Drug abuse and criminality
V. Treatment options
VI. Drug abuse, crime and human rights
VIII. Organization and administration
IX. International co-operation : perspectives and prospects
Pages: 49 to 61
Creation Date: 1973/01/01
Part II **
V. Treatment options
A. The context of treatment
B. Some forms of treatment
1. Abstinence programmes
2. Chemical maintenance and blockage programmes
4. Therapeutic communities
5. Self-help peer groups
6. Community consultation and crisis intervention centres
7. Multimodality treatment programmes
VI. Drug abuse, crime and human rights
VIII. Organization and administration
IX. International co-operation: perspectives and prospects
* Document E/AC.57/4.
** Part I of this article was published in No. 4 of volume XXIV.
The increasing problem of drug abuse and related criminality in many countries and the outright failure or, at best, limited success of the traditional approaches to treating drug abusers has underlined the need for new and more viable options, and a number of countries are currently experimenting with treatment methods that would appear to show some promise. The term "treatment" can be used in different connexions, including the penal disposition of cases (or civil procedures substituted for it), the medical attention given, the social and psychological services provided etc. The first-mentioned aspect has been dealt with in the preceding section; the concern here is with the more genuinely therapeutic methods. With all due recognition of the need for individualized treatment, emphasis here is on the delivery of large-scale treatment rather than on a conventional casework approach which would be prohibitive to the developing countries and not necessarily effective. This thinking is in line with the recommendations of the Commission on Narcotic Drugs and other bodies which have stressed the need to concentrate on target populations and methods likely to yield maximum returns and on mass treatment.
The limitations of treatment in the traditional penal institutional setting are self-evident; the drawbacks of a quasi-penal though ostensibly civil committal have already been noted, as has the fact that progressive treatment practices can, in principle, be applied across what has in recent years become really a continuum of measures with differing degrees of freedom and control. The least desirable end of this range - i.e., treatment in prison or quasi-prison - may mean, depending on resources, treatment in special institutions (though rarely) or in hospital wings or treatment wards (e.g. in Sweden) or a less structured approach; more often, it means not-so-benign neglect. Some countries have tried to distribute drug abusers among their different prisons to avoid what they consider the danger of "contamination" of the rest of the prison population by the addicts, little attention seems to have been given to their contamination by really criminal elements. Assuming that some reasonable attempt at treatment is made, it might include detoxification, chemical therapies, group counselling or therapy, some vocational rehabilitation and an attempt at after-care.
It has been noted that after the initial withdrawal period, the period of drug-free incarceration may not be as difficult for the addict as the renewed exposure to old stresses and temptations which he faces upon release. It has been estimated that some 90 per cent of addicts return to addiction and street crime upon release from prison. [ 50] There may be many reasons for this, but it is clear that after-care must be strengthened and begun immediately upon leaving prison. The disabilities suffered by addicts, because of their frequent criminal records and their previous addiction, militate against adequate job placement; coupled with the addicts' rather low frustration tolerance and general lack of good work habits, the prospects are discouraging. The period of institutionalization is usually too short to change basic life styles, and the question arises anyway of whether living in the world can be learned while removed from it. Where the legislation requires a penal or quasi-penal approach, the provision of suitable treatment on probation, parole and in intermediate settings (half-way houses, hostels etc.) would seem to be highly preferable.
Where diversion from the criminal justice system can be effected actually and not just nominally, a genuinely medico-social approach to treatment should be instituted. The 1963 Narcotics Control Law in Japan, for example, introduced a system of compulsory hospitalization and rehabilitation for narcotic addicts (as well as strict measures against illicit narcotics trafficking). The heroin addiction problem has successfully abated, though other problems have arisen (see footnote 34 in Part I). Different combinations of treatment venues are needed and should receive more experimental attention. [ 51]
The treatments listed below can be carried out in different settings, though some settings are better suited for the use of certain methods than others.
Detoxification and abstinence procedures are the most accepted and least controversial. But unaccompanied by supportive services (and often even when they are) they have had an alarmingly high attrition rate. These procedures may reduce the habit and decrease its cost and criminal activity for a period - usually all too briefly. They may also be a stepping-stone to other, more lasting, treatments. This underlines the importance of filling the vacuum created by separation from the drug and the life-style connected with it with meaningful and rewarding experience that might compensate at least for the psychological if not the physiological deprivation suffered. Some programmes where an intensive effort has been made in this direction report encouraging results. [ 52]
In the mid-1960s, the oral use of methadone was perfected as a technique for helping addicts abstain from heroin. Methadone, a synthetic narcotic, prevents withdrawal symptoms and satiates the addict's craving for heroin; although it is addictive, it has advantages over heroin: its effect lasts 24 hours as compared to heroin's four to five; no euphoric effect is associated with oral administration of the drug; dosage can be stabilized at a fixed amount. Methadone has been given to addicts in different settings and the experience to date seems sufficiently encouraging (see pp. 53-54 below) to have led to large-scale expansion of its use though still primarily on an experimental basis.
Although heroin maintenance has been criticized as perpetuating addiction and past programmes utilizing it have had to be substantially revised, it has particular scope in attracting addicts who do not succeed on methadone or who do not volunteer for it in the first place. The main arguments for this alternative is that it would break the market for heroin and reduce the impetus for expansion caused by the high profits of illegal distribution. While there are limitations inherent in this procedure (difficulties of dosage stabilization, decreased motivation for rehabilitation etc.), it might offer scope for carefully controlled and monitored small-scale programmes.
Narcotic antagonists such as cyclazocene and naloxone block heroin's euphoric effect on the central nervous system, but do not satisfy the addict's continuous craving for heroin. Their use is based on conditioning theory and on the belief that addicts can be deconditioned - i.e., freed from addiction and the compulsive craving for heroin. So far, this technique has not worked with any significant number of addicts and serious side-effects have been reported. The development of a safe anti-addiction tool with a long-lasting effect could greatly advance the treatment of drug addiction.
Traditional psychiatric and psychotherapeutic approaches appear to have been largely unsucessful with addicts. If the sociopathic analogy has any validity, the prognostic parallel may be recognized. Addiction is not necessarily a personality disturbance, though personality problems may underlie a resort to drugs. Addiction is, however, a behaviour disorder and the traditional therapies relying on verbalization have proved largely ineffective in such cases. Recent experiments with "reality therapy" and "aversion therapy" (based on the principle of operant conditioning, or rather of de-conditioning, but through psychological rather than chemical means) have claimed some successes. Still other approaches using variants of group therapy such as "family therapy" and "encounter therapy ", may have special potential for addicts and drug abusers since they attempt to tackle the frustrations and deeper needs which may have led to initial drug use.
In recent years, in certain countries a number of "therapeutic communities" have been formed where the total (generally residential) environment is utilized in the attempt to restructure the addict's personality and life style. The basic approach has been to select addicts with high motivation and expose them to the influence of the self-regulating therapeutic community. There is stress on intensive group therapy, on counselling by ex-addicts, and on mutual support and aid rather than treatment by mental health professionals. This is a reflection of the trend of the past decade towards self-help community action and a rejection of services furnished exogenously. In spite of the effectiveness of this approach for those who remain in the closed community, attrition rates have still been high and careful evaluation studies are lacking.
There has been a trend in a number of countries for young people to initiate self-help schemes to aid those amongst them with special problems, such as drug misuse. A number of these have been supported by private trusts and foundations as well as by official sources. Some youth movements with a social, religious, or "back to nature" orientation have stressed the need to prevent "internal pollution" as well as the importance of retrieving and sustaining former drug users. The sense of purpose and the mutual concern of some of these movements have succeeded in endowing some lives with a meaning they previously lacked, thus reducing the need for artificial substitutes. Peer pressures and activities of different kinds, related particularly to national and community needs, would seem to offer a vast and still largely untapped resource that offers significant scope.
Community mental health and welfare centres have been assuming increasing importance in both developing and developed countries, ensuring a more effective pattern of distribution of services at the local level. They seem to offer special scope for both prevention and treatment of drug abuse, including alcoholism. 53 Free clinics staffed by interested professionals, experienced youths and volunteers, have sprung up in some cities primarily for the purpose of offering emergency services to deal with the psychological as well as physiological effects of overdoses of drugs not requiring hospitalization, e.g. cannabis, hallucinogens, barbiturates (except for large overdoses which, as in the case of heroin, present a threat to life) and amphetamines (whose violence-prone users tend to avoid hospitalization for fear of arrest) and mixed drug use. 54 In order to exert a more lasting impact, some of these centres have begun to offer long-term help in a variety of other problems of human malfunctioning. 55 Such centres can also act as points for referral to other services providing specialized care.
Programmes offering a range of treatment alternatives, or a combination of them, would seem to have particular scope for the treatment of addict/offender. They are more likely to attract addicts, to preserve respect for human rights and human dignity by providing an element of choice of treatment, and to permit directing of addicts from one treatment modality to another, as well as their transfer, in accordance with their special needs. Although typologies have not yet been worked out enough for evaluative studies conducted to permit the relative prediction of success, some efforts in this connexion have been made. 56 Multimodality programmes would thus tend to decrease failure rates of individual methods, help them to contribute to each other, promote new strategies and permit savings through the pooling of staff and facilities. The scope of this approach, however, will have to await further research comparing the success of the different techniques of multimodality programmes with that of comparable techniques used alone.
The importance of long-term objectives and of a systematic evaluation of programmes for the treatment and prevention of drug abuse is generally admitted: yet careful evaluation has been seriously lacking in most of the programmes introduced. This has been due, in part, because of the urgency with which some programmes have been instituted to cope with the growing drug/crime problem and in part because of inherent difficulties in the programmes developed, including the definition of treatment goals and the determination of appropriate measures for success and failure. The criterion of total abstinence is an obvious test, but it may be too extreme and its use has been questioned. Assessment of the range of possible benefits and adverse effects that can be produced by different programmes often involves value judgements. Sound multifactor evaluations assume increasing importance with the growing complexity of approaches such as multimodality treatment. The importance of built-in evaluation schemes in continuing programmes, pilot and demonstration projects, has been emphasized by expert group meetings in both the drug abuse and the crime fields: it has been stressed by the Commission on Narcotic Drugs in its recommendations for action.
Some recent pioneering attempts at more rigorous evaluation have used a set of criteria including decreased antisocial behaviour, demonstrated by the absence of arrests or incarceration. 57 Measured by these criteria, methadone maintenance was deemed to be the most effective procedure. A sharp decrease in crime as shown by the arrest rate of the methadone-treated population was recorded, as well as a steady and marked increase in the employment rate. [ 58] The expansion of this treatment method has been undertaken as a result of this study and is being undertaken increasingly on an out-patient basis. It has, however, been emphasized that any treatment programme using methadone maintenance must be prepared to provide a broad variety of supportive service to deal with problems that include mixed-drug abuse, chronic alcoholism, psychiatric or behavioural problems as well as a variety of other social and medical problems.
In some countries, ambitious efforts at evaluation are being conducted in an effort to correct apparent shortcomings of past evaluation efforts. [ 59] Emphasis has been placed on the significance of differences in patient composition and on the limited utility of arrests as an index of criminality, in view of the fact that it is not a simple function of the volume of crime committed, but varies with the type of crime favoured by an offender and the level of police activity at any one time. A simple reduction in arrests may not always imply a comparable reduction in major crime.
To sort out the complex web connecting addiction, crime and treatment, a longitudinal perspective on criminal behaviour as it relates to addiction is essential. More sophisticated procedures being developed to provide such information will also make it possible to isolate the impact of treatment programmes and their different facets on deviant behaviour and to make comparisons.
The treatment of drug addicts and drug-related offenders raises certain problems of human rights. In this area, there is indeed considerable scope for co-operation across divisional lines encompassing the Commission on Human Rights, the Commission on Narcotic Drugs, and this Committee, as well as the interested specialized agencies and organizations.
The concern with the safeguarding of human rights in the administration of justice and the recent pleas for the observance of the basic rights of prisoners have special poignancy in the case of drug addicts whose affliction would seem to be severe enough punishment in itself - if punishment is what society demands of its control apparatus, and in spite of protestations to the contrary, it still largely does. Although in some countries a medico-social approach is genuinely accepted, in far many more a moralistic approach prevails with the old adage of" let the punishment fit the crime ". Even if this tenet is adhered to, the punishment is usually disproportionate to the offence and could often be easily construed as "cruel" and hence inconsistent with most constitutional provisions and the Universal Declaration of Human Rights.
In civil committal, which has been referred to before, the criterion for committal is usually not the test of dangerousness or helplessness (in accordance with the legal doctrines of parens patriae and the power of the State to take steps for public protection although many of the persons concerned are neither dangerous nor helpless) but, rather, the criminal act. Mention has been made of both the shortcomings of such quasi-criminal procedures and the need for appropriate remedies if they are to be effective.
Other questions of human rights arise with respect to such treatment procedures as methadone maintenance. The issue here is of whether the creation or continuance of a serious medical disorder - physical dependence - is warranted in order to decrease antisocial behaviour - the community's primary concern. Critics of such treatment procedures have also argued that a coercive system which forces the addict to accept methadone maintenance or other treatment procedures as a condition of probation and parole is a violation of civil liberties. Others, however, have underlined that the realistic choice lies between an addict being, for example, on methadone or in prison, and that accepting the treatment alternative gives addicts an option they would not otherwise have. This, of course, raises the whole question of freedom of choice of treatment or non-treatment which has also been posed in wider connexion and which involves the difficult problem of the rights of individuals versus the rights of the community as a whole.
The provision of a range of alternatives having a valid rationale and reasonable prospects, so that some degree of choice may be exercised within a broader therapeutic model, does perhaps most adequately meet the different considerations involved, but any final conclusion must await additional evidence and experience. This area should provide fruitful ground for joint efforts by the several divisions concerned and the Committee might wish to make its recommendations as to whether and how this work should proceed.
The desirability of a multidisciplinary, multimodality approach to problems of drug abuse has been repeatedly emphasized at recent meetings and in other connexions. Training for the different kinds of personnel dealing with drug abuse and abusers is largely lacking and urgently needed. Some training would relate to the special expertise of the particular disciplines and services concerned; other elements could be imparted jointly. Different kinds and levels of social defence personnel obviously require this kind of special training, as do the medical and social services, teachers and school authorities, community workers etc. Experiments with training cutting across professional and administrative lines have had a significant measure of success - in the United Kingdom, for example, where prison and medical personnel have been brought together for joint training and problem-solving sessions, and in Switzerland, where doctors and members of the press have jointly sought more effective approaches to drug abuse and abusers. In fact, joint training focusing on problems of mutual concern not only adds specialized expertise and operational skills, but helps to open channels of communication and to improve co-ordination and co-operation between the different agencies and services concerned.
The United Nations regional social defence institutes have a very helpful role to play in this respect. The regional institute for the Middle East has conducted research in the field of drug abuse and has expertise in this field that can be constructively utilized for the benefit of the countries of the region. The United Nations Asia and Far East Institute for the Prevention of Crime and the Treatment of Offenders at Fuchu, Japan, can call upon substantial Japanese experience in dealing effectively with narcotics problems. The international training courses held at the institutes usually have a special theme reflecting the main focus of the course, and courses in the various aspects of drug abuse could easily be introduced. The fact that many of the trainees are in policy-making positions and play an active role in their countries upon their return would help to ensure the impact of such courses and to promote regional co-operation on problems of drug abuse.
One of the most significant innovations regarding personnel working with addicts and the prevention of drug abuse is the use of selected ex-addicts for this purpose. This extension of the trend begun by Alcoholics Anonymous is reflected in the growth of self-help movements based on the credo that only "the blind can help the blind ", but it is also a manifestation of a wider movement to use paraprofessionals in a variety of roles. The use of ex-prisoners in the rehabilitation of prisoners has received considerable attention in recent years and the hopes for it seem to have been well-founded. The use of ex-addicts as a valuable resource for the treatment of drug abusers and as preventive agents seems to be substantiated by the experience to date in a number of countries - in Turkey and the United States of America, for example - though better evaluation of their use and more specific indications for their deployment and training are still required. Special attention needs to be given, especially in the developing countries, to the possibility of making more profitable use of multipurpose workers able to cross professional frontiers and to the value of holding crash courses given by mobile training teams to help alleviate and forestall serious problems of drug abuse and related criminality.
One of the main reasons for the limited effectiveness of past efforts at drug-abuse prevention and control is that they have often been fragmented, unco-ordinated and they were largely palliative. The need to ensure a better deployment of resources bas been stressed by the Commission on Narcotic Drugs and by concerned observers in different countries. In recognition of the importance of a more coherent and economical approach, some countries have established central agencies to oversee, monitor and sometimes also finance official action for drug abuse prevention and control. [ 60] Other countries may find it opportune to establish interministerial committees to co-ordinate action against drug abuse, which cuts across administrative lines, ensuring some continuity and a relatively constant level of activity. [ 61] Attempts have also been made to integrate nonofficial action so that the essential element of public participation in and support of preventive and treatment programmes can be maximized. [ 62] In some countries, there have been intensive efforts to mobilize citizen action as an adjunct to official police activity aimed at the identification of " pushers". It is most important that in efforts of this kind the goals be realistic and that appropriate channels for public participation are open. [ 63] Special efforts should be made to enlist the co-operation of groups that have remained largely uninvolved (for example the drug industry). Public support of programmers is essential in ensuring their success and in helping to remove the social and economic disabilities so often imposed on former ex-addicts and ex-offenders. The exact balance of action at the central and local levels will vary with individual countries and specific contexts.
In gauging the nature and scope of required action to deal with the drug abuse/crime problem, some countries have found it useful to establish special commissions of inquiry which have assessed the gravity and extent of the country's drug-abuse problem and made often far-reaching recommendations for future action. [ 64] Special advisory councils, criminal law reform commissions and other bodies operating on an ad hoc or continuing basis have a useful role to fulfil in unifying national action against drug abuse as it relates to crime and other problems, in establishing priorities, in monitoring and assessing progress in implementation, and in pinpointing areas of continuing need. [ 65]
It has to be recognized however that Commissions, Committees and special bureaux alone will not deal with a problem as pervading and as multifaceted as that described in this paper. Nothing less than a total governmental effort to deal with the problem, backed by close international co-operation and enlisting the whole range of public support, can possibly succeed. This calls for a major effort by all concerned to overcome the problems of co-ordination which typically hamper such major efforts at the national and international levels.
The presence of so many organizations with responsibility for different aspects of the narcotics problem poses a major issue of effective co-ordination nationally and internationally. In the international sphere the United Nations has been called upon to assume a major role in this regard; and within the Organization the Commission on Narcotic Drugs and the International Narcotics Control Board occupy strategic positions. The ramification of the problem are wide enough, however to, ensure that no area of United Nations activity is without some interest and responsibility for the drug-abuse problem. Politically, economically, and socially it has its effects.
The crime aspects of drug abuse are equally a part of the major problem of crime prevention and control for which the committee carries responsibility. Its major concern, therefore, is to ensure that the prevention of the amount of crime deriving from drug abuse or induced by the attractions of illegal profits receives adequate attention by all concerned.
The Committee is aware of the existing resources for carrying out this work, which include a small staff at Headquarters, the United Nations Social Defence Research Institute in Rome, which has been in direct consultation with the Division of Narcotic Drugs, the regional social defence institutes and interregional advisers, the special experts advising Governments on different aspects of social defence, and a network of over 200 national correspondents in 75 countries.
Since the crime/drug syndrome is difficult to disentangle, there is a need to provide for the maximum possible co-ordination of efforts and for the cross-fertilization of expertise and experience. It would seem to be important to arrange for the social defence programmes to be represented on all bodies dealing with drug abuse and international trafficking in narcotics and to be provided with the information which might flow from the work of the other functional bodies of the Organization; the Committee will, in turn, undoubtedly wish to invite the representatives of the Division of Narcotic Drugs to participate in the Committee's work on a continuing basis and in other appropriate social defence meetings. The Committee might also wish to recommend the kind of consultative arrangements between the respective programmes that would enhance the future co-ordination of work and long-term co-operation.
Secondly, the need to include the prevention of drug abuse in broader projects for social defence planning is self-evident and this concern for planning should be carried into broader national planning where it is appropriate to deal with the growth or commercialization of drugs. This is no mere academic or conceptional issue which can be dealt with by crime and crime/drug problems being given a nominal place in the discussions on economic and social development. There is a real need to ensure that in the allocation of resources at the highest level, crime and the crime/drug problem are given adequate attention. This means providing eventually the trained social defence planners able to work with economic and social planners in preparing long-term policies and programmes for the prevention of crime - including the prevention of crime related to drug abuse.
The United Nations work programme in the field of social defence for the next several years includes a number of items having direct relevance for strategies to deal with problems of drug abuse. As mentioned earlier, drug-abuse aspects can profitably be included in the items on social defence policies in relation to development planning and on public participation in the prevention and control of crime and delinquency. Work is also proceeding on the Standard Minimum Rules for the Treatment of Prisoners, and an Expert Working Group on the Rules will be convened in September to consider their possible modification and better implementation and reporting procedures. In its review of the standards for the treatment of special groups of prisoners, the Group can well devote attention to the standards required to ensure adequate treatment for imprisoned drug addicts. The social defence programmes are concerned with the transnational aspects of crime and strategies for its control and prevention. It has been intended to give special emphasis in this work to the problem of drug abuse in all its ramifications and to the international arrangements and strategies required to cope with it. In 1973 work will be initiated in preparation for the Fifth United Nations Congress on the Prevention of Crime and the Treatment of Offenders. The Committee might give special attention to placing on the Congress agenda a possible item dealing with the problems of transnational crime, of which those relating to drug abuse are an important aspect.
Taking into account the work of the Commission on Narcotic Drugs, the Committee will probably wish to urge that the network of administrative arrangements to control transnational crime - which includes drug-trafficking as well as counterfeiting, aerial hijacking, kidnapping, extortion and other transnational offences - should receive intensified attention of Members States of the United Nations. In view of the international nature of drug offences and the imprisonment of drug offenders of different nationalities by several Governments, there is the need for suitable arrangements between Governments for the exchange of such offenders and for sentences to be served in the offenders' home countries.
Items on which work is to be initiated in the forthcoming years, such as those on educational policies and on child-rearing practices and delinquency prevention, can usefully include, also, the prevention of drug abuse (for example, among the children of addicts). A project on youth and drug abuse is to be undertaken, in pursuance of General Assembly resolution 2859 (XXV), in eight countries. A study on the subject might also explore the peer-group role in drug abuse as related to delinquency, and in their control and prevention.
In the proposed efforts at collaboration, the greatest emphasis will naturally be placed - as the Commission on Narcotic Drugs has requested - on projects having implications for practical action. Here the use by the Commission on Narcotic Drugs, the Commission for Human Rights, and other United Nations bodies of the facilities available at the regional institutes (established or to be established) merits special consideration. In addition to including in their training courses the question of drug abuse and strategies against it, and of co-sponsoring and/or participating in subregional and national workshops and study tours - for example, of the kind conducted in several countries of the region by the Division of Narcotic Drugs in 1968 with the participation of the then director of the United Nations Asia' and Far East Institute for the Prevention of Crime and the Treatment of Offenders at Fuchu, Japan - with a strengthened research capacity the institutes could also help significantly in conducting special studies of narcotics/crime problems in their regions and in devising policies and programmes adapted to local conditions to cope with them. They could develop training materials for workers in this field and for self-help projects, which could be used later in the proposed correspondence courses on planning for social defence. On the research side the United Nations Social Defence Research Institute in Rome is already active and its contribution will be dealt with by its Director in his report on the Institute's work.
No doubt the Committee will share the belief of the Commission on Narcotic Drugs in the value of case studies, pilot and demonstration projects as an instrument of action-research designed to guide practical action, testing joint conclusions and applying recommendations. Such projects, focusing on the different aspects discussed above, utilizing basic findings and experimenting with promising approaches, offer fruitful prospects. However, the success of such measures depends greatly upon the projects and the personnel required to operate them. Above all, in this field, they depend upon care being taken not to dissipate resources in minor modifications of approaches already very questionable. The interregional advisers on social defence and the regional social defence institutes can fulfil a useful role in suggesting, initiating, monitoring and helping to evaluate such projects.
The last-mentioned function can further benefit from the work which the Secretariat will be undertaking on the evaluation of methods for crime prevention and control. This could well be designed to incorporate programmes for the prevention and control of drug-related crime and to help meet the recommendations of the Commission on Narcotic Drugs stressing the need for the scientific evaluation of procedures. There is ample and obvious scope for the experience of different countries with the drug/crime problem to be compared and for specific demonstration projects to be designed using different kinds of legal and rehabilitative approaches. This has not been tried before on any world scale, but it presents no insuperable problems if carefully organized by countries prepared to co-operate.
The Committee may wish to endorse the intention of the Secretary-General to explore the possibility of carrying out, within the limits of the existing resources an over-all evaluative study of measures likely to work, with respect to both the legal and rehabilitative aspects of the crime/drug problem, consisting primarily of a survey of the existing literature from a policy-making point of view. The aim would be to provide an analysis of the experience of the various countries in handling the problem of crime/ drug abuse for the benefit of Member States.
As indicated, the effort will evidently be made to ensure the most rational utilization of existing resources and to integrate the work on drug abuse aspects with other continuing activities. An effective contribution could also be made to the collection and exchange of information on the crime-related aspects of drug abuse and on strategies for its control and prevention that could be useful to the Commission on Narcotic Drugs, Governments and interested organizations in strengthening and supplementing their work in this field. The development of information systems could provide a useful source of expertise and experience in tackling the seemingly intractable problem of crime/ drug abuse which has to date received only scant attention.
Information is regularly being obtained, through the network of over 200 national correspondents in the field of social defence in some 75 countries, on developments in crime prevention and control. This sometimes includes data on the problem of drug abuse and measures being taken against it. Reporting on this aspect could be made more systematic; the correspondents also disseminate United Nations materials and recommendations and could well include information on drug abuse in this function. Together with the Social Defence findings; those of co-operating non-governmental organizations, and the information derived from the regional institutes and interregional advisers, this could provide, with the adequate support, the elements for effective datagathering to help the Division of Narcotic Drugs in discharging the functions with which it has been entrusted.
EDITOR'S NOTE. Reproduced below are some of the highlights of the Committee's discussion of this paper, contained in its report *
The Committee took the view that there could be no single system for national action to deal with drug problems, national efforts needed to be supplemented by international cooperation. Moreover, the best legal and technical controls could be no substitute for measures to change certain attitudes and value systems which were promoting the misuse of drugs, seeking to develop a more tolerant society.
Any national programme to deal with the crime-drug problem would need to include an awareness by police and the courts of their preventive role and that would have to be supported by adequate therapeutic measures including adequate therapeutic and rehabilitation centres. If it was hoped to obtain satisfactory results, a national programme would need to proceed from a flexible concept of deviance since it was obvious that, as the values in a society changed and the habits of people were transformed, the older and narrower legal definitions or local outmoded standards could even become criminogenic factors in themselves. However, in that area it was understood that a great deal more research would be needed and a great deal more field work would have to be done.
Attention was invited to new legislation which had been enacted in some countries making it possible to handle the problem of drug control and the repression of drug traffic in much more efficient and flexible ways - adopting subtler techniques for the rehabilitation and treatment of addicts. It was recommended that the relationship between traditional forms of drug use and their transformation into more harmful practices and abuses should be studied in depth.
It was felt that an increase could be expected in the over-all problem. The indications were that where crime and drug abuse were linked, they were often associated with deep personal problems, or psychological or psychopathic disorders so that even after the drug phase had passed, other difficulties might be expected. The criminal aspects of behaviour which exploited such disorders or weaknesses for profit had particular significance. For that reason, the importance of dealing with the sources of the drug problem in supply and trafficking should receive far more attention.
The Committee noted the reference to the tremendous potential for more effective action which lay in the various regional institutes - the United Nations Asia and Far East Institute for the Prevention of Crime and the Treatment of Offenders at Fuchu, Japan, the National Center of Social and Criminological Research at Cairo. The proposal to have a United Nations institute in Costa Rica was particularly supported to provide maximum effect on the drug problem in that region. The great importance of using these institutes more effectively to deal with the crime-drug problem either in training, research or in the elaboration of pilot or demonstration projects could hardly be over-estimated. The Committee hoped that the various funds and agencies, national and international, dealing with the drug problem would use these crime prevention institutes more effectively.
Furthermore through the United Nations Social Defence Research Institute in Rome it might seek to make use of all the procedures mentioned such as, for example, interrepresentation on the various committees, the use of national correspondents, interregional advisers and the various approaches through technical assistance channels. There was a particular need to select some of the most effective examples of recent legislation for evaluation and dissemination. This would be one of the projects for consideration by the sub-committee to be set up to consider an international plan for crime prevention.050p000
50. United States Comptroller General, "Limited use of federal programmes to commit narcotic addicts for treatment and rehabilitation" (20 September 1971).051p000
51. See, for example, G. H. Starkey and D. J. Egan, "Combined treatment of the criminal opiate addict by medical and law enforcement professions ", Third National Conference on Methadone Treatment (Rockville, Md., United States National Institute of Mental Health, 1971), Public Health Service publication No. 2172, pp. 108-110.052p050
52. See, for example, Robert I. DuPont, "Heroin addiction and crime reduction", American Journal of Psychiatry, Washington, D.C., vol. 128, No. 7 (January 1972), pp. 856-860.053p050
53. See, for example, V. N. Guzhevskii and N. G. Ostashevskaya, "Opyt organizatsiii/ spetsializirovannoi narkologicheskoi sluzhby v promyshlennom gorode" (Experience in the organization of a specialized narcological service in an industrial city) Soveskoe Zdravookhran yenye, Moscow, vol. 29, NO. 2 (1970), pp. 24-27.054p050
54. In Italy and some other countries, telephone consultation services provides advice on drug-abuse problems and professional help in an emergency where needed. See Breda, op. cit., p. 443.055p050
55. The Center for Special Social and Health Problems in San Francisco, for example, is concerned with drug abuse, sexual problems, violence and hatred, compulsive gambling, suicide, management of death and dying, crime and delinquency, inability to manage finances, obesity and insomnia.056p050
56. See, for example, James A. Inciardi, "The use of parole prediction with institutionalized narcotic addicts ", Journal of Research in Crime and Delinquency, New York, January 1971, vol. 8, No. 1; James A. Inciardi and Dean V. Babst, "Predicting the post-release adjustment of institutionalized narcotic addicts ", Bulletin on Narcotics, XXIII, 2, pp. 33-39.057p050
57. Frances Rowe Gearing, "Successes and failure in Methadone treatment of heroin addiction in New York City ", presented at the Third National Conference on Methadone Treatment, New York City, 14 November 1970 (mimeographed).058p050
58. The other criteria of performance were: freedom from heroin hunger (measured through urinalysis to show a decrease in heroin use); increased social productivity, demonstrated by work, study or vocational training, and willingness to accept help for the consumption of drugs or alcohol, or for psychiatric difficulties. Another study designed to evaluate the cost/effectiveness of four treatment modalities ranked methadone maintenance first, followed by imprisonment and parole, civil committal, and detoxification in order of preference. The results indicate that the length of in-patient treatment is not a critical variable, and that, therefore, reductions in costs can be made without significantly affecting relapse rates by reducing or eliminating in-patient phases; that in programmes emphasizing withdrawal from heroin, the initial year or so following rehabilitation is the critical period; and the first few weeks most critical; that the form of addict supervision following withdrawal from heroin makes a great deal of difference; that additional out-patient support yields rapidly diminishing returns, and that methadone proved the most efficient in reducing the social cost of heroin addition because, in spite of its relatively high cost, it is considerably more effective in preventing relapse, there being considerable cross-elacticity of demand between heroin and methadone. Edwin T. Fujii, "Public investment in the rehabilitation of heroin addicts ", unpublished paper, International Research Consortium on Drug Legislation and Programmes, Stanford University, February 1972 (mimeographed).059p050
59. See Edwin T. Fujii, op cit.; Irving F. Lukoff and James Vorenberg, "Methadone maintenance evaluation studies: some unresolved issues of crime and drug abuse "; and Addiction Research and Treatment Corporation Evaluation Team, "Progress reports, 1970-1971" (mineographed).060p054
60. In 1971, a Special Action Office for Drug Abuse Prevention was established by the President of the United States of America to co-ordinate federal drug abuse efforts in treatment, education and research. In Africa, for example, Chad, the Ivory Coast, Gabon and Dahomey have established the "national narcotics bureaux ", and Toga a "central bureau" to help prevent illicit traffic in narcotics and to co-ordinate all operations concerned with its suppression.061p054
61. Luis Rodriguez Manzanera, "La lucha del Estado Mexicano contra la producción, tenencia y trafico ilicito de estupefacientes ", Criminalia, Mexico, D.F., vol. 39, No. 12 (December 1970), p. 857.062p054
62. An independent national Drug Abuse Council was established in the United States of America early in 1972 to provide public leadership in this area; its functions include the analysis of the development and results of public policies in the drug-abuse field; dissemination to the public of accurate data on the causes, extent and treatment of drug abuse; promotion of needed research; synthesis and distribution of available information on research and treatment; and evaluation of treatment and education programmes.063p056
63. In the United states of America a campaign to have addicts and the general public report "pushers" to the authorities has been initiated, in the hope that it will curtail illicit dealing in drugs and encourage addicts to turn to methadone and other treatment programmes. As long as access to these is precluded by long waiting lists, however, addicts may be reluctant to compromise their existing sources of supply.064p056
64. In the United Kingdom , for example. See Second Report of the Inter-Departmental Committee on Drug addiction (Brain Committee) (London, H.M.S.O., 1965); Canada , Interim Report of the Commission of Inquiry (The Dain Commission) into the Non-medical Use of Drugs (Ottawa, Queen's Printer, 1970); United States President's Commission on Law Enforcement And Administration of Justice , Narcotics and Drug Abuse ( Washington, D.C., U.S. Government Printing Office, 1967) and National Commission on Marijuana and Drug Abuse, Washington, D.C., U.S. Government Printing Office, 1972).065p056
65. Some aspects have heretofore received insufficient attention in most countries, for example the patterns and dynamics of the spread of drug abuse in their communities.