By Tua Agaiava*
For years, the incarceration of offenders with long term histories of drug abuse, without appropriate treatment, was largely ineffective in curbing their long term criminal behaviours.
A significant proportion of these offenders kept reappearing through the justice system costing tax payers millions of dollars in policing, court, prison and health services.
Whilst the relationship between ‘alcohol and other drugs’ and crime is a complex one; alcohol/drugs is one of the most reliable predictor of crime; hence it is not a waste of resources to invest in initiatives such as the Samoa Drug Court.
Samoa has a long way to go in developing its Alcohol and Drug Services.
However, the recently launched ‘drug court’ is a great start. The wisdom of the Samoan Government, the Justice and Court systems must be commended for taking a courageous step to offer an alternative to imprisonment.
Offending behaviours that are driven by alcohol and other drugs will not go away miraculously simply by putting an offender in prison. This approach has been tried previously in many countries with very minimal success in stopping the high rates of recidivism – costing tax payers billions of dollars a year.
Offenders with long history of drug use will not just simply give up their drug use after a period of incarceration. Without professional help, a significant proportion will return to their drug of choice and the cycle of criminality continues.
Treatment, mandated by the court, if delivered by appropriately trained professionals [who understand motivational interviewing and stages of change theories – and how they apply to Samoan context], can work and can bring about sustainable change.
Sure there will be a small proportion who will not respond positively to treatment. However if the Drug Court initiative results in a 5-10% reduction in re-offending amongst alcohol/drug using offenders, that is a significant improvement worthy of Government support and investment.
Health treatment is not a soft option as opponents of such programs would argue.
There is nothing more confronting to most offenders than having to discuss the context of their drug use and offending behaviours; and take responsibility for the harm caused to the community.
Further, all drug diversion programs including the Samoa Drug Court still have avenues to deal with offenders who breach the conditions of their treatment – including but not limited to incarceration. Soft option? – I beg to differ.
From a rehabilitation perspective, eligible offenders who demonstrated motivation for a drug free future are given the opportunity to change, so they can contribute positively to their family, community and country. Imprisonment without treatment is more expensive and ineffective in the long run. Breaking the cycle of drug abuse and generational crime require interventions that address the drivers of criminality including alcohol and other drug use.
Internationally, drug diversion programs in countries like Australia and New Zealand have resulted in significant reduction in reoffending rates, saving tax payers millions a year in policing, prison and legal costs.
Tasmania trialled its Court Mandated Drug Diversion program in 2007, diverting high numbers of eligible offenders to more positive and productive alternatives.
The evaluation of this program found a high proportion of diverted offenders, graduating successfully from the program. Many found stable employment and re-integrated back into their families and local communities.
Evidence Based Treatment
Accurate assessment of offenders’ eligibility for drug treatment programs, is critical to the success of the Samoa Drug Court. An offender’s motivation to change largely dictates whether they will successfully complete a court sanctioned treatment program and abstained from their drug use in the long term.
Off course, there is a proportion of ‘drug-using offenders’ who will not respond positively to health treatment. These offenders are therefore inappropriate for diversionary alternatives and are likely to undermine the integrity of the Drug Court program.
Hence the use of evidence based biopsycosocial assessment tools is critical to screen out those who are ‘treatment-resistant’, including offenders with psychopathic tendencies. This is usually a very small proportion of offenders – and incarceration may be the only option.
Alcohol remains our biggest problem
The holistic focus of the Samoa Drug Court to hear matters associated with both licit and illicit drugs is supported by the literature.
Users who experiment with illicit drugs are likely to also have an alcohol problem; all addictions must be assessed and treated with evidence based treatment if relapse prevention measures have any chance of being successful.
The holistic focus of the Samoa Drug Court will also ensure that all drugs, licit and illicit, receive the same attention for treatment.
Despite the increased focus on ice (and other amphetamine-based drugs) in the media, alcohol will remain our biggest problem in terms of economic loss and the negative impact on health, families and communities.
If our data collection systems are accurate, alcohol more than any other drug, will feature more in assaults, motor vehicle accidents, family and domestic violence, emergency presentations, preventable illnesses as well as absences from the work place.
Ice is a problem that needs to be tackled head on; but with everything considered, it is not our biggest drug problem. Despite the increased focus on psychostimulant-based drugs (e.g. ice) in the media, international evidence consistently shows that alcohol is still our number one concern.
The capacity of our Drug Courts to deal with all these drugs, both licit and illicit, is a positive move.
Where to from here?
Establishing effective, holistic alcohol and drug services in Samoa is a long term goal. Rome was not built in one day. Tasmania and Victoria have some of the best alcohol/drug treatment programs in Australia but it took years to develop. Samoa will not be an exception. The Samoa Justice System has taken the lead in this area and should be congratulated for doing so. Efforts by Samoa Police targeting the supply, trafficking and the availability of illicit drugs should be complemented by effective treatment alternatives.
Samoa has some of the best innovative and effective licensing laws that Australia and New Zealand can learn from including ‘limiting the availability of alcohol on Sundays’ and ‘closure of all night clubs or pubs at midnight’. These are fantastic measures but are inadequate without effective treatment services.
The momentum created by our Drug Court initiative must not be lost.
Treatment is primarily a health issue and ultimately our health and community services have critical roles to play.
Tackling our drug problem requires an integrated approach, which should include ‘measures that control the supply and availability of drugs’, to ‘medical treatment options’, ‘psychosocial treatment services, ‘rehabilitation services’ and ‘harm minimisation measures’ at the population level. Treatment is a continuum from ‘medical detoxification’ at the acute end to ‘harm minimisation’ and ‘health promotion’ at the other end. There is no point is setting up rehabilitation services unless we have good detoxification services. On the other hand, it is pointless to put a drug user through medical detox only to relapse 5 days later due to the lack of support services.
Evidence consistently shows that relapse within 24 hours of detox is a reality for a proportion of drug users without support services providing proactive follow up.
The Samoa alcohol and drug treatment model in the long term should consider the following:
a) detoxification options for high risk drugs such as alcohol, opiate drugs and other addictive pharmaceuticals;
b) pharmacotherapy options particularly for alcohol and opiate based drugs;
c) psychosocial and counselling services delivered by both Government and NGO providers;
d) Residential rehabilitation service; and
e) Community based education and harm minimisation programs for the general population.
More importantly, Samoa’s treatment model should be built around clinicians with the appropriate skills and knowledge in this specialised area. The experiments in Australia and New Zealand in the 1970s and 1980s of recruiting former drug users without tertiary qualifications to provide alcohol and drug counselling and treatment services, should be avoided in Samoa.
Co-existing Mental Health Treatment
Finally, any effective drug treatment program should recognise the need for mental health treatment alongside alcohol and drug interventions.
A significant proportion of offenders with a history of drug abuse will present with a co-existing mental health issue.
We need to invest in appropriate trainings for our clinicians as well as Probation and Parole officers, to ensure they have the skills and knowledge to assess comorbidities, and offer evidence based treatment to break the cycle of drug-driven criminality.
*Tua Agaiava is the Primary Health North - Manager of Community Social Work/ Mental Health services – in the Tasmania Health Service. He worked for 7 years as Clinical Team Leader and Special Project Consultant for the Alcohol and Drug Services in Tasmania - Australia.