Drug Abuse in Hanoi: Insights and Implications for Intervention

March 2002

Executive Summary

The document presents and discusses the results of the interviews of 33 heroin injectors and 15 young heroin smokers in Hanoi. In-depth interviews were conducted at a private location ensuring their absolute confidentiality. The results of the study may be considered limited because the sample was small, and opinions and feelings are recorded from a single viewpoint -- that of the drug users. However, this is a privileged perspective, because it relates the views of those who have been affected in first person. Such perspectives provide insights that can be particularly useful for the development of effective interventions.

Therefore, following the presentation of the results of the interview, the discussion summarizes the most important insights and presents concrete and evidence-based suggestions for the improvement of prevention activities and treatment services.

Many users started using drugs in their teens -- most before 21 years of age.
Prevention activities should target young people (20-25 years old) and especially adolescents (10-19 years old) before they start experimenting.

Many factors appeared to have a role in putting young people at risk of using heroin.
Different kinds of prevention activities should be planned and implemented aimed at weakening risk factors and strengthening protective factors.

Most users left school before starting to use drugs.
Prevention activities should not just be channeled through schools, because they would miss a target group of vulnerable young people. At the same time, activities that help young people stay in school would have an additional prevention effect.

Many users said they started using drugs because they were curious or bored.
The provision of alternative activities would contribute to preventing drug use. Activities should be chosen that young people themselves find interesting, fun and challenging. These programmes should be run by young people to the extent possible, and a special effort should be made to involve more marginalized groups.

Many users came from families with problems, especially female drug users. Moreover, many users said they started using drugs while they were going through a difficult or sad period in their lives.
The creation of comprehensive services to help young people through difficult times would contribute to preventing drug use. Services that are youth friendly should be accessible, confidential and include staff specifically trained to counsel adolescents. Such services could also include counselling aimed at motivating young people to stop using drugs or to enter treatment.

Most users got their information on drugs from friends and only a few from specialists or the mass media. Many had inaccurate and/or exaggerated information. 
Peer education would be an appropriate channel to deliver information on drugs to young people. Information should be accurate and, when possible, tested with the target group. Different groups of peers should be involved.

There appear to be two or three years between when young people start smoking marijuana and when they move to injecting drugs. 
Treatment services targeting young people are crucial to prevent smokers from beginning to use drugs. Services should be user-friendly, accessible to young people, confidential, age-appropriate (especially in terms of counselling and providing family therapy) and provide links to a wide range of social services.

Most users did try to stop using drugs on several occasions. Besides some limited HIV prevention service, the only treatment service offered was detoxification. Sometimes detoxification was provided according to a practice that had not proven effective. Moreover, available evidence indicates that detoxification is not enough, and, in fact, most users in this study relapsed -- some of them many times. 
A range of evidence-based treatment services (HIV prevention, including information, skills, clean needles, condoms, counselling and referral to treatment; early intervention and psychological support, including cognitive behavioural therapies and relapse prevention techniques and; family therapy and substitution treatment) provided through a range of settings (outreach, in-patient, out-patient, community-based) should be developed to assist users and addicts to stop using drugs. Moreover, the government should assist in setting and adhering to evidence-based standards of care.

Peers appeared to have the most important role in the lives of users.
Outreach through peers would be effective in reaching users and addicts and provide them with appropriate services.

The family was the most supportive institution towards drug users, encouraging them to enter treatment and paying for their treatment and fines. The police were also often involved -- at times in a supportive role -- for instance, providing drug users with HIV/AIDS prevention information. 
The provision of family therapy and the general involvement of families in the range of treatment services to be developed would be effective in enhancing treatment outcomes. The role of the police in encouraging drug users to voluntarily enter treatment and in providing them with HIV/AIDS prevention information could be encouraged.

Most of the female drug users had been commercial sex workers before starting to use drugs and all of them belonged to a family with problems. 
Treatment services targeted at women should be provided and include counselling for cases of physical or sexual abuse, support in finding a job and childcare during treatment.

Only a few users had received any HIV prevention service through peer educators and the police, and these services had been limited to the provision of information.
A range of HIV prevention services should be developed within a comprehensive system to assist users and addicts to stop using drugs. The use of peer educators would appear to be particularly effective given the reported importance of peers in the lives of the users in this study.

Testing for HIV/AIDS was often compulsory and not confidential. 
Voluntary and confidential testing combined with pre- and post-treatment counselling has been found to be effective in promoting behaviourial changes.

HIV positive drug users suffer from a double stigma: that against drug users and that against HIV positive people.
Every effort should be undertaken to fight against the social stigma that is attached to drug use and HIV/AIDS.