How to combat drug addiction: The Chinese experience

Abstract

In recent years, both the Commission on Narcotic Drugs of the United Nations and the World Health Organization have attached great importance to the treatment of drug addicts and have from time to time offered valuable advice and information on this problem, which they divided into three parts, as follows: (1) detection and registration of drug addicts; (2) treatment of drug addicts; (3) prevention of drug addiction. This three-fold division has not only served as a basis for the systematic study of the problem and stimulated discussion of its more interesting aspects, but has also been useful in showing how the programme of treatment should be carried out and what the objectives of our common efforts should be. If each country continues submitting within this framework informative reports on the experience and knowledge it has gained, so that further studies can be undertaken for the purpose of arriving at accurate conclusions, there can be no doubt that the world-wide effort for the suppression of drug addiction will progress steadily until complete success is finally achieved.

Details

Author: Y. L. Yao
Pages: 1 to 6
Creation Date: 1958/01/01

How to combat drug addiction: The Chinese experience

Y. L. Yao Counsellor, Ministry of the Interior, Republic of China

In recent years, both the Commission on Narcotic Drugs of the United Nations and the World Health Organization have attached great importance to the treatment of drug addicts and have from time to time offered valuable advice and information on this problem, which they divided into three parts, as follows: (1) detection and registration of drug addicts; (2) treatment of drug addicts; (3) prevention of drug addiction. This three-fold division has not only served as a basis for the systematic study of the problem and stimulated discussion of its more interesting aspects, but has also been useful in showing how the programme of treatment should be carried out and what the objectives of our common efforts should be. If each country continues submitting within this framework informative reports on the experience and knowledge it has gained, so that further studies can be undertaken for the purpose of arriving at accurate conclusions, there can be no doubt that the world-wide effort for the suppression of drug addiction will progress steadily until complete success is finally achieved.

Suppression of drug addiction has long been regarded by the Chinese Government as a very important task. Last year, I wrote an article on China's established policy in this field which was published in this Bulletin.*Now, I would like to describe, in the light of the aforementioned three topics, some of the methods and techniques that have been used in China for this important task.

A. DETECTION AND REGISTRATION OF DRUG ADDICTS

Anyone engaged in the work of suppressing drug addiction knows quite well that the detection and registration of addicts are extremely difficult tasks. That is because a person, once he has become a drug addict, will try to conceal this fact in every possible way, even though he is remorseful and wants to rid himself of his addiction. He is in a state of self-contradiction : he fully appreciates the measures taken by the Government to eliminate addiction and yet, for various reasons, he hesitates to submit to a cure.

This psychological state of self-contradiction may be attributed to the following causes.

  1. In general, drug addicts have an inferiority complex : they fear legal sanctions and social scorn. They think that once their addiction is exposed, not only they themselves, but also their families will be despised by the community. Hence, they just drag on from day to day, living a wretched life.

Vol. X, No. 1.

  1. Some people use narcotic drugs as medicaments for their ailments. These people fear that when they are discovered to be addicts by government authorities, the supply of narcotic drugs will be cut off and their chronic ailments will be aggravated. They know that using narcotics in this way is just like drinking poison to quench thirst and yet they do not want their ailments to become worse.

  2. Then there are the labourers who depend on narcotic drugs to keep up their strength. They are afraid they may not be strong enough to work once the supply of narcotics has been cut off and that they will consequently be unable to support their families. In order to continue making a living, they simply ignore the harmful effects of drug addiction, giving little thought to what may happen to them in the future.

  3. Lastly, there are those who use narcotics purely for pleasure. These people find stimulation as well as sensual delight in narcotic drugs. They would rather be the victims of this invisible killer than suffer momentarily and cure themselves of the bad habit. What makes the matter worse is that some of them have been wrongly informed that addiction to narcotics is incurable. Therefore, they do not want to undergo treatment if they can help it.

In view of the above, the first thing we have to do is to understand the psychological obstacles and remove them, if we are to succeed in converting drug addicts into new men. This undertaking can be likened to waging a battle with an enemy. A famous strategist of ancient China had some wise teachings which we can follow in our combat with addicts. He said : "To know your own plans and to be acquainted with those of the enemy means constant victory." He also said : "To conquer hearts is superior to attacking cities." Bearing these principles in mind, the Chinese Government has adopted the following two courses of action as its strategy and tactics in its battle with drug addicts :

1 . Drug addicts are encouraged to register voluntarily through persuasion and publicity campaigns. This action is comparable to calling upon the enemy to surrender in a battle. Its aim is to conquer without firing a shot. To achieve this, intensive publicity campaigns should be conducted on the widest possible scale. Facts about the highly damaging effects of narcotic drugs should be convincingly presented to the public. In order to overcome the psychological obstacles which prevent the addicts from taking the right course, measures for the implementation of narcotics laws that can help the addicts solve their problems should be widely publicized so that everyone is familiar with them.

The following are matters of importance at this stage:

  1. A deadline should be set for voluntary registration. A period of from one to three months would be appropriate. During this period drug addicts are expected to accept the advice of government authorities and appear voluntarily before narcotic treatment agencies for registration. The past of those registering would be forgiven. They should be treated with sympathy and kindness. The use of harsh words towards addicts should be avoided so as to build up their self-respect instead of aggravating their inferiority complex. But, at the same time, they must fully realize that the Government is determined to enforce its regulations for the suppression of narcotics, so that they know it is neither possible nor advisable to evade registration and so that they may avail themselves of this opportunity of self-salvation.

  2. The Government should visualize the worries of the addicts when they attend for registration and the difficulties that they will have to face after the cure of addiction. Appropriate arrangements should be made to assure the addicts of government help in solving their problems. For instance, in the case of those who use narcotics as medication for their chronic ailments, arrangements should be made to cure their ailments while they are undergoing treatment in respect of addiction. In the case of those who have been depending on narcotics to sustain their strength, assistance should be given to their families so that they do not have to worry about the livelihood of their dependents while being cured. After the addicts have been registered, the Government should arrange for the supply of drugs during the period when they go through the process of withdrawal. All this requires careful handling on the part of the Government, in order not to create any doubt in the mind of the addicts.

Of course, any promise made by the Government must be fulfilled. Empty promises should never be made because in the implementation of measures for the suppression of narcotics, prestige is of the utmost importance. Once prestige is lost, any amount of talking will be useless. This is a most important point to be borne in mind.

2 . Addicts are compelled to submit to treatment by means of inspection and exposure. This action is taken immediately after the period of publicity and persuasion. It is tantamount to the issue of an order to attack after the enemy has refused to surrender. A time limit should be set for this step to make it distinct from ordinary inspections and exposure.

Because the evil habit of using narcotic drugs is deeprooted, it is impossible to expect all the drug addicts to come out from hiding. Therefore, powerful political and social forces must be mobilized to force the recalcitrants. By setting a time limit, we serve a warning to the addicts that they cannot delay any longer, and at the same time, we seek to heighten the enthusiasm of the anti-narcotics personnel so that they can accomplish their mission of detecting the addicts in one drive.

It is to be noted that regular inspections and exposures are made in accordance with the laws and regulations for the purpose of uncovering new addicts or recidivists after the completion of the entire anti-narcotics campaign. In order to make a distinction between the regular ones and those that take place immediately after the period of publicity and persuasion, the latter have been designated as "general inspection" and "general exposure ".

Even in the period of general inspections and general exposure, the Government will give a last chance to the addicts who have not registered to come forth for "self-redeem registration" within one month. If an addict surrenders himself to a judicial or police organ within the period of grace, he will be treated with leniency. The difference between " self-redeem registration" and "voluntary registration" is that the former takes place at a later date and the registering addict should have been punished under the law. It is only because he does show signs of repentance by surrendering to the authorities that he is pardoned. On the other hand, an addict who voluntarily submits to treatment during the period of publicity and persuasion may be regarded as a sick person asking for help and has not yet become an offender in the sense of the law. That is why voluntary registrations are made with narcotic treatment agencies and those registering in this category are accorded special treatment; their names, for example, are withheld from publication.

Once the period of general inspections and exposures is begun, the following arrangements are to be carried out:

  1. Organization of inspection teams : inspection teams are composed of representatives of the agency directly responsible for the suppression of narcotics and of other organs concerned. These teams will visit various places, particularly places where night-life goes on such as dance halls, restaurants and amusement centres.

  2. Installation of information boxes : the general public is encouraged to give to the competent authorities oral or written information on drug addicts. If the informant so desires, his identity will be kept confidential.

  3. Intensification of the work of tracking down drug peddlers and uncovering addicts : drug peddlers under arrest will be called upon to name all the drug addicts to whom they have sold narcotics. By supplying this information, they will get a reduced sentence in return. Similarly, arrested addicts will be asked to name other addicts with whom they are acquainted.

  4. Signing of "inform-on-addicts pact" by households : households in the same locality are encouraged to sign such a pact undertaking to inform on any addict found in their midst. When signers to a pact have succeeded in keeping a good record for their locality, each of them will be awarded the title of "Honourable Household".

  5. Inspection of public and private hospitals and clinics : thorough inspections are made at these places to see whether any drug addicts have been admitted without proper authorization. At the same time, all medical practitioners are asked to submit a list of drug addicts who were their patients at one time or another.

  6. Examination of " suspected addicts" : addicts who have been arrested as a result of information received about them are called " suspected addicts ". Suspected addicts are referred to examining agencies by the competent authorities for examination. Upon confirmation of addiction, the addicts will be sent to narcotic treatment centres, together with examination reports and other necessary papers, for medical treatment. Their names will be posted in public places. They still have to stand trial upon discharge from the centres.

To ensure that the aforementioned two courses of action yield the desired results, the following basic principles must be observed.

  1. All the available forces for a general attack on drug addicts must be mobilized. There are addicts at all levels of our society. To uncover all of them requires not only the co-ordinated efforts of the various government agencies concerned, but also the enlistment of social forces. In other words, to uncover addicts is a responsibility of the Government andof every individual in society. Therefore, besides enacting narcotics laws, the Government should endeavour to cultivate a spontaneous anti-narcotics spirit among the people. We would thus have a powerful social force on the one hand and governmental action in the form of patient persuasion and intensive inspection and exposure on the other. Thus, faced with legal and moral sanctions, the addicts will come to realize that there is no hope of escape but to submit themselves to early treatment.

  2. We must be true in word and deed, and know the best way to attain results. Having the power is not enough; we must utilize it in the most appropriate way if we are to have good results. What often makes an addict respond slowly is that he wants to wait and see whether the measures taken by government authorities are in keeping with their words, and whether the implementation of suppression measures may not be obstructed by influential circles and become ineffective. Regarding the first point, it has been emphasized previously that the Government must keep its word. The best thing to do is to let the facts speak for themselves. For instance, excellent results can be obtained by including in publicity teams persons who have been cured of addiction and have actually received the benefits as promised by the Government. Regarding the second point, the doubts in the minds of the addicts can best be dispelled by making prominent persons in social and political circles primary targets when the two courses of action described above are followed. In this way, the common people can feel certain that the Government is serious in its intentions. The punishment of an addict belonging to influential circles serves most effectively as a warning to all others.

B. CONTROL AND TREATMENT OF ADDICTS

As a rule, drug addicts should be given medical treatment immediately following registration. However, in densely-populated areas, a great deal of equipment, much personnel and a number of treatment centres would be needed to give treatment to all registrants at the same time. When there are not enough facilities and manpower, the registrants have to be divided into groups for treatment at different periods. It has to be borne in mind that severe cases of addiction cannot be cured in a short time, and that some of the addicts who are old or sick will prefer to take treatment at home. Therefore, measures must be worked out simultaneously for the control of addicts and the treatment of addiction inside and outside treatment centres. Back in 1935, when the Chinese Government launched its programme for the suppression of opium in six years and other narcotics in two years, it adopted the following provisions :

  1. For drug addicts who have voluntarily submitted themselves to treatment, the competent authorities must prepare a list giving the name, sex, age, place of birth and occupation of each addict, to be forwarded to a narcotic treatment centre. Then, a time limit for complete cure is set for each addict according to his age, physical condition and degree of addiction. If, owing to old age or ill health, an addict is not in a condition to be cured of addiction within a short period of time, and his case has been verified, he may apply for a permit for the use of opium for a specific period. Such permits are issued in accordance with the yearly reduction schedule for reducing the number of opium addicts, as follows :

  1. For the first period, ending on the last day of 1936, the total number of addicts is to be reduced by one-fifth;

  2. For the second period, ending on the last day of 1937, the remainder from the previous year is to be reduced by one-fourth;

  3. For the third period, ending on the last day of 1938, the remainder from the previous year is to be reduced by one-third;

  4. For the fourth period, ending on the last day of 1939, the remainder from the previous year is to be reduced by one-half;

  5. For the fifth period, ending on the last day of 1940, the remainder is to be reduced to nil.

Permits are renewed at regular intervals, usually every six months. The following particulars must be shown on the permit:

  1. Addict's name, age, place of birth, address and occupation;

  2. Addict’s height, weight, features and characteristics;

  3. Addict's reason for being unable to cure addiction at the moment and name of examiner who certifies the validity of the reason given;

  4. Amount of opium consumed daily and type of opium used by the addict;

  5. Permit number, date and place of issue, and effective period.

  1. Permit-holders are required to buy opium from licensed opium stores in the place where they live. The permit must be shown to the dealer when making a purchase. Each purchase may not exceed the amount for ten days' consumption and the amount bought in each month may not exceed the amount allowed for the whole month.

If a permit-holder moves elsewhere or is travelling outside the city or district in which he resides, he is required to turn in his permit to local authorities at the place of arrival for transmission to competent authorities at the place of his original residence for cancellation, and to obtain a new permit from local authorities. If a permit-holder is on travel for only a short duration, he may obtain a traveller's permit by presenting his original permit.

  1. Opium treatment centres are to be established throughout the country. Addicts will be admitted to these centres for treatment at different periods. The following directions must be faithfully carried out in these centres :

  1. Addicts are to be treated with kindness and affection. The best medicine and the most effective method of treatment should be used so that suffering is reduced to the minimum. Careful observations must be made even of the "method of smoking" normally used by the addict and his "smoking habits" in order to give him proper treatment.

  2. As a general rule, addicts should not be allowed to leave the centre until they are completely cured of addiction and their health is restored. Particular attention should be given to those addicts who have been using opium as medication for chronic ailments. Their ailments should be diagnosed and given appropriate treatment with a view to curing both the addiction and the ailments.

  3. Treatment centres are to be managed by experienced personnel and provided with recreational facilities, so that when an addict leaves his home for the centre, he feels as if he is going on a holiday or convalescent trip, and not to a jail or place of exile. By making the treatment centre a comfortable and pleasant place for addicts, any unwarranted fears the addict may have will be dispelled.

  4. The boarding conditions in the centre may be divided into several classes. In principle, all expenses incurred should be borne by the addicts, but reductions in payment or total exemptions may be granted to an indigent addict. In so far as possible, arrangements should be made to reserve for an addict the position he held before entering the centre for treatment, and his family should be given financial or other forms of assistance by the Government in hardship cases, In this way, an addict does not have to worry about his post and his family, and can receive treatment with his mind at rest.

  1. For those addicts who have been permitted to continue smoking opium for a specific period of time during which they are to cure their addiction at home, the Government should provide effective withdrawal pills at cost. Indigent addicts may buy such pills at a reduced price or obtain them free. After addiction has been cured, the addict is required to pledge himself against recidivism, some of his relatives or neighbours acting as guarantors. He will be examined by competent authorities in the locality, and if everything is satisfactory, his name will be deleted from the Addict's Register. His permit should be turned in for cancellation at the same time. If an addict fails to cure himself of addiction within the allotted time, he will be sent to a centre for compulsory treatment.

  2. Following the proclamation of the decree for the suppression of narcotics within a specified time, the Government must also take stern measures dealing with the supply of narcotics. These measures are:

  1. Prohibition of the cultivation of opium poppies, to be carried out in stages : local governments will submit detailed reports on poppy-growing areas and acreage under cultivation. On the basis of these reports, the Government will issue permits for the cultivation of opium poppies in amounts to be determined by the Government on the basis of gradual reduction each year. The lands previously used for growing poppies will be planted with other suitable crops.

  1. Estimation of the amount of opium required for consumption and the enactment of regulations governing the procurement of opium : the Government will give special permission to a limited number of merchants to purchase opium in poppy-growing areas in accordance with the regulations. The opium so purchased will be transported via designated routes to various destinations where it will be stored in government warehouses for distribution. The amount of opium to be transported will be reduced each year, in line with the schedule for the gradual reduction of the use of opium. Illicit traffic in opium will be subject to severe punishment.

  2. Rigid control of the sale of opium : all opium dens and opium-stores will be ordered to close down. Only licensed dealers will be allowed to sell opium to the addicts. Anyone who secretly supplies opium to addicts is subject to heavy penalties.

In regard to methods of curing addiction, we have not yet been able to establish a standardized effective formula. The method to be used varies with the subjective and objective conditions of an addict, but broadly speaking, it is either the method of abrupt withdrawal of narcotics or that of gradual withdrawal. A detailed description of these two forms of treatment, together with the preparation formula for withdrawal pills and directions for their use, has already been given in the annual report of the Chinese Government for 1952* and therefore will not be repeated here.

C. PREVENTION OF RECIDIVISM

The most important task in the suppression of misuse of narcotics is not so much the curing of addiction as the prevention of recidivism. That is why workers in this field place much emphasis on the mental and physical rehabilitation of an ex-addict and regard after-care as of the greatest importance in the entire process of curing addiction.

During the period of after-care, attention must be paid not only to the restoration of the ex-addict's physical health, but also to the building up of a sound mind, the recovery of high spirits, the enhancement of self-confidence and the readjustment of moral conduct. In this connexion, the following points are generally accepted as being of considerable importance :

  1. Proper care. - Generally speaking, able-bodied young men who became addicts through keeping bad company can have their health restored quickly once they are cured of addiction. But in cases where the addicts used narcotics as medication for chronic ailments, whether or not the ailments will recur after addiction has been cured depends much on the proper care of the addicts themselves. As for those who are already weak and feeble because of their dissolute life and whose health has been further impaired by drug addition, proper care is of vital importance after the cure of addiction if they are to live long.

Doc. E/NR.. 1952/80, and Add. 1.

The most common affections in the after-care period are fatigue, sleeplessness, palpitations of the heart, night sweats, diarrhoea and backache. The convalescent, in addition to taking tonics, should pay attention to the following pointers forgood health :

  1. Mental condition. - The convalescent should live in a peaceful environment and keep away from anything that may cause sadness, fear or depression. Pleasant conversations with others, listening to good music and leisurely strolls can help to bring him ease of mind.

  2. Work and exercise. - Unless he is young and strong, the convalescent should try to give himself adequate rest. While work and exercise are not absolutely forbidden, overwork and vigorous exercises must be avoided.

  3. Food and drink. - Althougha convalescent can eat or drink almost everything that an ordinary person takes, he should abstain from alcoholic beverages, spices and any foodstuff that causes indigestion.

  4. Living conditions. - A convalescent should live in a well-lighted and well-ventilated place. As we know, addicts usually live a topsy-turvy life, sleeping in the daytime and becoming active at night. Thus, they have very little opportunity to benefit from sunlight. Also, since they stay indoors most of the time smoking opium, the air they breathe in is polluted with opium-smoke. All this is bad for their health and therefore should be changed after the cure of addiction.

  1. Change of environment. - Ananalysis of the causes of drug addiction readily reveals that bad influences in the social environment are the chief cause. In other words, the development of addiction has much to do with the place where the person lives and the people with whom he comes into contact. Therefore, his removal to a new environment when cured deserves serious consideration.

Some time in the past, when treatment was given to a large number of addicts, the Chinese Government adopted various measures for their rehabilitation, taking into account the age, ability, physical strength and financial situation of the addicts. These measures were intended to change the living environments of the addicts, to give them guidance and training for employment and to build up their constitution.

Under these measures, the young and able-bodied addicts were organized into working teams by local authorities to be trained and assigned to various places to build roads, open up waste lands or construct fortifications. Craft centres were also established, where the addicts could learn handicrafts and the making of articles in everyday use, such as furniture and utensils, and learn to live a regular and disciplined life. Profits from the sale of such products all went to the addicts who made them. It was found that the more money an addict earned, the greater was his desire to work and the less the chance of recidivism.

As to addicts who were well-off and capable of working but were idle at home, the Government assisted them in finding employment. Those who were working were encouraged to change to other types of employment. In both cases, taking employment in a new place was most desirable. Addicts who were labourers depending on narcotics to sustain their strength, were helped to find lighter work after treatment so as to prevent recidivism.

  1. Psychological reform. - Since drug addicts have an inferiority complex, the basic remedy is to build up their self-respect and dignity. For this purpose, measures along the lines given below were formerly employed by the Chinese Government with satisfactory results.

  1. Formation of anti-narcotic associations throughout the country. - Theseassociations should include among their members prominent persons in the community and former addicts who have stopped using narcotics after being cured of addiction. The purpose of including former addicts in the membership is to honour them and set them up as models.

  2. Organization of celebration meetings. - Local residents hold celebration meetings for addicts who have been cured of addiction. The addicts so honoured will be invited to address the gathering, giving an account of their personal experience in receiving medical treatment and a pledge never to use narcotics again.

  3. Signing of non-recidivism pacts among ex-addicts. - Signers of such pacts will make their pledge in a public gathering to show their determination to abstain from narcotics. To those who have lived up to their pledge, the local government concerned will award the title of " Honourable Resident" as a means of encouragement.

  1. Diligent surveillance over ex-addicts. -With the exception of those who remain in the treatment centres to convalesce and those who are receiving productive training, addicts who have been cured of addiction are placed under the supervision and care of their own families. Local authorities will keep a list of ex-addicts and send inspectors to call on them from time to time to observe their behaviour and activities. In the supervision of ex-addicts, particular attention should be given to the following points.

  1. Addicts belonging to the following groups are the most likely to become recidivists and additional measures should be taken to prevent such an eventuality in their case :

  1. Those whose submission to treatment was not voluntary but was due to the fact that they were discovered to be drug addicts;

  2. Those whose voluntary submission to treatment was actually made under pressure from members of their families; or

  3. Those whose submission to treatment was due to the fact that they were no longer financially able to continue using narcotics.

  1. Ex-addicts should be kept away from improper places and bad people. At the same time, inspection personnel should watch closely for possible hiding places for narcotic drugs.

  2. Very often, addiction is formed through the prescription of narcotic drugs by incompetent physicians, or through the indiscriminate sale of drugs containing narcotics by drug stores. Hospitals, clinics, doctors' offices and drug stores where such cases occurred should be placed under constant inspection. Observations should also be made to see whether former addicts still go to these places for treatment or to buy drugs. If there are such cases, they should be thoroughly investigated.

  3. When it is found that an ex-addict has moved elsewhere, the reason for this move should be ascertained and the local authorities in his new place of residence should be notified. Similar contacts should be maintained between the local authorities concerned even when the ex-addict's stay in a new place is temporary.

  1. Heavy penalty for recidivism. - The basic principle adopted by the Chinese Government for the work of suppressing narcotics is : "Use patient persuasion before applying stern penalty." Considering that most addicts have fallen into the evil habit of using narcotics through no desire of their own, the mistake they made is forgivable, and an act of leniency towards them will enable them to respond to reform. However, resumption of the use of narcotics after cure is inexcusable, for there is no valid excuse which can be given for doing so. A recidivist cannot say that he is using narcotics as medication for his chronic ailment, since his ailment has already been cured. If the resumption is for the sake of pleasure, then the recidivist must lack all restraint; otherwise he could not have forgotten the sufferings he went through. That is why the Chinese Government has taken a policy of stern punishment for recidivists. Under the provisions of article 9 of the present "Regulations for the Suppression of the abuse of Opium and other Narcotic Drugs during the Period of National Emergency ", narcotic addicts are liable to imprisonment for from three to seven years for first offence; to imprisonment for a term equivalent to one and two-thirds of the original sentence for the second offence, and to the death penalty for the third offence. Ever since the enforcement of these regulations, very few cases of recidivism have been reported, and new cases of addiction have been still fewer. These facts show that the regulations are very effective.

As can be seen from the above, our combat against drug addiction consists of a series of measures ranging from education and persuasion to severe penalties. These measures, to be carried out in stages, would take some time to accomplish. Since each stage is closely related to the others, goodco-ordination is needed to ensure success. Any laxity, interruption or lack of co-ordination will seriously affect the continuity of the work, and might even cause it to end in failure. It is therefore very important to make full preparations before the order for the suppression of drug addiction is issued. An accurate estimate of the manpower and other resources required must be made beforehand, and these resources must be used in the most appropriate way until the entire work is accomplished.