be operational "within the first quarter of 2003." -------------- COMMENT -------------- ¶16. (U) While many GVN drug officials appear committed to drug treatment and rehabilitation, the network of generally modest centers seems to place more emphasis on detention than actual treatment. Vietnam's endemic problem of insufficient public sector resources exists in the drug treatment sector as well. Without a big push from the foreign donor community, major improvements in the success of drug treatment are unlikely any time soon. BURGHARDT