1) Suspects in crime cases with a history of drug offenses. If they have been to rehabilitation centers, why do they repeat their offenses and commit crimes?
Drug rehabilitation requires more comprehensive support than just being placed in a rehabilitation center. Separating drug users from society by placing them in rehabilitation centers is not the best way to help drug users. What is important is society’s acceptance of them, which is the most powerful support system we can provide them in line with their human rights. Their needs such as having a place of protection, stable employment, having a family, and continuing education are their inherent rights as human beings. However, these rights have been denied with incarceration records and societal stigma that hinder their reintegration into society, thus pushing them to repeat the same offenses and commit crimes. Indirectly, current policies encourage cycles of poverty among them and make it difficult for them to integrate and become human again.
1a) Can drug abuse affect the human brain to the extent that it leads them to commit crimes?
Figure 1: Drug Use Spectrum
Drug use is not a static thing. It is a spectrum (Figure 1) where drug abuse will make someone dependent on drugs (called drug dependence). The spectrum starts with someone who does not use or uses without problems, uses drugs occasionally, occasionally causing problems, to drug dependence.
However, UNODC estimates that only 1 out of 10 drug users are drug-dependent. Drug dependence occurs when the individual’s natural pleasure circuit is disrupted by drug use, causing an urgent need to fill the gap in dopamine levels through drug use. Therefore, this individual will use any means to obtain drugs to satisfy their pleasure circuit. These individuals need treatment, but only 1 out of 6 drug-dependent individuals receive drug treatment. This is due to only one specific treatment being provided: incarceration.
2) Is the flaw in our national correctional system or are there other factors to consider?
Imprisonment is not a solution to help drug users. Drug users need customized treatment according to their needs depending on their position in the drug use spectrum. Imprisonment only restricts the assistance that should be given to them.
Social factors also need to be considered such as financial needs, job needs, the need to improve living standards through education, the need for social skills to interact with society, and health needs such as methadone intake and access to mental health services provided appropriately to help drug users reintegrate into society. Furthermore, these needs should also be extended to their families such as spouses, children, and parents so that they can maintain family stability and avoid vicious cycles like poverty cycles can be prevented and reduce stigma and discrimination against them.
Therefore, decriminalization of drug use (decolonization of drug use) is the next step to eliminate the stigma and discrimination that have been formed since the Anti-Drug Campaign in the 1980s. In addition, empowering the Health system, legal system, Welfare system, family system, Education system, and others in a more comprehensive manner needs to be done to support decriminalization effectively.
3) Can anyone prevent these crimes (crime prevention)?
Crime can be prevented if appropriate comprehensive (public health-based) assistance has been provided earlier to address drug dependence.
4) What could trigger suspects to act like this?
The lack of effective support systems to prevent such actions at all levels.
5) How can the community help if families face the same situation (placing former addicts or drug users at home)?
The community provides awareness of harm reduction, treatment, support to reduce stigma and discrimination against drug users, and can help users towards recovery. Family members can contact NGOs such as the Malaysian Pure Relief Association to get support services.
6) Malaysia does not have specialized centers for mental health patients. We have mental wards, but only for those sent through court orders or if they threaten to harm anyone or themselves. However, those not sent by the court will be sent home after treatment, and many cases recur.
Could the lack of centers where those with mental health problems can go for help be a factor in such crimes?
Actions to address the lack of specialized centers for mental health should not be recommended by the World Health Organization (WHO).
According to the World Health Organization (WHO) 2022 report titled World Mental Health Report: Mental Health Transformation for All, there is an urgent need to reform mental health care and one of them is to empower mental health care by:
i) Building community-based service networks
ii) Reducing mental health care in psychiatric hospitals
iii) Making mental health costs reasonable and accessible to all
iv) Promoting individual-based care and based on human rights
v) Involving and empowering individuals who have experienced mental illness
Therefore, the existence of One Stop Center for Addiction (OSCA) in most Health Clinics throughout Malaysia is highly welcomed and should be strengthened to achieve transformation and reform of mental health care according to WHO guidelines. Mental health services need to be disseminated in every Health service, not just in specialized psychiatric clinics, but also in specialized geriatric, children, family health, women’s health, maternal and child health, and others. This is to facilitate individuals to obtain these services whenever and wherever they need them.
Written by Dr. Khairul, Dr. Iqa, and Rosyati