There is no doubt that one of the major problems facing all nations is that of substance abuse. Some substances which are legal (such as tobacco and alcohol), can cause serious health problems. Some, such as alcohol, also contribute to the commission of public order offences and offences of violence. Illegal drugs are seen to pose an even greater threat to the well-being of society. Since the detection and prosecution of drug offenders depends on enforcement practices and decisions about the allocation of police resources, this is an area which is particularly susceptible to changes in government policy. Thus, Thailand’s prison population has more than doubled over the past four years, reflecting the government’s commitment to wage “war on drugs.” Malaysia has experienced similar, but less dramatic developments.

An effective and strategic attack on substance abuse requires multi-agency involvement, including education and health services as well as criminal justice agencies. Several nations, including Cambodia and Korea noted that the problem of illicit drugs is also one which extends beyond national boundaries and that effective long-term strategies will require international co-operation. Given this backdrop, it is clear that correctional administrators become involved in cases only at a late stage, generally after offenders have become heavy substance abusers. Consequently, there are limits to the extent to which correctional departments can be expected to solve the problem. Nevertheless, the discussion of this agenda item revealed some interesting and potentially useful developments within the field of corrections.

Cambodia, Canada, China, Hong Kong (China), Malaysia and Singapore made formal presentations on this topic. This was followed by a lively and interesting discussion of a range of issues relating to the treatment of drug offenders.

Although the focus was on illicit substances such as opiates and amphetamine-based drugs, it should be recorded that several jurisdictions noted that alcohol abuse is a contributing factor to certain types of offences and may require treatment just as much as illicit drug abuse. Mongolia noted that, whilst illicit drugs were not a problem in that country, alcohol abuse posed serious difficulties. In New Zealand, Australia and Canada, alcohol abuse has had a particularly detrimental impact on Indigenous peoples and has played a huge role in their over-representation in the criminal justice system.

It is extremely difficult to measure the precise extent of the illicit drug problem amongst prisoners. Some have committed offences which are directly drug-related, such as the possession of drugs or involvement in drug dealing and trafficking. Others may have been convicted of offences which do not involve drug possession but which were committed in order to finance a drug habit (such as theft, robbery or burglary). Some of the national reports tended to identify “drug offenders” by reference to their commission of a drug offence. Others tended to use broader criteria, based on interviews with and assessments of prisoners. Further, on interviews with and assessments of prisoners, some took a broader definition of substance abuse (including alcohol) than others who focused on illicit drugs. Given the different patterns of drug use across the region and these different measuring posts, there are wide regional variations in official figures on the number of drug offenders in prison. China gave a figure of around 60,000 drug-related prisoners, or 4.6 per cent of the prison population. This was at the bottom of the range. Thailand, which measured the number by reference to conviction of a drug offence, recorded a much higher figure of 65 per cent. Canada concluded that 70 per cent of federal offenders have drug and/or alcohol problems, and Australia reported that 80 per cent of men and 90 per cent of women who return to prison reported that they had a substance abuse problem (including alcohol). New Zealand estimated that 83 per cent of the prison population had a problem with drugs or alcohol at some point in their lives compared with around 32 per cent of the general population. Most of the other jurisdictions which attempted to quantify the problem, put the figure at between 30 per cent and 50 per cent. These included Hong Kong (China) 30 per cent; Japan 30 per cent; Singapore 40 per cent and Malaysia 47 per cent.

Patterns of drug use clearly vary across the region and will, to some extent depend on availability. For example, if heroin is in short supply, there may be an increase in the use of marijuana or amphetamines. Drug use is also affected by “fashion trends.” Several nations noted that the use of amphetamines had increased and now presented a greater problem than heroin. The most dramatic example of this was Thailand. Australia, Singapore and Malaysia also expressed concern about growing amphetamine abuse.

Drug use presents obvious problems with respect to security (i.e. the problem of drugs being smuggled into prison); the safety of prisoners and staff (e.g. the risk of the transmission of diseases); and health (e.g. the needs of prisoners who need to be detoxified). The papers and the discussion ranged over a broad range of such issues. In terms of security, it was clear that different parts of the region experience problems. The paper produced by Tonga noted that perimeter security fencing is not always secure, generating obvious difficulties. The representative of New South Wales, Australia, noted that contact visits are permitted to prisoners and that this means drugs can sometimes be transferred from visitors to prisoners. However, contact visits are regarded as an important humanitarian feature of the Australian system. Some other jurisdictions adopt a more restrictive approach to prison visits, especially where there are concerns about the possibility of smuggling drugs. Most jurisdictions are extending the use of technology to attempt to combat the problem. For example, Canada uses ION scanners and Japan is increasing the use of X-rays. Canada has also introduced a policy of searching all people who enter prisons, including prison staff.

In terms of the health and safety of staff and inmates, it should be recorded that HIV/AIDS has not become the problem which was, at one time feared. There also appear to be few recorded incidents involving the use of syringes as weapons in prisons. However, shared syringes are contributing to problems of Hepatitis C infection.

Prisoners with drug problems tend to require high levels of medical and other assistance. For example, they tend to be high users of prescription drugs as well as illicit drugs. Evidence is also emerging which shows that ex-prisoners face particular health risks in the period immediately following release. Recent research in Victoria, Australia has shown that 25 per cent of all heroin-related deaths in that State involved ex-prisoners, and occurred within a short time of release.

Most nations adopt the philosophy that some offenders who face drug addiction problems should undertake programs in special drug rehabilitation centres or in special facilities within normal prisons. Cambodia classifies drug offenders into two groups. Group One consists of offenders who have committed a drug offence but who have not used or been addicted to drugs. Group Two consists of drug offenders who are users or addicts. Group Two prisoners are to be treated and managed separately from others. Non-government organisations have been active in trying to establish treatment centres. Hong Kong (China) and Singapore have for many years operated drug rehabilitation centres under the management and direction of their corrections departments. Hong King operates two Drug Addiction Treatment Centres and Singapore has a number of Drug Rehabilitation Centres. Both of these systems place a strong focus on offenders taking personal responsibility for their addiction and combine psychological treatment and counseling with a tough physical regime. Since the aim is to promote the offender’s reintegration into society, careful attention is given to community support (from family, government and non-government agencies) upon release. In Hong Kong (China), a Board of Review has been established to consider the inmate’s progress at regular intervals. Korea has established two institutions for drug addicts; the Yuijungbu Correctional Institution (which commenced in February 2001) and the Kimchon Correctional Institution for Juveniles. Indonesia is also considering the establishment of a new institution for drug rehabilitation.

A number of jurisdictions have established special treatment units within prisons. For example, Canada operates Intensive Support Units in seven institutions across the country. These units are designed in recognition of the fact that, despite security measures, drugs are sometimes available in the mainstream prison setting. Intensive Support Units involve a positive drug-free setting and require inmates to enter a contract to remain drug-free and to comply with the conditions of the Unit. New Zealand has pursued a similar strategy and has 18 Drug Free Units. A number of Australian States are moving in a similar direction.

Overall, therefore, there was general agreement that effective drug rehabilitation programs require a multi-faceted approach and that the traditional prison environment may not be the most effective approach. In recognition of this, Thailand has embarked on an ambitious “Boot Camp” initiative, under which drug offenders will undertake a program involving elements of military training combined with drug counseling and vocational training. Delegates to the conference were able to visit one of these camps, the Meng Rai Military Camp.

All jurisdictions face some problems with respect to drug offenders who do not accept that their drug abuse is a problem and are therefore resistant to treatment programs. China noted that long-term drug abusers may “lack a sense of guilt” and have “anti-punishment feelings”; for these reasons, “rehabilitation has to endure a more difficult process.” However, the delegations from China, Hong Kong (China), Canada, Singapore and Australia commented that motivational interviewing and counseling can be of some assistance in getting offenders to acknowledge their drug abuse as a problem and to undertake treatment programs. In a number of jurisdictions, such counseling forms an important part of the initial assessment process when prisoners first enter prison. There was a general agreement that this is an area requiring further research and evaluation.

Most jurisdictions adopt a mixture of treatment approaches, with a primary focus on psychological and other forms of counseling. In Hong Kong (China), for example, Drug Addiction Treatment Centres (DATCs) employ psychologists and other counselors. DATCs also encourage family involvement. This has the dual purposes of improving family understanding of the offenders’ problems and assisting in their rehabilitation. Malaysia adopts a “multi-disciplinary psychosocial model” and Japan aims to combine educational and psychological programs. Like Hong Kong (China), Singapore has a highly structured program involving several stages. In Singapore, failure at one stage can result in the person returning to an earlier stage in the treatment process.

It is clear that substance abuse programs must cater for the specific needs of individual offenders. In the words of the Canadian report, there should be a “differential treatment model rather than a ‘one size fits all’ approach.” Similarly, the Australian and New Zealand papers referred to the specific needs of female and Aboriginal prisoners. For example, many of the issues faced by a middle-aged alcohol abuser may well differ from those faced by young amphetamine users. Several contributions suggested that integrated offender management holds the key to the successful targeting of programs.

It is not possible in this report of the conference proceedings to describe the models which are adopted in each jurisdiction but the national papers provide a valuable resource for detailed study. However, two other themes can be highlighted: program delivery and accreditation.

The most common model is for programs to be developed by psychologists, but for their delivery to be entrusted to other appropriately trained personnel operating under the general supervision of psychologists. In most cases, these other personnel are drawn from the ranks of correctional services staff, supplemented by other trained counselors. For example, both China and Canada have a large number of trained correctional staff who take a great deal of responsibility for program delivery, under the general supervision of psychologists.

These arrangements raise some interesting questions. The first is whether treatment staff are employees or whether these services are contracted out. It is interesting to observe that in Australia, the public sector prisons tend to contract out the provisions of many treatment programs but the private sector tends to employ treatment staff directly.

The second question relates to accreditation. Several jurisdictions, including Australia, Canada, Hong Kong (China) and Singapore noted that there is a need to ensure “quality control” of people employed in program delivery. This is important both for the integrity of the programs themselves and because a person’s response to treatment program can affect his or her prospects of release on parole. The report from Canada contains detailed discussion of the process of program accreditation which is adopted in that country, involving a panel of international experts. This process is extremely thorough and may be out of the reach of many parts of the region. However, there is clearly an opportunity for further dialogue between APCCA nations on these difficult questions.

Most of the reports and presentations focused on psychologically-based treatment of drug offenders. However, the conference discussion moved onto the question of pharmacological interventions. A number of jurisdictions make use of Methadone (including Australia, Canada and Hong Kong (China)). Some are also using Naltrexone. Methadone is essentially a “substitute drug” for heroin and can generate its own problems of addiction. However, it is generally recognised to be a safer alternative. The representative from New South Wales, Australia, also noted that the use of Methadone for some prisoners had reduced the risks of prisoners acquiring blood-borne diseases through the sharing of needles.

Naltrexone operates in a different way. It is an “antagonist” which blocks a person’s craving for a drug. It has particular use in the context of heroin but research is also being conducted in its use for other drugs. The delegation from Singapore gave a most useful summary of that country’s extensive experience with Naltrexone. They reported that, when used in conjunction with integrated counseling and other forms of treatment, Naltrexone appears to be very successful. However, there are some risks. In particular, people who cease Naltrexone and who then take heroin are at very high risk of overdose due to the lingering antagonistic effects of the drug.

In summary, the basic message is that a coordinated approach to drug treatment may involve the use of both psychologically-based programs and pharmacological interventions. However, the evidence suggests that pharmacological intervention is, in itself, insufficient.

There was agreement that effective drug treatment requires a coordinated approach involving both prison and post-release phases. In Hong Kong (China), for example, DATC inmates are subject to a mandatory period of 12 months’ supervision upon release. During this period, they are subject to regular urine testing and to follow-up counseling. The reported success rate is good with 68 per cent of males and 78 per cent of females successfully completing the 12-month supervision period.

Several other papers also referred to the importance of effective post-release strategies and the continuity of care. As noted by Malaysia and Australia, this can involve partnerships with community-based organisations as well as families. This focus on the “throughcare” of drug offenders is consistent with the increasing focus, across the region, on integrated offender management (see the report of Agenda Item One).

Drug offenders will continue to pose many challenges for correctional authorities in the years to come. It is not easy to discern the most likely future trends and challenges, but they appear to be as follows:-

Greater focus on programs specific to the needs of the individual offender through integrated offender management and careful assessment.

An extension in the use of drug-specific facilities in the form of specialist rehabilitation centres or units within existing prisons.

More extensive use of pharmacological interventions in the form of drugs such as Naltrexone and Methadone.

Ensuring “quality control” in the delivery of programs.

Program accreditation and benchmarking.

More detailed evaluations of the success (or otherwise) of different forms of treatment.

The conference discussions provided a valuable platform for the exchange of information and experiences between APCCA members. It is to be hoped that further discussions will ensue and build on this foundation.