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Cablegate: Drug Treatment Centers in Vietnam

This record is a partial extract of the original cable. The full text of the original cable is not available.

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

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