Cold turkey at Vietnam’s compulsory drug rehab centers

This picture taken on November 2, 2017 shows staff handing a dose of methadone to a recovering drug addict at a treatment clinic in the northern city of Bac Giang. During four years of compulsory rehab in Vietnam, Trung spent his drug-free days gluing together false eyelashes as part of what authorities billed as valuable 'work therapy' for his heroin addiction. But critics say the work of Trung and tens of thousands of others is tantamount to forced labour that rarely helps users extinguish their addiction. (AFP)
Updated 11 December 2017
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Cold turkey at Vietnam’s compulsory drug rehab centers

HAIPHONG, Vietnam: During four years of compulsory rehab in Vietnam, Trung spent his drug-free days gluing together false eyelashes as part of what authorities billed as valuable ‘work therapy’ for his heroin addiction.
But critics say the work of Trung and tens of thousands of others is tantamount to forced labor that rarely helps users extinguish their addiction.
Police sent Trung to a state-sponsored rehab center on the outskirts of Hanoi, one of 132 in Vietnam, where he says he faced routine beatings from guards and hours of labor for nominal pay.
“Life there, from eating, to walking, to sleeping, to working — there was no human rights at all,” explained the 50-year-old, who first began using drugs some three decades ago.
He started using again soon after his release in 2014 — up to 80 percent of addicts from the centers relapse, according to official figures.
Trung’s labor therapy has since been replaced by a daily shot of methadone from a government-run drop-in clinic, which he insists is the only effective treatment he’s had.
Today he says he is keeping the addiction at bay, and is trying to mend ties with his only son.
Between 2014 and 2016 more than 65,000 addicts cycled through the centers, usually a mix of compulsory patients sent by police with those admitted by exasperated relatives.
Sometimes they house other marginal groups — the mentally ill and disabled, the homeless, the elderly — along with addicts like Trung, who support the treatment model on paper even if they resent the abuse inside.
Most will stay for one or two years, or up to four if they are deemed unfit for release, and are subject to a range of daily labor — from farming cashews to making sportswear for Western clothing brands, which they can sometimes earn a meagre salary from.
Rights groups accuse officials at the centers of skimming from those salaries or pocketing boarding fees paid by some users’ families, and say addicts are detained against their will.
“These are a failure in terms of drug treatment, but they’re incredibly successful in terms of generating money for government functionaries who run the centers,” said Richard Pearshouse, an associate director at Human Rights Watch who authored a report about the facilities.
Though similar centers exist throughout Asia, experts say the term length and the sheer number of facilities in Vietnam set it apart.
Conditions inside vary widely, though several overcrowded centers have experienced mass breakouts.
The government has acknowledged the need to reform the facilities and has softened drug policies, piloting community-based treatment and methadone clinics.
“Vietnamese laws and regulations are being perfected, especially when it comes to drug rehabilitation and treatment, to consider drug addicts patients,” said Le Thanh Tung, director of the Department of Social Evils Prevention in Hai Phong city.
The center houses some 500 addicts — mostly admitted by relatives — who after an initial period of cold turkey withdrawal behind padlocked doors are moved to dorm rooms.
Once clean, they are put to work sewing shoes or tending vegetable gardens and can receive vocational training as electricians or carpenters.
Many in Vietnam think the scheme is a good thing.
“Drug addicts do nothing good for the family or the community, they should be locked away,” said Ms Luong, mother of two heroin-addicted sons.
“When you have a drug addict in your house, you live in hell. I have two as such,” she told AFP in tears.
Her sons used to pawn her furniture to fund their habit, prompting her to send one to a rehab center. She kicked the other out and hasn’t seen him in years.
Like most of the 200,000 registered drug addicts in Vietnam, her sons were hooked on heroin, though methamphetamines are increasingly popular among Vietnam’s youth.
Several organizations are trying to roll out community-based care to allow recovering addicts to lead normal lives, and even keep steady work.
But some programs have struggled to gain traction.
“The number one obstacle for us is the lack of awareness about how complex addiction treatment is, people want to have a silver bullet,” said Oanh Khuat, executive director of the Center for Supporting Community Development Initiatives (SCDI), an NGO that promotes voluntary and community-based programs.
That approach is one that heroin addict Quan thinks could work for him.
He spent three months and nearly $900 on a voluntary program — another rehab option run by the government — hoping for better treatment he might have received at a compulsory center.
But he quickly started using again after he left.
“The rehab model in Vietnam isn’t efficient,” the chain-smoking 46-year-old told AFP.
He’s home again with his family, but jobless and getting high every day.
“We see no help, nothing from the local authorities,” he said. “They have always created trouble for me, supervising me as if I was a criminal.”


Take a healthy approach to the issue of nutritional supplements

Updated 21 April 2018
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Take a healthy approach to the issue of nutritional supplements

JEDDAH: There is a growing need for dietary supplements in Saudi Arabia, given the increasing popularity of junk food and the effective role supplements can play in treating diseases caused by mineral and vitamin deficiencies.

A recent study found that 22 percent of Saudi people take nutritional supplements. It is no surprise, then, that many Saudi businesses have forged partnerships with international dietary-supplement companies.

Dr. Rowaidah Idriss, a Saudi dietitian with a Ph.D. in nutrition, said dietary supplements can be defined as substances that provide the human body with a nutrient missing from a person’s regular diet. However, she stressed that they are not intended to replace healthy eating.

She also warned against taking them without first talking to a doctor or dietitian, as some products can have side effects, especially if taken before surgery or with other medicines. 

“They can also cause problems if someone has a history of certain health issues,” she added.

A blood test can determine which nutrients we are not getting enough of in our diet, and therefore which supplements might be beneficial. Nutritional supplements are also used to help treat certain health conditions. 

“Vitamin C, for example, is often used to reduce cold symptoms,” said Idriss. “Fish oil is taken to lower elevated blood triglycerides.”

She suggested four daily essentials that can bridge nutritional gaps in our diet: a multivitamin, vitamin D, calcium and omega-3 fatty acids. 

“I routinely recommend a daily multivitamin and mineral supplement to my clients after consulting with their doctors,” she said. 

“For menstruating women, who require 18 milligrams of iron each day, a daily supplement helps boost iron intake.”

She said people over the age of 50 are advised to take a multivitamin to ensure they are getting enough B12, which plays a key role in the functioning of the nervous system and the development of red blood cells. 

“Older adults are more vulnerable to B12 deficiency because they are more likely to have decreased production of stomach acid, which is needed to release B12 from the proteins in food.” said Idriss. 

“It is also a good idea to take a daily multivitamin if one is following a low-calorie diet.”

She also pointed out that a high intake of DHA and EPA, the two omega-3 fatty acids found in fish oil, are linked with a lower risk of heart disease and Type 2 diabetes. A deficiency of DHA might also increase the risk of Alzheimer’s. 

“A daily intake of 1,000 milligrams of both DHA and EPA is equivalent to eating 12 ounces of salmon a week,” said Idriss.

The dietitian believes that the Saudis who take food supplements often do so more to benefit their appearance than their health. 

“Saudi women consume more dietary supplements than other people in Saudi Arabia,” she said. 

“They do so either to lose weight or to care for their hair and nails. Bodybuilders also take large amounts of supplements.”

However, both groups, according to Idriss, tend to take supplements on the recommendation of friends and trainers, not doctors. 

She warned that commercials and social-media rumors can persuade people to buy supplements online that may not be approved as safe by the Saudi Food and Drug Authority, and advised people to get as much of their daily nutrient needs as possible from healthy eating.

Dr. Rowaidah Idriss

“Along with vitamins and minerals, a healthy diet provides fiber and hundreds of protective phytochemicals, something a supplement cannot do,” she said, adding that the body absorbs natural food more effectively than supplements.

In addition, combining supplements with medications can have dangerous, even life-threatening, effects. 

“Drugs for heart disease and depression, treatments for organ transplants, and birth-control pills are less effective when taken with herbal supplements,” she said.

“Taking an anticoagulant, aspirin, and a vitamin E supplement together may increase the potential for internal bleeding or even stroke.”

 

Natural sources

With the spread of fast-food restaurants and their alluring ads, the long-term health of the Saudi people is in danger, as children and young people snub natural sources of nutrients, such as fruit and vegetables. 

“This can lead to many deficiency diseases. Moreover, vegetarians can develop similar illnesses due to the absence of meat in their diet,” she said.
Dr. Ashraf Ameer, a family-medicine consultant, said the importance of nutritional supplements lies in treating mineral and vitamin deficiency, especially for pregnant women, growing children, diabetics, people with chronic diseases, and the elderly. 

“However, these products should come from reliable companies and meet Saudi food and drug requirements,”he added.

Mohammed Yaseen, who has a food supplements business, said his company works with a leading British health-care company to provide the Saudi market with high quality products.

“With this we hope we can contribute to the national transformation program by raising private-sector spending in health care from 25 percent to 35 percent, which in turn would lead to the sector’s financial sustainability and boost economic and social development in the Kingdom,” Yaseen said.

Decoder

Vitamin Terms

DHA stands for docosahexaenoic acid. EPA stands for eicosapentaenoic acid.  Phytochemical is a biologically active compound found in plants.