US embassy cable - 03HANOI549

UNCLAS SECTION 01 OF 03 HANOI 000549 
 
SIPDIS 
 
STATE FOR EAP/BCLTV; INL/AAE 
 
E.O. 12958: N/A 
TAGS: SNAR, PGOV, SOCI, VM, HIV/AIDS, CNARC 
SUBJECT:  COMMUNITY DRUG TREATMENT IN VIETNAM:  NOT MUCH TO IT 
 
REF: A.  Hanoi 353  B.  02 Hanoi 2836 
 
1.  (U) SUMMARY:  Despite improved national guidance on 
community drug treatment as well as an increasing awareness 
among authorities of the need for more rehabilitation 
services at different levels, implementation appears rather 
thin and uneven, primarily due to a lack of trained 
personnel and insufficient resources at the local level. 
The focus of community drug treatment is detoxification, 
after which, official "peer pressure" seems to be virtually 
the only component.  Ref a reported on Vietnam's drug 
treatment centers.  END SUMMARY. 
 
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POLICY FRAMEWORK 
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2.  (U)  Vietnam offers two main forms of treatment for drug 
addicts.  One is a network of drug treatment centers spread 
throughout the country.  Some addicts are sent to centers 
for "compulsory" treatment; others arrive voluntarily. 
According to the Standing Office of Drug Control (SODC), 
there are 73 centers at the provincial level, which have a 
capacity of between 50 to 3,000 addicts each.  Provincial 
authorities support most centers, but others are supported 
by mass organizations, such as the Youth Union (ref a). 
 
3.  (U)  In addition to the national network of provincial 
drug treatment centers (ref a), there is also a community 
drug treatment structure.  (Comment:  This is in line with 
Vietnam's "vertical structure" form of government as well as 
its tradition of "mobilizing" the population to help solve 
social and other problems.  End Comment.)  The "National Law 
on Drug Prevention and Suppression," passed by the National 
Assembly in 2000, established the broad policy for drug 
treatment in its Chapter Four.  The law, while relatively 
general, notes that the "State encourages individuals, 
families, agencies, and other organizations to implement 
home-based and community based detoxification. . ." 
 
4.  (U)  Since the law's passage, the GVN has issued 
additional directives pertaining to community drug 
treatment.  On May 15, 2002, the GVN issued Decree 56 (ref 
b), which addresses family and community based treatment. 
It stipulated that the minimum length of community treatment 
should be six months and that such treatment must be 
conducted in accordance with five steps developed by the 
Ministry of Labor, Invalids, and Social Affairs (MOLISA) and 
the Ministry of Health, including:  (1) reception and 
classification; (2) detoxification; (3) education; (4) work; 
and, (5) supervised return to the community.  In addition, 
there are provisions for closer supervision over the addicts 
by local authorities, as well as a provision for assistance 
in detoxification assistance if home treatment is 
unsuccessful. 
 
5.  (U)  According to Dr. Tran Xuan Sac, MOLISA's Deputy 
Section Chief of the Department for Social Evils Prevention, 
the goal of Decree 56 was to enhance the effectiveness of 
community and family-based treatment by having professional 
advice and some medicines more readily available.  He opined 
that this could help relieve some of the pressure on the 
compulsory treatment centers.  Dr. Sac noted that, while 
families are responsible for the most costs for this 
treatment (except detoxification), they are eligible for 
"preferential government loans."  In an effort to encourage 
vocational education, organizations that provide such 
training to addicts also may receive such loans, he added. 
Local authorities subsidize the cost for the initial 
detoxification process (usually seven to 10 days) up to a 
maximum of 250,000 VND (approximately USD 20). 
 
6.  (U)  Following up on Decree 56, the GVN issued an 
interministerial circular in January 2003 that provides 
further guidance.  According to the circular, addicts 
admitted to community-based treatment should also receive 
reeducation classes from the local authorities.  However, 
recovering addicts may be held "criminally liable" for 
continued drug use.  According to Dr. Sac, this means that 
addicts undergoing community-based treatment who continue to 
use drugs "may be sent" to compulsory drug treatment 
centers, if the local People's Committee determines this is 
necessary. 
 
7.  (U)  Dr. Sac noted that criteria regarding participation 
in community drug treatment vary among localities.  This is 
due, in part, to available resources, he added.  However, 
"normally, heavy addicts or those who have used hard drugs 
(i.e., heroin) for over three years are not eligible," he 
said.  According to Dr. Sac, MOLISA views community drug 
treatment as more suitable for less severely addicted 
individuals.  The chairman of the local People's Committee 
makes the final decision on an individual's participation, 
with the advice of an advisory committee consisting of the 
police, local social affairs and health officials, and 
various mass organizations, such as the Youth and Women's 
Unions. 
 
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ON THE GROUND REALITIES 
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8.  (U)  During poloffs' visit to the Thuy Ai detoxification 
center in Hanoi's Hai Ba Trung district, Dr. Nguyen The Dan, 
the official in charge, said that most addicts arrive at his 
center "at the urging" of their families or local 
authorities.  His staff evaluates each addict prior to 
admittance to determine eligibility.  Some addicts admitted 
are HIV-positive, he added.  The day we visited, six new 
addicts were admitted for detoxification; among them were 
three who are HIV-positive, according to Dr. Dan. 
 
9.  (U)  Dr. Dan said that addicts normally stay at his 
center about 10 days.  He claimed that nearly all who enter 
the detoxification process complete it successfully.  At the 
end of the process, his staff tests the addicts.  If they 
appear to be "detoxified," they may return to their families 
for home-based treatment.  Dr. Dan could not say 
specifically what the "treatment" at home entailed, but 
noted that the addicts receive "regular" visits from local 
officials who "encourage" them to stay away from drugs 
and/or "their drug-using" friends.  Dr. Dan said that he 
knew of no literature sent home with the addicts to provide 
advice to their families, but added that his medical staff 
"stays in contact" and "may make a home visit" if the family 
so desires.  While lamenting that the center has no trained 
drug counselors, Dr. Dan claimed that hands-on experience in 
the detoxification center and medical training enables the 
staff to provide "useful advice and support" to recovering 
addicts and their families. 
 
10.  (U)  Dr. Dan noted that a recent survey of "graduates" 
from the community treatment in his local area concluded 
that the recidivism rate is "about 72 percent."  He said 
that, while this compared favorably to provincial drug 
treatment centers, "it must be understood that we are 
generally dealing with a less severely addicted population." 
(Note:  The GVN claims a recidivism rate of about 80 
percent, but a more realistic figure is probably in the 90- 
95 percent range, similar to other countries.  End Note.) 
 
11.  (U)  Tuyet Huong, manager of a "club" for recovering 
addicts that works with Dr. Dan's center, said that she 
holds "voluntary" weekly meetings at the center.  At the 
meetings, recovering addicts get together and talk about 
their efforts to stay away from drugs.  There are also 
lectures from local officials, who emphasize the need to 
avoid drugs as well as the value of various recreational 
activities and physical training.  Huong said that she also 
works with local employers to help find jobs for recovering 
addicts.  Huong noted that "work is a very important part of 
staying away from drugs."  During the course of our visit, 
we spoke with two recovering addicts working in a nearby 
motorbike washing facility.  With officials present, they 
said that the center had been "very helpful" to their 
recovery and they "appreciated"  having a job and knowing 
there was a place they could go for activities and support. 
One of the recovering addicts noted that, while he had the 
opportunity to participate in community treatment, he knew 
of others who had committed criminal acts and were "forced" 
by local authorities to go to drug treatment centers. 
 
12.  (U)  The community drug treatment services available in 
Chau Khe commune, Bac Ninh Province, were far less developed 
compared to Hanoi.  Nguyen Khanh Lan, Director, Sub- 
department for Social Evils Prevention, Bac Ninh Department 
of Labor, Invalids, and Social Affairs, said that community 
drug treatment has been an option in Bac Ninh since 1991. 
He added that, while local drug problems are less severe 
than in Hanoi, proximity to the capital had resulted in a 
"significant and growing drug problem" in the province.  In 
terms of its socio-economic status and addict population, 
Chau Khe commune, with a population of about 17,000, is 
"typical," he claimed. 
 
13.  (U)  Nguyen Van Huong, Deputy Chairman of the commune 
People's Committee, said that detoxification is "about the 
only" organized aspect of community drug treatment, however. 
Similar to Hanoi, after successfully completing the 
detoxification process, addicts are sent home, where they 
"are supervised by their families, local officials, and the 
mass organizations."  According to Huong, there is no 
community center, outreach program, support group, or job 
placement.  Huong claimed that local officials and/or 
representatives from mass organizations cover outreach 
through periodic home visits.  During these visits, 
according to Huong, officials provide "advice" about the 
need to stay away from drugs.  However, the recidivism rate 
is about 85 percent, Lan admitted. 
 
14.  (U)  Lan and Huong separately emphasized the commune's 
need for more support to provide better services.  Huong 
said that he had appealed for more provincial support, but 
without success so far.  He lamented that the province will 
only contribute a "modest amount" for detoxification.  With 
more resources, Huong said that he would hire a counselor to 
provide professional services recovering addicts and their 
families. 
 
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COMMENT 
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15.  (U)  From our discussions with MOLISA and review of 
available laws, we expected a more comprehensive approach to 
community drug treatment.  Questions regarding the specifics 
of what actually happens when addicts return home were met 
with long-winded and rather vague responses.  With further 
probing, it became clearer that what authorities consider 
"community treatment" consists essentially of detoxification 
followed (or not even) by lectures on the evil of taking 
drugs, leaving open the possibility that officials could use 
compulsory center treatment as a potential threat or 
punishment for "lapses."  While local officials with whom we 
met appear committed to the idea of community drug treatment 
and rehabilitation as one way of dealing with the drug 
issue, Vietnam's systemic problem of insufficient public 
sector resources (felt most acutely at the local level) 
prevents a more comprehensive approach.  Without significant 
help from the foreign donor community, major improvements in 
community drug treatment are unlikely any time soon. 
BURGHARDT