Assessing the effectiveness of Malaysia's drug prevention education and rehabilitation programs

Journal of Substance Abuse Treatment, Vol. 5, pp. 253-262, Printed in the USA. All rights reserved.

1988 Copyright 0

0740-5472/88 $3.00 + .OO 1988 Pergamon Press plc

INTERNA TIONAL PERSPECTIVE

Assessing the Effectiveness of Malaysia’s Drug Prevention Education and Rehabilitation Programs JAMESF. SCORZELLI, Northeastern

University

Abstract- The multifaceted drug prevention education and rehabilitation system of Malaysia appears to have contributed to the steady decrease of the number of identified drug abusers in the country. In thb article, those components of the Malaysian system that would be most applicable to the American effort were examined. In the same manner, because the fastest growing minority group in the United States are Asian Americans, in which a significant proportion involve persons from Southeast Asia, those components in the Malaysian system that are applicable to Southeast Asian Americans were examined. DRUG ABUSE is a major health concern of the world and has reached epidemic proportions. In fact, a 1982 report of the United Nations indicated that the prevalence of illicit drugs presents a real danger to both the national security and the economic stability of many nations. The seriousness of drug abuse as a threat to the security of a country is best illustrated by Malaysia, which on February 19, 1983, declared its drug problem a national emergency. As a result of this declaration, Malaysia initiated a massive effort in law enforcement, preventive education, and rehabilitation to eliminate this dadah (which means dangerous drug) menace. An important part of Malaysia’s battle against drug abuse is its well developed preventive education and governmental rehabilitation programs. In this article, the magnitude of the country’s drug problem and its preventive education and rehabilitation system will be discussed. Furthermore, because of the similarity between Malaysia’s massive antidrug campaign and President Reagan’s recent declaration of a “war on drugs,” which is reflected in the $1.7 billion omnibus antidrug bill, which was signed into law in November of 1986, those components of the Malaysian system that would be most applicable to the American effort will be examined. In the same manner, because the fastest growing minority group in the United States

are Asian Americans, in which a significant proportion involve persons who are from Southeast Asia, an attempt will be made to identify whether there are any components in the Malaysian system that could be applied to those Southeast Asian Americans who have problems with drug abuse.

BACKGROUND

Malaysia has been an independent nation since 1957 and has one of the fastest growing economies in Southeast Asia. Although it can be considered an Islamic country in that the constitution requires that the prime minister be a Muslim, Malaysia is religiously and culturally diversified. Specifically, its 15 million population consists of approximately 45% Malays, 38% Chinese, 11% Indians, and 7% indigenous groups. All Malays are Muslims, most of the Chinese are Taoists or Buddhists, and Hinduism is the representative religion of the Indians. Although Malaysia is not a producer of illegal drugs, the country’s location with respect to the Golden Triangle has resulted in it being a major trafficking and transhipment area. The Golden Triangle, composed of Burma, Thailand, and Laos, is the world’s third largest producer of heroin (Walsh, 1981) and a large part of this heroin is used internally. In addition to the problem of illegal opium derivatives, there has been an increase in the use of marihuana (referred to as ganja), and psychotropic pills (mainly benzodiaze-

Thisstudy was supported by a World Health Organization Fellowship. Requests for reprints should be sent to Prof. James F. Scorzelli, Ph.D., Director, Rehabilitation Counseling Program, Northeastern University, Boston, MA 02115.

253

J. F. Scorzelli

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pines) and alcoholism (Foong et al., 1986; Navaratnam et al., 1987). The seriousness of the drug problem in Malaysia was further illustrated by a statement of an official from the Ministry of Home Affairs, who stated that 46% of the country’s crime was drug related, and that the nation’s addicts consume close to 600 thousand dollars worth of heroin a day (Ministry of Home Affairs, 1985). In fact, from 1970 to March of 1986, 123,038 individuals have either been arrested or have volunteered for treatment for drug abuse (refer to Table 1). Recidivism rates are 65% to 80%, and 74% of these individuals are heroin users. When these factors are taken into account, the magnitude of the drug problem readily becomes apparent (Anti-Dadah Task Force, 1987a). The country’s drug laws are quite stringent in that there is a mandatory death penalty for trafficking or for possession of 15 grams of heroin or morphine, 1,000 grams of opium or 200 grams of marihuana (presumption of trafficking). But the country’s major effort in curtailing drug usage is its highly developed preventive education and rehabilitation system. Specifically, there is compulsory treatment for all drug users, and Malaysia’s Drug Dependent Treatment Act of 1983 clearly defined drug usage as an illness and not as criminal behavior. PREVENTIVE EDUCATION IN MALAYSIA

In Malaysia, the governmental Ministries of Information and Education and the National Anti-Dadah

Association Malaysia or Pemadam are the major institutions responsible for preventive education. The Ministry of Information’s role pertains to the dissemination of information in order to increase public awareness concerning the “evils” of drug abuse. Since 1980, its functions have involved the following: 1. Field officers of the Information Department and other media personnel have been provided with inservice training on methods of disseminating information about drug abuse to the public. As of 1985, 100 officers have been trained, and these individuals have received refresher courses. In addition, the Ministry has begun a program to train ex-addicts to be communicators (media broadcasts, assemblies, etc.), and as of 1987, 25 persons have completed training. 2. Training courses on disseminating information were conducted by the field officers for local community leaders in villages and towns. 3. On an on-going basis, community leaders are encouraged to extend their knowledge about preventive education to the public in their respective areas by giving out information and encouraging the public to actively participate in anti-dadah programs. 4. Information about drug abuse is provided through television documentaries, drama, filmlets, antidrug songs, and news coverage on a regular basis. Furthermore, the National Film Department of the Ministry is required to produce one documentary, and one 60-second trailer about drug abuse each year (Anti-Dadah Task Force, 1984; T. Yu, personal communication, July 1987).

TABLE 1 Number of Individuals Detected for Illegal Drug Use January 1970~March 1997

Type of Drug of Abuse (%) Year

Number

% Male

1970-75 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 (March)

12,466 9,650 6,047 9,422 a.299 7,154 10,391 13,363 14,624 11,915 9,591 7,329 1,893

91.6 96.2 97.7 96.8 97.1 97.0 97.3 97.4 98.5 99.1 98.4 97.7 -

% Female

Heroin

Cannabis

Morphine

Opium

Other

2.4 1.6 2.3 3.2 2.9 3.0 2.7 2.6 1.5 .9 1.6 2.3 -

76.3 61 .O 88.4 84.2 81.2 82.7 82.6 82.4 77.4 72.0 75.1 73.6 -

4.7 16.7

16.6 13.5 8.1 4.7 5.1 4.9 5.9 4.5 6.4 6.9 8.7 11.0 -

6.3 6.3 6.9 7.7 8.5 8.7 5.3 6.0 7.2 6.1 6.9 4.3 -

1.7 2.1 1.8 1.7 2.3 5.5 6.7 4.7 3.8 3.4 5.0 5.8 -

8.8

7.3 9.3 10.5 12.6 13.1 12.8 15.1 25.8 15.2 -

Note: In 1986, 41.1% of these individuals were between 15 and 24 years of age; 28% were between 25 and 29 years of age, and 24% were between 30 and 50 years of age. Among the Other category of Type of Drug of Abuse, tranquillizers (benzodiazepines) comprised the largest proportion. Source: Anti-Dadah Task Force, 1987b.

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Malaysia’s Drug Prevention Education & Rehab

In conjunction with the Ministry of Information, the Ministry of Education has initiated several training programs, including: 1. In-service training courses for teachers on preventive drug education, and since 1984, 846 teachers have attended these courses. 2. In 1982, 14 special officers of the Ministry were appointed at state education departments in order to plan and carry out drug prevention education at the state level. 3. The development and dissemination of printed materials, including guide books, pamphlets, and posters about dangerous drugs to the schools. 4. The integration of drug prevention education in graduate and postgraduate courses in counseling, including an eight semester program for the Bachelor of Education, and a one-year postgraduate program for the Diploma of Counseling. The one year diploma program in drug counseling is offered by the National University of Malaysia’s Department of Psychology, and 75 students have received their diploma degrees since 1983. 5. The development of a weekend course in peer leadership, which is meant for student leaders in the schools. The objective of the course is to increase the awareness of student leaders regarding the dangers and negative effects regarding drug usage. Also, it is hoped that these potential student leaders will be able to help their teachers identify possible drug usage among their fellow students. 6. Self-reliance camps, which are for “high-risk” school students who have had problems of truancy or experimentation in drugs, or who have been involved in delinquent behavior. This week-long session is aimed at improving the student’s selfawareness, motivation, and knowledge of the world of work. During this session, heavy reliance is placed on career education and group dynamics. 7. An Anti-Dadah Badge scheme that provides students who are in a uniformed organization (i.e., Boy Scouts) in the secondary schools to be actively involved in the antidrug effort. Specifically, in order to earn this badge, a student will have to pass a proficiency test on drugs, to keep a log book of newspaper and magazine clippings on drug abuse, and to help in the preparation of antidrug posters, songs, and logs (Ministry of Education, 1987). Besides these activities, the Ministry of Education has implemented a curriculum for drug preventive education in the nation’s schools. During primary education, this involves the emphasis of health related topics rather than any direct mention of drug abuse. This includes personal hygiene, relationship with others in the child’s family and community, and how to obtain success in school and in one’s life. During a student’s secondary education, drug prevention education components are integrated into selected subjects, such

as Health Education, Living Skills, and Citizenship Studies. The stress placed at this level pertains to character building, the development of a positive selfimage, planning of healthy recreational alternatives, and making and maintaining healthy relationships with peers and with one’s family (Foong et al., 1985; Ministry of Education, 1987). In conjunction with the public school system, a similar preventive education curriculum has been incorporated within all of the country’s teacher training colleges. Lastly, Pemadam is the country’s major voluntary organization most clearly identified with preventive education. The organization, initiated in 1976, is organized at the national, state, district, and village level. The prime minister has the responsibility of appointing the national president of the association, and thus although private, Pemadam is closely interrelated with the government. Pemadam works closely with all religious groups in the country, social, welfare, and civic organizations, youth clubs, private industry, and trade unions. Some of its many functions include, the training of aftercare religious counselors, disseminating a wide variety of cassette tapes, films, and brochures; organizing seminars, mobile exhibits, competitions on antidrug themes (poems and songs), and other publicity activities on preventive drug education. DRUG REHABILITATION IN MALAYSIA Rehabilitation in Malaysia involves both governmental and voluntary agencies. However, the major effort in rehabilitation pertains to the governmental rehabilitation centers, and these separate facilities involve the following types of services and activities: 1. Physical restoration a. orientation and intake (detoxification is done prior to entry at a general hospital or at the facility by “cold turkey,” unless the person is over 55 years of age or has medical complications). b . evaluation c. calisthenics, physical training and para-military drills 2. Moral guidance and religious instruction 3. Vocational and recreational therapy 4. Psychological services a. individual counseling b. group counseling c. family counseling 5. Review and discharge It is important to note that the governmental rehabilitation programs are designed to reshape the drug dependent person in all areas of his/her life, and each aspect of the program reflects this holistic health view. That is, the physical training and military drills serve to enhance a sense of discipline and cooperation

256

in order to stimulate feelings of pride and accomplishment. The purpose of the religious instruction is to help reestablish one’s religious beliefs and spiritual life. Although the emphasis of the religious instruction is Islam, special arrangements for religious guidance are provided to residents of other faiths. The purpose of vocational and recreational therapy is to help the resident form good work habits. The work programs include such activities as vegetable gardening, carpentry, rattan furniture making, tailoring, auto mechanics, metal work, and the cultivation of mushrooms. Lastly, the psychological services are used to provide the residents with an opportunity to resolve personal and emotional problems related to their drug usage. Although family counseling is included under this heading, it is more of family education in that the family members of the drug abuser are made aware of the services at the center and told about the negative effects of drugs. The six governmental rehabilitation centers in Malaysia can accommodate 2,050 persons, and seven more are under construction, with expected completion occurring within the next year. Although the present centers are only for men, a center for women, which will be able to accommodate 100 women, will be opened before the end of 1987. Included in the rehabilitation system is the one-stop center concept. Although only two of the present centers can be viewed as one-stop, there is a trend toward all the centers having this designation. Specifically, a one-stop center includes a joint effort among all governmental ministries in that as soon as a person has been identified as a drug abuser (urine test and medically certified at a general or district hospital), he/she is brought to the center where a magistrate issues a detention order. If addicted to heroin, detoxification begins. Once the resident has been certified medically fit, he or she is provided those services listed above. A detailed description of a program at the one-stop center at the Pusat Serenti facility is provided in Table 2. In addition to the structured programs at these centers, the government started a work brigade unit in 1984 at Sungai Merchong in the state of Pehang in which 50 inmates were made responsible for the harvesting and care of a palm oil estate. Similarly, under the government’s policy to rehabilitate uncultivated land, residents at the Pusat Isaf Diri center at Bukit Mertajam have developed a farm and are presently working on the cultivation of a rice padi. Basically, once these farms become self-supporting endeavors, they will be given back to their original owners. These attempts at farming reflect the government’s policy of community involvement in the rehabilitation of the drug addict. The length of stay at the rehabilitation centers is two years, yet based on his or her behavior, a resident can be released after 16 months. All the centers utilize the phase system in that an inmate can progress to a

I

J.F. Scorzelii TABLE 2

Treatment Components at the On&top Center Pusst Serentl 1. Detection. A suspected drug addict is brought into the center by the police and given a urine test. If the urine test is positive, the person is committed to the center for up to 24 months by a detention order from a magistrate. 2. Detoxification. Inmate is locked in a room (18 x 20 feet), with attached bathroom facilities and undergoes “cold turkey” detoxification. If the withdrawal is severe, or if he is 55 years of age or above and/or has medical complications, the inmate is sent to the nearest hospital. 3. Orientation. A one-week period devoted to making the inmate aware of the program of services begins as soon as he has recovered both physically and mentally from the withdrawal of an opium derivative. 4. Physical Training. Physical training continues throughout the inmate’s stay and begins following orientation. It consists of a regimen of calisthenics and militarystyle drill in the mornings and recreational games in the evening. The exercises consist of two miles of jogging and a variety of stretching exercises. Included in this phase is participation in flag raising ceremonies and general housekeeping chores. 5. Psychological Services. Individual counseling is based on the clients needs, while group counseling is required of everyone. These groups consist of ten inmates and meet once a week. For those inmates with families and who give permission, family counseling is sometimes provided during parental visits. 6. Religious Instruction. Religious instruction is conducted from 8:00 PM to 10:00 PM for all inmates regardless of faith. On Fridays, it is compulsory for Muslims to attend the Mosque for prayers. Special arrangements are made for inmates of other faiths, and at times, their religious instruction is not as consistent as it is for the Muslims. 7. Work Therapy/Vocational Training. The use of vegetable and mushroom gardening is the major form of work therapy, and inmates are provided an opportunity to participate in one of the following vocational training programs: carpentry, TV/radio repair, auto mechanics, shoe repairing, rattan furniture work, laundry work, tailoring, or metal work.

higher stage, with more responsibility and privileges, based on his or her performance. Each phase is identified by a different color shirt, with the attainment of the highest phase (Phase 4) resulting in weekend passes, and an opportunity for an inmate to assume a leadership position and to secure employment before his or her discharge. The phase system was adopted and is similar to that found in most therapeutic communities (TC’s). Table 3 describes the programs involved in each phase. Prison System

The prisons in Malaysia also have rehabilitation programs for the drug abuser and their services parallel

257

Malaysia’sDrug Prevention Education & Rehab TABLE 3

Phase System at the Rehabilitation Centers in Malaysia Phase 1 (O-5 months) 1. 2. 3. 4. 5. 6.

Orientation Religious Education Military Drill (4 hours daily) Civics course Recreation Counseling

Phase 2 (6-10 1. 2. 3. 4. 5. 6.

months)

Religious Education Counseling Military Drill (1 hour daily) Civics course Recreation Vocational training

Phase 3 (1 l-l

5 months)

1. Same as Phase 2, except that community projects are organized so as to integrate the resident into society. Phase 4 (16-24 1. 2. 3. 4. 5. 6. 7.

months)

Religious Education Counseling Military Drill (1 hour daily) Civics course Vocational training Recreation Review for discharge

those of the rehabilitation centers. However, unlike the centers, the length of treatment coincides with one’s sentence, and for female offenders, there is a special unit in a women’s prison. Those women who have been arrested on drug charges undergo a similar rehabilitation process, except that physical training is not as rigorous nor does it involve paramilitary drills. A Malaysian who is sentenced to prison instead of being committed to a rehabilitation center is someone whose drug related charge is other than usage or although a drug abuser, has committed a serious crime. The rehabilitation program is similar and involves many of the same components as do the centers, for example, phase system, physical training, vocational training, and counseling. At present, a prison solely for drug abusers is being constructed at Serembam. Juveniles In Malaysia, anyone under 21 years of age is defined as a juvenile and, for those youth who are delinquent or commit criminal acts, their deposition is determined by a juvenile magistrate. Usually, first offenders whose crimes are not serious (against persons) and who have a family support system are placed on ex-

tended supervision or probation. If the juvenile is a management problem with a previous history of delinquent acts, he or she can be committed to a Social Welfare Home. These institutions are segregated with respect to age and sex. The length of commitment rarely exceeds three years, and these training schools place heavy emphasis on education, religious instruction, counseling, and vocational training. In addition to the Social Welfare Homes, Malaysia has a juvenile correctional system administered by the Department of Prisons. These institutions are referred to as the Henry Gurney Schools and are for those youthful offenders who have committed serious crimes or have attempted to escape from a Social Welfare Home. The six Henry Gurney Schools are for boys 14 to 21 years of age and have a maximum commitment of three years. The rehabilitation programs in these schools are similar to those provided in the prisons, except that more emphasis is placed on family education. A juvenile who has been identified only as a drug abuser is viewed as a “sick” person in need of treatment. He/she can be given extended supervision, which sometimes involves some form of outpatient or inpatient treatment at a nongovermnent drug facility, or the youth can be sent to one of the governmental rehabilitation centers that have been previously discussed. However, if the young drug abuser has also committed a serious crime and the drug usage is viewed as secondary to the criminal act(s), the youth can be sentenced to a Henry Gurney School. Among these schools, there is one segregated drug rehabilitation unit for the youthful offender who is a drug abuser. Voluntary Agencies In order to treat the drug abuser, private agencies must have governmental approval, and there are a variety of such agencies in Malaysia, ranging from day programs to residential facilities. For the most part, these facilities are composed of those drug abusers who have volunteered for treatment and are exempt from prosecution for drug usage but are not exempt from other drug related charges. Many of the voluntary agencies are Christian based or involve the use of traditional medicine. Religious instruction is an important part of the treatment milieu of most of these facilities.Presently, there is really only one Therapeutic Community (TC) in Malaysia, which is a facility called Pusat Pertolongan in Ipoh. Pusat Pertolongan operates a house for men and another for women, and its treatment philosophy is based on a peer hierarchical structure incorporated within a phase system. Furthermore, the drug abuser is viewed as an emotionally disturbed, irresponsible individual who needs resocialization training in a community living situation. The TC accepts volunteers and court referrals from 12 to 50 years of age, and the treatment

J. F. Scorzelli

258

staff is mainly composed of exaddicts. The specific treatment components resemble those of Day Top Village where emphasis is placed on confrontation, the use of encounter groups, and a variety of work tasks. Aftercare

Once a resident leaves a governmental rehabilitation center, he or she is placed in a two-year program of aftercare. During this time, the person is required to report to a local police station once a week where he or she is given a urine test and is required to participate in individual counseling. Even though this type of individual supervision is mandatory, a person may also be sent to a residential or day treatment program. The decision as to what is the most appropriate type of aftercare is made by the magistrate in consultation with an officer from the Ministry of Home Affairs. It is possible that a person who turns himself or herself in as a drug abuser (volunteer), may be placed only on aftercare rather than being sent to a governmental rehabilitation center. For these persons, all of Malaysia’s voluntary agencies would play an important role in his or her rehabilitation. Among the aftercare facilities, three day treatment centers and one residential facility are operated by Pemadam. Although as discussed, Pemadam’s major role pertains to preventive education, its aftercare residential camp involves six months of treatment where the treatment program is very similar to that provided by the governmental centers. However, because of its voluntary nature, a resident can leave any time he chooses this (facility is only for men). EFFECTIVENESS ANTIDRUG

OF MALAYSIA EFFORT

As indicated by the above description of the drug preventive education and rehabilitation system in Malaysia since the prime minister’s declaration of a national emergency in 1983, there is a well coordinated, integrated effort between all the governmental ministries, voluntary organizations, and the community in order to eliminate the problem of drug abuse. In the following section, the incidence of newly identified drug abusers, demographic variables, and drug usage trends will be examined as one measure of assessing the effectiveness of the Malaysian effort. In examining the incidence of newly registered drug abusers (refer to Table l), one observes a steady decline, beginning in 1984. In fact, the only drop in identified drug abusers since the government instituted its policy of registration occurred in 1980. However, this small decrease has been attributed to the poor opium harvest in the region during the previous year. Furthermore, although the reported number of new addicts for 1987 only comprises a three-month period,

governmental projections appear to indicate that this downward trend will continue in 1987 (Anti-Dadah Task Force, 1987b). As these incidence rates are examined, it is important to note that Malaysia has experienced a significant economic recession during the last two years, and the country still has not fully recovered. In conjunction with the decrease in new drug abusers, the supply of the available heroin has also decreased. This is reflected in the increased number of drug seizures, as well as the fact that the purity of heroin has dropped, and there has been close to a 50% increase in the street price (a drug habit costs about $40/day). In addition, the heroin addict is now injecting the narcotic, while prior to 1985 the major method of intake was by “spiking” or mixing the narcotic with cigarette tobacco (S. Barathan, personal communication, August 3, 1987; Ibrahim Khairuddin, July 9, 1987). Thus, one could assume that due to the decreased purity of the narcotic and the fact that it is less available, injection provides the Malaysian drug addict a more efficient method of obtaining the desired effect.’ Although drug abuse in Malaysia, as well as elsewhere in the world, is a problem that afflicts the nation’s youth, there has really never been a problem within the country’s schools. Based on the 1986 statistics, only 1% of public school students and .2% of college students were registered as drug abusers. As shown in Table 4, heroin has not been the major drug of abuse for these children. Although some researchers in Malaysia question whether the governmental statistics provide an adequate estimation of drug usage in the schools (Foong et al., 1985; Navaratnam, 1981), there does not appear to be any substantial data that support their contention. For instance, a 1976/77 study of 16,166 secondary school students (16-18 years of age) in the state of Pinang reported that 13.7% had used some type of a drug (Navaratnam, 1981). However, a similar study of 1,178 secondary school students in Pinang, conducted in 1984, reported that only 3% of the students had used drugs (Foong et al., 1986). Although interesting, both studies utilized self-report instruments and really had no method of assessing the accuracy of the students’ responses. Furthermore, unlike the governmental statistics, alcohol and cigarettes were among the identifiable drugs utilized. As discussed, the rehabilitation programs in Malaysia utilize a holistic health approach in treating the drug abuser. These programs, especially the governmental centers, were developed after a thorough investigation of other drug rehabilitation programs in

‘Note: Heroin in pure form is referred to as Grade 4 (white powder) and is usually injected, while Grade 3 (brown in color) is usually smoked. In Southeast Asia, heroin is for the most part, Grade 3.

259

Malaysia’s Drug Prevention Education & Rehab TABLE4 lncldence of Drug Abuse in Schools and Type of Drug Used (1993-l 996)

Type of Drug Abused

Year

Number

1983 1984 1985 1988

192 275 118 240

Cannabis (%) 71 183 23 112

(37) (59) (19) (43)

Heroin (%) 21 10 4 9

Psychotropic Pills W) 22 (11) 12 (4) 84 (35)

(11) (4) (3) (4)

inhalant (%)

Other W)

88 89 91 45

10 (5) 1 (1) -

(35) (32) (77) (19)

Source: Ministry of Education, 1987.

the world, and ample use was made of external consultants. Therefore, the governmental rehabilitation programs and the aftercare system involve all those components that have been shown to be effective in treating a drug abuser so that he or she can maintain a “drug free” life. Nevertheless, the recidivism rates are still quite high (65-80%), and based on an unpublished report from an official of the Ministry of Home Affairs, of those persons released from the government centers, 40% return to drug usage, 38% disappear (government loses contact with them); 2% die, and only 20% remain drug free (Ministry of Home Affairs, 1987). The reported reasons for this large recidivism rate have involved such factors as the lack of community and family acceptance and an inability to find employment upon release from a rehabilitation center. With respect to the latter, 20.7% of the registered drug abusers in 1986 were unemployed, while 53.2% were laborers (refer to Table 5). This employment picture has remained relatively stable since 1981 and has

not been affected by the country’s recent recession. Furthermore, 65% of the registered drug abusers in 1986 were school dropouts (Anti-Dadah Task Force, 1987b). These data appear to suggest a possible relationship between the high relapse rate and an individual’s employment status and educational attainment. Nevertheless, it should be pointed out that the estimations of recidivism are not based on any criteria that utilizes the amount of time that the person has been drug free. That is, many authorities feel that drug dependency is a disease, that success can only be measured by the number of drug “free days,” and that relapse is a possibility that must be accepted (Deissler, 1970; Ray, 1983). The disease model is held by some of the drug professionals in Malaysia, and in 1987 a recommendation was made to the government to implement a system of methadone maintenance (A. A. Aziz, personal communication, July 2, 1987). Although the reasons for the high recidivism appear to involve a multiplicity of variables, Malaysia has not relinquished its intensive rehabilitation and treatment

TABLE 5 Percent of Drug Abusers Identified by Occupation (1970-l 996)

Students Year 1970- .75 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986

School

College

Unemployed

Laborers

Shopkeepers

Clerical

Skilled

Manaaement

Other

2.4 8.0 6.3 2.3 1.3 1.3 1.2 .6 .8 .8 .8 1.0

1.0 1.2 1.5 .3 .3 .3 .2 .l .l .3 .l .2

48.5 32.2 30.0 49.6 48.1 37.2 19.1 15.3 13.5 17.8 18.9 20.7

24.9 30.6 29.8 28.0 31 .o 39.8 48.5 49.8 48.7 46.4 53.6 53.2

4.3 7.0 5.7 3.9 4.4 5.7 6.9 7.4 8.8 8.0 7.9 6.3

3.0 5.9 5.9 2.8 2.3 2.7 3.8 2.0 1.9 1.2 1.4 1.1

4.4 4.9 3.9 4.2 3.8 5.2 5.0 6.2 5.3 3.3 2.9 3.2

.3 .2 1.2 1.8 .9 1.3 1.3 .9 .7 .3 .2 .6

11.4 8.1 15.8 5.6 6.4 5.1 12.2 15.1 20.2 19.0 14.2 13.2

Source: Anti-Dadah Task Force, 1987b.

260

J.F. Scorzelli

programs. In fact, there has been more focus placed in this area within the last two years, involving the development of prerelease halfway houses for those persons with less than six months to serve at a rehabilitation center and involving increased community cooperation. Community involvement has resulted in the growth of the community rehabilitation committees, whose role is to help the societal reintegration of the former drug abuser. Therefore, with this increased community involvement and the additional emphasis on employment, the impact of Malaysia’s rehabilitation system on curtailing drug abuse should be more dramatic within the next few years.

IMPLICATIONS FOR THE UNITED STATES In comparing drug preventive education and treatment programs of different nations, it is important to understand that these programs are closely associated with the political-cultural climate of each country being examined. This factor is apparent when comparisons are made between Malaysia and the United States. First of all, although the political systems of both countries are similar, Malaysia is a relatively small, developing nation, with three very distinct racial groups. Even though the direct governmental role with respect to drug abuse is the result of the prime minister’s declaration of a national emergency, most of Malaysia’s social and educational programs are administered by the national government. Thus, such direct control and intervention by the federal government would be highly unlikely in America, where jurisdiction rests mainly with the individual states and the private sector plays a large role in education and rehabilitation. Nevertheless, there are still many aspects of the Malaysian system that have been or could easily be implemented in the United States with respect to drug preventive education and rehabilitation. One such area concerns preventive drug education in the public school system. Unlike America, where 61% of high school seniors have reported that they have used drugs (U.S. Department of Education, 1986), drug abuse does not appear to be a significant problem in the Malaysian schools. In part, this is due to the well integrated preventive education programs, the use of cocurriculum activities, and family participation that begins in elementary schools. These programs, as discussed, are almost identical to the recommentations and models provided in the recently published monograph, What Works: School Without Drugs (U.S. Department of Education, 1986). In fact, as described by the illustrations provided in this monograph, those American school systems that have developed well integrated drug preventive education programs have drastically reduced

the incidence of drug abuse (U.S. Department of Education, 1986). In conjunction with school based preventive programs, effective drug preventive education also involves the use of the media and community organizations in making the public aware of the seriousness of the problem of drug abuse. Although not as structured as Malaysia’s antidrug campaign, there has been increased media coverage in America on drug prevention, reflected in the number of anti-drug ads (“How to say no to drugs”), and intensive community involvement, such as the newly developed program of Drug Awareness-Resistance Education (D.A.R.E.) America. Finally, although often mandatory in Malaysia, programs of drug testing for athletes and governmental officials have occurred and received considerable media attention in the United States. With respect to rehabilitation, the comparability of treatment strategies in Malaysia and the United States become more difficult. In Malaysia, the major drug of abuse is heroin; cocaine is nonexistent, and although there have been reports of an increase in alcoholism (Malaysia New Strait Times, 1985), alcohol abuse does not appear to be a problem (in fact, half of Malaysia’s population are Muslims and thus, religiously prohibited from consuming alcohol). In contrast, the major drugs of abuse in the United States are the legal drug, alcohol, and cocaine (National Institute on Drug and Alcohol Abuse, 1986). Although heroin addiction is still a problem in America, the number of heroin addicts have remained relatively stable at about 600,000 since the early 1960’s (National Institute on Drug and Alcohol Abuse, 1986). Furthermore, the treatment strategies in America for drug abuse are multiple, involving inpatient hospitalization, outpatient treatment, therapeutic communities, and for the heroin addict, methadone-maintenance programs. For the most part, Malaysia’s rehabilitation effort involves compulsory treatment at the governmental rehabilitation centers and mandatory aftercare. However, it should be pointed out that there has been a trend in the United States toward decriminalizing drug usage, and treatment is often mandated by the courts in lieu of a prison sentence for those convicted of drug usage. Even though there are many differences between the nature of the drug problem and rehabilitation system in Malaysia and that in the United States, there are also some similarities. Besides afflicting the nation’s youth, there appears to be a relationship between drug abuse and educational attainment and employment status in both Malaysia and the United States-the one possible exception could pertain to cocaine usage - (National Institute on Drug and Alcohol Abuse, 1986; U.S. Department of Health and Human Services, 1978, 1981). Furthermore, the Malaysian rehabilitation program is largely based on the

iMalaysia’s Drug Prevention Education & Rehab

therapeutic community concept, which began in the United States with Synanon (Deissler, 1970). Although not as structured or required as in Malaysia, religious instruction or some type of religious belief are inherent in many drug treatment programs in the United States. For instance, the self-help movements of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) include spiritual illumination as a major factor in recovery. Similarly, although again not as structured as the Malaysian system of physical training, recreational therapy has been found to be an important component in the treatment of the drug abuser in many rehabilitation programs in the United States, and although controversial, paramilitary training has been introduced within the Georgia correctional system. However, the most significant aspect of the Malaysian rehabilitation effort seems to pertain to their use of aftercare, and the holistic health approach that is implemented within the rehabilitation programs. That is, well developed aftercare and follow-up programs and treatment strategies that include a “holistic view” of health would appear to be essential if drug rehabilitation is to be effective.

America’s Southeast Asian Population As indicated, Asian Americans are the fastest growing minority group in the United States, comprising about 2% of the population, and since 1975, 780,000 of these persons came from Southeast Asia (U.S. Bureau of the Census, 1986). Although there is no research suggesting that drug abuse afflicts this group any more than any other segment of the American population, an awareness and understanding of a person’s cultural and racial heritage can enhance the effectiveness of his or her treatment program (Wehrly & Deen, 1983). With this in mind, it would appear that Malaysia’s multiracial population may provide insight as to whether there are specific drug treatment strategies that are more suitable with persons of different racial/cultural backgrounds. This would pertain mainly to those Malaysians who are of Chinese descent in that the majority of the Southeast Asian group that have migrated. to the United States since 1975 are also of Chinese descent (i.e., Vietnamese boat people). Except for some of the voluntary agencies in Malaysia, especially those that utilize traditional medicine, the rehabilitation programs’ treatment components are consistent, regardless of one’s race. The one possible exception may pertain to religious instruction, since persons who are not Muslims often do not receive as much religious instruction. Nevertheless, religious instruction is still mandatory for all the residents of the rehabilitation programs. Although not as obvious, there does appear to be an aspect of the

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Malaysian system that takes a person’s cultural background into account. Specifically, most Malaysians are at least bilingual (the national language of Bahasa Malaysia and, if not a Malay, their native tongue or dialect; English is also spoken by many Malaysians). Thus, even though the government through the development of a national language has been trying to make these cultural differences less apparent, the country still celebrates a variety of national holidays related to each racial group, and these differences are apparent in social interaction. Because of this increased sensitivity, a Malay would be aware of the importance of success, the family, and the respect of ancestors of Malaysians who are of Chinese descent, while a l&laysian of Chinese descent would know the importance of the Islamic religion in the life of a Malay. Research conducted in Malaysia has not indicated that there are differences among the racial groups with respect to drug usage (Navaratnam et al., 1987). Although the largest number of identified drug abusers are Malays, if each group is compared based on their population proportion, the Indians would be the most afflicted. These slight differences in numbers appear to be more related to economic factors (unemployment) and migration into the larger cities where the young person loses the support of his or her family and community network-a pattern that is more closely identified with the Malays and Indians than with the Chinese. In summary, although there does not appear to be any different treatment focus for Malaysians of Chinese descent (as well as those of any other racial group), there does appear to be a sensitivity and awareness of one’s cultural background and values. Thus, it would appear that preventive education and rehabilitation programs in the United States that include a large number of persons of Asian descent need to be aware of these cultural factors and, if possible, to utilize professionals who are of Asian descent or can speak the language or dialect of the recipients involved in the programs.

CONCLUSION The multifaceted drug preventive education and rehabilitation system of Malaysia appears to have contributed to the steady decrease in the number of identified drug abusers. Although the intensive enforcement effort is another factor that cannot be overlooked in the curtailment of drug abuse, law enforcement alone is not sufficient. Those components of the Malaysian system that appear applicable to America’s effort in combatting drug abuse involve a well integrated preventive education program, beginning at the elementary school level, an organized

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antidrug campaign initiated by the media and community organizations, the adoption of a holistic health focus with drug treatment programs, and the development of structured aftercare programs. Finally, although there does not appear to be any preventive drug education or treatment strategies specifically used for different racial or cultural groups in Malaysia, there is a greater sensitivity to a person’s cultural background and values. This increased cross-cultural awareness would appear to be an important factor to consider in the development of drug preventive education and rehabilitation programs in the United States if these programs are to serve a large number of persons of Asian descent. REFERENCES Anti-Dadah Task Force (1984). Report to the Prime Minister’s Office, National Security Council. Kuala Lutnpur, Malaysia: Author. Anti-Dadah Task Force (1987a). Report to the Prime Minister’s Office, National Security Council. Kuala Lumpur, Malaysia: Author. Anti-Dadah Task Force (1987b). Current statistics on narcotic control in Malaysia. Kuala Lumpur, Malaysia: Author. Deissler, K. (1970). Synanon-Its concept and methods. Drug Dependence, 5, 28-35. Foong, C. P., Maznah, I., Navaratnam, V., & Kong, H.S. (1985). A survey of drug abuse prevention strategies. Piang, Malaysia: National Drug Research Center, University of Sciencei,Malaysia\ Foong, C.P., Maznah, I, Navaratnam, V., & Kong, H.S. (1986). A comparative study of the psychosocial profile of drug using

and non drug using school children. Pinang, Malaysia: National Drug Research Center, University of Science, Malaysia. Malaysia New Strait Times (1985). Report of meeting of the Malaysian Medical Associatio\ 1985. Ministry of Education (1987). Drug prevention education programs in Malaysian School System. Kuala Lumpur, Malaysia: Author. Ministry of Home Affairs (1985),A repod, Kuala Lumpur, Malaysia: Author. Ministry of Home Affairs (1987). A report. Kuala Lumpur, Malaysia: Author. National Institute on Drug and Alcohol Abuse (1986). A report. Washington, DC: Author. Navaratnam, V. (1987). Drug abuse among Malaysian youths. Pinang, Malaysia: National Drug Research Center, University of Science, Malaysia. Navaratnam, V., Ratnahngnam, M., Dittman, M., & Yoong, C.P. (1987). A study of the personality profile of drug addicts. Pinang, Malaysia: National Drug Research Center, University of Science, Malaysia. Ray, 0. (1983). Drugs, society and human behavior. St. Louis, MO: C.V. Mosby. United Nations (1982). The United Nations and drug control. New York: Author. United States Bureau of the Census (1986). A report. Washington, DC: U.S. Government Printing Office. U.S. Department of Education (1986). What works: Schools Without drugs. Washington, DC: Author. U.S. Department of Health and Human Services (1981). Comparative effects of drug abuse treatment modalities (Research Report, ADM 81-1061). Washington, DC: National Institute on Drug Abuse. Walsh, W.D. (1981). Importance of Iraqi-Iranian conflict. Drug Enforcement, 8(l), 7-12. Wehrly, B., & Deen, N. Counseling and guidance issues from a worldwide perspective: An introduction. Personnel and Guidance Journal, 61, 452-454.