COMMUNITY DRUG TREATMENT IN VIETNAM: NOT MUCH TO IT

UNCLAS SECTION 01 OF 03 HANOI 000549

SIPDIS

STATE FOR EAP/BCLTV; INL/AAE

E.O. 12958: N/A
TAGS: SNAR PGOV SOCI VM HIV AIDS CNARC
SUBJECT: COMMUNITY DRUG TREATMENT IN VIETNAM: NOT MUCH TO IT

REF: A. Hanoi 353 B. 02 Hanoi 2836


1. (U) SUMMARY: Despite improved national guidance on
community drug treatment as well as an increasing awareness
among authorities of the need for more rehabilitation
services at different levels, implementation appears rather
thin and uneven, primarily due to a lack of trained
personnel and insufficient resources at the local level.
The focus of community drug treatment is detoxification,
after which, official "peer pressure" seems to be virtually
the only component. Ref a reported on Vietnam's drug
treatment centers. END SUMMARY.

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POLICY FRAMEWORK
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2. (U) Vietnam offers two main forms of treatment for drug
addicts. One is a network of drug treatment centers spread
throughout the country. Some addicts are sent to centers
for "compulsory" treatment; others arrive voluntarily.
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 others are supported
by mass organizations, such as the Youth Union (ref a).


3. (U) In addition to the national network of provincial
drug treatment centers (ref a),there is also a community
drug treatment structure. (Comment: This is in line with
Vietnam's "vertical structure" form of government as well as
its tradition of "mobilizing" the population to help solve
social and other problems. End Comment.) 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 individuals,
families, agencies, and other organizations to implement
home-based and community based detoxification. . ."


4. (U) Since the law's passage, the GVN has issued
additional directives pertaining to community drug
treatment. On May 15, 2002, the GVN issued Decree 56 (ref
b),which addresses family and community based treatment.
It stipulated that the minimum length of community treatment
should be six months and that such treatment must be
conducted in accordance with five steps developed by the
Ministry of Labor, Invalids, and Social Affairs (MOLISA) and
the Ministry of Health, including: (1) reception and
classification; (2) detoxification; (3) education; (4) work;
and, (5) supervised return to the community. In addition,
there are provisions for closer supervision over the addicts
by local authorities, as well as a provision for assistance
in detoxification assistance if home treatment is
unsuccessful.


5. (U) According to Dr. Tran Xuan Sac, MOLISA's Deputy
Section Chief of the Department for Social Evils Prevention,
the goal of Decree 56 was to enhance the effectiveness of
community and family-based treatment by having professional
advice and some medicines more readily available. He opined
that this could help relieve some of the pressure on the
compulsory treatment centers. Dr. Sac noted that, while
families are responsible for the most costs for this
treatment (except detoxification),they are eligible for
"preferential government loans." In an effort to encourage
vocational education, organizations that provide such
training to addicts also may receive such loans, he added.
Local authorities subsidize the cost for the initial
detoxification process (usually seven to 10 days) up to a
maximum of 250,000 VND (approximately USD 20).


6. (U) Following up on Decree 56, the GVN issued an
interministerial circular in January 2003 that provides
further guidance. According to the circular, addicts
admitted to community-based treatment should also receive
reeducation classes from the local authorities. However,
recovering addicts may be held "criminally liable" for
continued drug use. According to Dr. Sac, this means that
addicts undergoing community-based treatment who continue to
use drugs "may be sent" to compulsory drug treatment
centers, if the local People's Committee determines this is
necessary.


7. (U) Dr. Sac noted that criteria regarding participation
in community drug treatment vary among localities. This is
due, in part, to available resources, he added. However,
"normally, heavy addicts or those who have used hard drugs
(i.e., heroin) for over three years are not eligible," he
said. According to Dr. Sac, MOLISA views community drug
treatment as more suitable for less severely addicted
individuals. The chairman of the local People's Committee
makes the final decision on an individual's participation,
with the advice of an advisory committee consisting of the
police, local social affairs and health officials, and
various mass organizations, such as the Youth and Women's
Unions.

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ON THE GROUND REALITIES
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8. (U) During poloffs' visit to the Thuy Ai detoxification
center in Hanoi's Hai Ba Trung district, Dr. Nguyen The Dan,
the official in charge, said that most addicts arrive at his
center "at the urging" of their families or local
authorities. His staff evaluates each addict prior to
admittance to determine eligibility. Some addicts admitted
are HIV-positive, he added. The day we visited, six new
addicts were admitted for detoxification; among them were
three who are HIV-positive, according to Dr. Dan.


9. (U) Dr. Dan said that addicts normally stay at his
center about 10 days. He claimed that nearly all who enter
the detoxification process complete it successfully. At the
end of the process, his staff tests the addicts. If they
appear to be "detoxified," they may return to their families
for home-based treatment. Dr. Dan could not say
specifically what the "treatment" at home entailed, but
noted that the addicts receive "regular" visits from local
officials who "encourage" them to stay away from drugs
and/or "their drug-using" friends. Dr. Dan said that he
knew of no literature sent home with the addicts to provide
advice to their families, but added that his medical staff
"stays in contact" and "may make a home visit" if the family
so desires. While lamenting that the center has no trained
drug counselors, Dr. Dan claimed that hands-on experience in
the detoxification center and medical training enables the
staff to provide "useful advice and support" to recovering
addicts and their families.


10. (U) Dr. Dan noted that a recent survey of "graduates"
from the community treatment in his local area concluded
that the recidivism rate is "about 72 percent." He said
that, while this compared favorably to provincial drug
treatment centers, "it must be understood that we are
generally dealing with a less severely addicted population."
(Note: The GVN claims a recidivism rate of about 80
percent, but a more realistic figure is probably in the 90-
95 percent range, similar to other countries. End Note.)


11. (U) Tuyet Huong, manager of a "club" for recovering
addicts that works with Dr. Dan's center, said that she
holds "voluntary" weekly meetings at the center. At the
meetings, recovering addicts get together and talk about
their efforts to stay away from drugs. There are also
lectures from local officials, who emphasize the need to
avoid drugs as well as the value of various recreational
activities and physical training. Huong said that she also
works with local employers to help find jobs for recovering
addicts. Huong noted that "work is a very important part of
staying away from drugs." During the course of our visit,
we spoke with two recovering addicts working in a nearby
motorbike washing facility. With officials present, they
said that the center had been "very helpful" to their
recovery and they "appreciated" having a job and knowing
there was a place they could go for activities and support.
One of the recovering addicts noted that, while he had the
opportunity to participate in community treatment, he knew
of others who had committed criminal acts and were "forced"
by local authorities to go to drug treatment centers.


12. (U) The community drug treatment services available in
Chau Khe commune, Bac Ninh Province, were far less developed
compared to Hanoi. Nguyen Khanh Lan, Director, Sub-
department for Social Evils Prevention, Bac Ninh Department
of Labor, Invalids, and Social Affairs, said that community
drug treatment has been an option in Bac Ninh since 1991.
He added that, while local drug problems are less severe
than in Hanoi, proximity to the capital had resulted in a
"significant and growing drug problem" in the province. In
terms of its socio-economic status and addict population,
Chau Khe commune, with a population of about 17,000, is
"typical," he claimed.


13. (U) Nguyen Van Huong, Deputy Chairman of the commune
People's Committee, said that detoxification is "about the
only" organized aspect of community drug treatment, however.
Similar to Hanoi, after successfully completing the
detoxification process, addicts are sent home, where they
"are supervised by their families, local officials, and the
mass organizations." According to Huong, there is no
community center, outreach program, support group, or job
placement. Huong claimed that local officials and/or
representatives from mass organizations cover outreach
through periodic home visits. During these visits,
according to Huong, officials provide "advice" about the
need to stay away from drugs. However, the recidivism rate
is about 85 percent, Lan admitted.


14. (U) Lan and Huong separately emphasized the commune's
need for more support to provide better services. Huong
said that he had appealed for more provincial support, but
without success so far. He lamented that the province will
only contribute a "modest amount" for detoxification. With
more resources, Huong said that he would hire a counselor to
provide professional services recovering addicts and their
families.

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COMMENT
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15. (U) From our discussions with MOLISA and review of
available laws, we expected a more comprehensive approach to
community drug treatment. Questions regarding the specifics
of what actually happens when addicts return home were met
with long-winded and rather vague responses. With further
probing, it became clearer that what authorities consider
"community treatment" consists essentially of detoxification
followed (or not even) by lectures on the evil of taking
drugs, leaving open the possibility that officials could use
compulsory center treatment as a potential threat or
punishment for "lapses." While local officials with whom we
met appear committed to the idea of community drug treatment
and rehabilitation as one way of dealing with the drug
issue, Vietnam's systemic problem of insufficient public
sector resources (felt most acutely at the local level)
prevents a more comprehensive approach. Without significant
help from the foreign donor community, major improvements in
community drug treatment are unlikely any time soon.
BURGHARDT