The Great Alcohol Debate: Most developed countries have long ago turned their back on forcing detox and treatment
By KIERAN FINNANE
“Forced detoxification” is neither “effective” nor “ethically acceptable” as a way of treating addiction, according to an editorial published under the name of 10 Australian and international researchers in the latest issue of Addictions, the top international journal of addiction studies.
The editorial mainly takes aim at the compulsory detention and forced detox of drug users in developing countries but gives a brief overview of the approach in the developed world. Some of its points have relevance for the current debate in the Northern Territory on compulsory rehab for problem drinkers as proposed by the Country Liberal Government.
We learn that a number of Australian and US states legislated for the involuntary treatment of ‘inebriates’ in the late 19th and early 20th centuries. US Federal courts were also sending heroin-addicts for six months’ compulsory treatment during the mid-20th century. However, with the notable exceptions of Russia and Sweden, compulsory detention of addicted individuals has “either been abandoned or fallen into disuse in most developed countries”, says the editorial.
This has been for two main reasons: “First, it failed to treat addiction effectively, with most people detained returning to drug use after release. Secondly, this approach has been criticized for violating the human rights of drug users.”
Russia and Sweden continue their compulsory detention of addicted people “in the absence of rigorous evaluations of the efficacy or safety of this approach”.
The editorial provides a range of references for the various points it argues, including questions of the effectiveness of compulsory treatment, one of which is available online. It dates from 2010 and was published by the NSW Bureau of Crime Statistics and Research. Its authors are Wayne Hall, Professor and NHMRC Australia Fellow at the University of Queensland Centre for Clinical Research, and Jayne Lucke Associate Professor and Principal Research Fellow at the UQ Centre for Clinical Research.
Conditional ethical approval from WHO and UNODC
Opioid dependence is the main addiction discussed in the article, but perhaps some points can be extrapolated to the NT debate. On ethical considerations the authors report that a 1986 World Health Organization consensus view was that legally coerced drug treatment was legally and ethically justified if: (1) the rights of the individuals were protected by “due process”, and (2) if effective and humane treatment was provided.
They also report that the United Nations Office on Drugs and Crime (UNODC) has recently argued that coerced drug treatment is an acceptable alternative to imprisonment that is consistent with international drug control treaties and supported by evidence of effectiveness. “However, UNODC describes long-term compulsory residential drug treatment without the consent of the offender as a form of imprisonment that is not effective in treating problem drug use and is in breach of international human rights agreements.”
The authors point to the ethical issues that often often arise in interactions between the correctional and drug treatment systems: “Treatment staff see the drug offender as their client and hence as someone who should be involved in treatment decisions, is owed an obligation to respect confidentiality, and whose drug use should be dealt with therapeutically rather than punitively. By contrast, correctional and judicial personnel see treatment as directed by the court, and drug use as a breach of a court order that should be reported by treating staff.
“The effective and ethical use of coerced drug treatment requires a shared understanding of goals of treatment and a clear statement of the roles and responsibilities of correctional and treatment staff for monitoring and reporting upon an offender’s progress in drug treatment.”
‘Boot camps’ clearly do not work
The authors go on to look at what works and what doesn’t when treatment is offered under “legal pressure”. In considering the voluntary drug treatment programs on offer in US prisons, they report that “meta-analyses of these programs clearly show that boot camps do not reduce drug use or recidivism”.
“Therapeutic community approaches” however are more effective, “especially those that link prisoners into treatment after release”. One study found that these approaches in prison “produced a 5.7 per cent reduction in recidivism and the financial benefits of doing so exceeded their costs”.
A comprehensive program of compulsory rehabilitation for recidivist drug offenders was established in NSW in 2006. The rationale was that it would be more cost-effective than imprisonment per se “which had failed to affect the drug use and criminality of these offenders”. The authors point out that “a major problem for those establishing the program … was the lack of evidence on the effectiveness of compulsory drug treatment in prison”.
“There were no randomised controlled trials of the effectiveness of these programs, no evidence on their
cost-effectiveness, and little guidance on how and to whom to provide such treatment. The most relevant evidence came from studies of the effectiveness of voluntary prison-based treatment programs.”
Of possible relevance for the NT’s debate is also the “civil commitment for drug dependence” that was trialled in California and New York in the 1960s: “Practitioners reviewing this experience in the late 1980s reached the consensus that ‘long-term client aftercare and monitoring’ were essential to successful compulsory drug treatment.” In this respect it is worth pointing out that Attorney-General John Elferink has described only a three-month program, with more of an emphasis on getting drunks off the streets than on their rehabilitation. He accepts the high risk of therapeutic failure, hoping that if people pursue their drinking afterwards, they will at least be “more discreet”.
Friday, December 20, 2024
The freedom of the press still furnishes that check upon government which no constitution has ever been able to provide – Chicago Tribune.
Thanks for researching the topic and writing this very timely article Kieran.
I hope your references are noted, and the studies you have cited are considered carefully by politicians and their advisors, as their decisions on these matters will affect many lives, and possibly use up a great deal of the NT’s scarce disposable funds and even scarcer time. It is way past time to act, but the actions must be based on the best evidence and thinking available.
Spending very large amounts of money just to get irritating drunks out of sight in detention for a while is not good enough. Addicts are sick people. They deserve the option of respectful, effective help, but they cannot be compelled to accept therapeutic help against their wills, or the investment in resources will be wasted.
Nor should they be deprived of their liberty, by being locked up indefinitely or periodically for only refusing to accept an offer of help, just for the sake of getting them out of sight and out of mind, when they have not actually broken any laws.
To punish them with imprisonment without adequate reason or due process would be a gross and unjustifiable breach of their civil, legal and human rights.
Having an unwanted counsellor available during their three month stay in detention, and then releasing them back into the same environment without supports, will not solve the problems or help those who suffer from alcohol addictions, but it will burn up a great deal of scarce capital and goodwill.
It would be far better to have a system that simply withdraws the privilege of access to alcohol from self-destructive drinkers for a period, combined with reasonable pressure on them to consider offers of help whilst they are banned and sober enough to make clear decisions.
The system should also include provision of high quality help to those who make the decision to accept it, and an everyday living environment that reduces the opportunities to obtain alcohol and lessens the triggers on impulses to drink it.
A floor price based on alcohol content, combined with effective enforcement of a Banned Drinkers Register supported by powers to impose Income Management for periods, would “turn down the grog tap” available to self-destructive drinkers whilst providing respite for their families and also slowing the rate of producing new addicts.
Powers to assess the causes and nature of the drinkers’ addictions and behaviours, and recommend that they consider undergoing suitable treatment would complement the turning down of the grog tap measures, providing the choice of a way out of the addiction without resorting to the shame and pain of criminalisation and imprisonment. These moves would be less costly and much more effective than the mandatory treatment option.
“Discreet” drunks? Maybe up on High Street, but down on Mean Street? Get real!
It is well past time to push the truth. And we all know what that is NO Job Nothing to do but drink smoke dope drop pills. The life style perpetuated by our generous welfare system. And I do not in any way refer to those who are not part of the problem addicts. Everyone is different but this entire time wasting money wasting because of addicts is seeing a total neglect of those in real need. Our kids without beds and food. Our sporting facilities our youth centre seniors and more. Lets stop the focus on those with addictions and spend all that money assisting in providing a great opportunities to everyone else. If it is true and forced rehab will not work spend the money where it will be best spent in preventing the next generation from the same faith. If all that money had have been spent in a new youth centre providing for kids. Put monies to sporting clubs to reduce the cost to participate in sport. Wow planning for a future that involves participate not neglect. So you all focus on this issue and in ten years the problems will be greater. Change lanes now. A future for our town or more of the same. This stupidity has to end
In the NT, the Third Party Insurance component of annual car registration is $501. In Queensland it is $383.
The following research shows that in terms of Austrralian statistics, the “NT stands out for the high proportion of road deaths associated with alcohol consumption with 55 per cent of road deaths associated with high risk drinking (Northern Territory Department of Transport and Infrastructure 2004) – source STRONGER FUTURES ALCOHOL PROPOSALS – REGULATION IMPACT STATEMENT (NTG Dept. of Families, Housing, Community Services and Indigenous Affairs. Nov. 2011).
Insurance premiums are just another indication of the need to turn the tap down, helping to prevent the highest rates of alcohol-related hospitalisations in Australia and lower costs of living in the NT.
The following is a very informative article anyone interested in this debate will benefit from reading.
http://www.smh.com.au/national/damming-the-rivers-of-grog-20121119-29m5r.html
The foetal alcohol damage to so many NT children will play itself out not just in another lost generation on imploded remote communities, but in a drain on our public health system and, most importantly in my opinion, in a drain on our public education system in both remote and urban communities.
Teachers in public schools teach to the lowest common denominator, and while streaming helps, we ignore to our own peril the negative impact on our public schools.
This is not theoretical. This is happening today, and because of the damage already inflicted, will continue tomorrow.
Because of our tolerance for strong, cheap grog, we are breeding brain damaged youth incapable of being educated to a standard that will allow them to take up an autonomous position in our shared society. Just how short-sighted and ordinary is that?
This is nose-on-your-face stuff.
Some of the comments are really clutching at straws. Road deaths, babies born with brain damage through cheap grog. The list of excuses grow for prohibition. I will continue to say it is up to individual responsibility not for organisations chasing the large dollar fundings to do nothing but inform and grow the problem to ensure greater funding for their groups. Individuals make their choices for themselves. And the problems will grow constantly until realisation sets in for those individuals that there are no more excuses and they have to make a choice. The money for nothing groups are not there anymore to keep them drunk and dependent. Oh my, independence for individuals, now that is something to fight for. You guys want someone or something to control and dominate. Buy a pet. People are not pets.
Janet Brown @ November 24. “The money for nothing groups are not there anymore to keep them drunk and dependent.” Are you referring to welfare payments for Indigenous people here?
If you are, then perhaps you should go out of town and see the lack of employment prospects. Whenever I read your posts, they seem to be focused on Alice Springs, rather than Central Australia.
When one lives and works on a community, the problems associated with and the reasons for alcohol-abuse are much more clearly seen than they are by observing people in the streets of Alice Springs.
Steve Brown constantly remarks about how informed he is by attending to housing issues around town, but he goes home each night.
Your comment about clutching at straws reveals more about your social awareness than your interpretation of higher insurance premiums related to excessive road death payouts and Foetal Alcohol Spectrum Disorder, which you describe as “babies born with brain damage through cheap grog”.
Failure to understand the growth of alcohol supply, cheap or otherwise, within the Australian community over the past 20 years, both in terms of product alcohol content, manipulative marketing and licensed outlets is no excuse for your opposition to “prohibition” and support for “indendence of individuals” in choosing whether to consume alcohol or not.
As has been pointed out many times, the supply of drugs such as marijuana, cocaine, ecstasy, heroin, etc are prohibited by law enforcement.
In the central Queensland backpacker haven of Agnes Water, the local butcher ceased trading this week and the premises are about to be occupied by the local bottle shop who are doubling in size.
This has been occurring in other Australian tourist destinations, of course, like Alice Springs (surprise) and Byron Bay. The latter recently banned Woolworths from opening their Dan Murphy liquor franchise in the CBD cinema complex with the help of the NSW Independent Liquor and Gambling Authority (IGLA).
Sort of gives your use of the word “independent” a broader meaning, don’t you think?
So are you telling us grog is available in the communities? Of course I focus on Alice in relation to grog availability communities are dry. Like I said clutching at straws. And in any town in Australia if there is no employment people move to where employment is available. And in Alice we have lots of employment opportunities. And lots of those on welfare from communities come not to find work but to remain on welfare. Using employment is another of your straws.
@Janet
Your comment about “babies born with brain damage through cheap grog” shows an unfortunate lack of empathy for those with a more personal experience of foetal alcohol damage than your comment leads me to think you have had.
I always look forward to your comments, but you might want to tread a bit more warily here. This issue is not as easily dismissed as you might think. And while free will is all well and good, it’s worth remembering that those damaged by alcohol while still in the womb are often born with a restricted ability to exercise any significant degree of free will at all.
Janet, your understanding that communities are “dry” is abysmally ignorant of grog running or roadhouse bars in the proximinity of communties, via backroads or blacktop.
The police do their best to enforce it, but they are in agreement with restricting supply, e.g., the BDR, Thirsty Thursday or haven’t you read the Briscoe reports?
The connection between alcohol-abuse, poverty, productivity and “drinking to oblivion” (Tatz, 1978) will not be solved by simply stating that alcoholics must take responsibility.
The community needs to take responsibility for the Alcohol Industry’s leeching of taxpayer funds in the same way that the Tobacco Industry was mandated to provide health warnings on their otherwise delusionary marketing hype.
The Alcohol Industry needs to take responsibility, but we have seen that they are reluctant to do this so far. However, taxation and lobbying for reform is well underway.
In your latest post, you haven’t made comment about the increasing avenues of supply within the community, the yearly “Schoolie” deaths from binge drinking and the crack-down that is occurring, despite the appalling Foetal Alcohol Spectrum Disorder (FASD) statistics.
Byron Bay youth are running a Summer Program called “Cringe the Binge” – all of this seems to place you at odds.
Hal like children born with crack, heroin and other drugs due to the lack of care from addict mothers. I feel sad that in our society that this happens. But the need is to assist in helping these mothers and families but when you use this very damaging inflicted harm from the mothers to promote restrictions on the rest of the public I find that not only insulting but disrespectful to the community. Decent people care about the injustice in life and do not support such behaviour so why the desire to make changes in our lives when these people in question do not change their behaviours. Two wrongs do not make a right. And if a family member had issues of addiction it would be for family to deal with it. Trouble with most of those on welfare lifestyles is a constant desire to accept no responsibly for their actions, inbred by organisations wanting to blame everyone else but those with the problems.
@Janet
Unless I am mistaken, children born with heroin and cocaine addictions can overcome their addictions and go on to lead productive lives. Their main baggage seems to be a psychological propensity to addiction, a manageable mind-set.
Foetal alcohol damage, on the other hand, is forever. It’s not surprising that this is not widely known, the strength of the grog lobby being what it is.
I note that in your last post you use the terms insulting and disrespectful. I assure I am trying not to be either, provocation notwithstanding.