FAMILY IS THE SPUR TO BEATING THE HABIT

THE public hope is that heroin addicts will find a cure. But the truth
is that once people are hooked, no treatment will help more than a few
get off heroin any quicker than those who never go through a program.

They might abstain for a while, they might at least have a break from
a chaotic heroin existence, but their ``career'' on heroin, as it's
called, will last about 10 to 12 years. The best evidence is that only
about 10per cent of addicts entering any of the available treatment
programs will be heroin-free a year later.

It is the era of ``harm minimisation'' and drug experts, knowing they
will see the same people time and again, aim to keep dependent users
alive and free of such viruses as HIV. The need for more funding is
undeniable, but those who know say we're kidding ourselves if we think
it leads to abstinence.

Dr Nick Crofts, from the Macfarlane Burnet Centre for Medical
Research, said Australia had a ``touching and naive'' faith in
treatment and rehabilitation as a ``solution'' for heroin addiction.

The Howard Government is giving more resources to rehabilitation
programs than any previous federal government. The Prime Minister, Mr
John Howard, has talked to dozens of parents and acknowledges that
services are stretched. His Government has allocated $64million for
treatment through its $290million Tough on Drugs strategy, and brought
forward $20million last month for new and existing programs. But such
programs have extremely limited success in getting addicts to abstain.

Methadone Maintenance Treatment and Other Opioid Replacement
Therapies, the most authoritative publication on Australian drug
treatments, warns that abstinence is neither easily achieved nor
sustained by heroin-dependent people, and that the majority return to
the drug shortly after detoxification. ``The proportion of people who
become and remain abstinent is of the order of 10per cent within the
first year after treatment,'' it says.

One of the book's editors, Associate Professor Richard Mattick, the
research director at the National Drug and Alcohol Research Centre,
said that while few long-term studies have been done on rehabilitation
treatments, ``heroin dependency is a chronic relapsing disorder that
won't go away. Some people can stop, but the majority don't''.

It is not just treatment centres that are stretched in dealing with
increasing heroin use and harm. The Melbourne Magistrates Court
estimates that 85per cent of its cases are drug-related. An Australian
Institute of Criminology study suggested that 8000 core drug users
could be responsible for 90per cent of all break-ins in Australia.

Law enforcement has been spectacularly unsuccessful in preventing
heroin use and importation and Victorian police have been at the
forefront in seeking new responses. With State Government approval,
the police are testing a program that sees people who are caught with
the drug for the first time being cautioned and sent for compulsory
counselling rather than to court.

Drug experts hope such diversion programs represent the future in
heroin rehabilitation and that putting more effort into treating
people in the early stages of addiction will shorten their using
``careers''. But the pilot programs are so new it is too early to tell
if they will work.

In Australia, there are three types of treatment programs -
maintenance, where users are prescribed the drug methadone as a heroin
replacement; detoxification, where they go ``cold turkey'' for about a
week with the help of medication to help relieve the withdrawal
symptoms; and relapse prevention programs such as Narcotics Anonymous
or therapeutic communities such as Odyssey House, which use
psychological strategies to deal with underlying issues of drug use.

Nobody denies the programs need more money. Mr David Crosbie, chief
executive of the Alcohol and Other Drugs Council of Australia, which
does yearly report cards on how much governments spend on drugs, wants
funding doubled.

``There seems to have been a deliberate policy of under-funding
services for this client group,'' Mr Crosbie said. ``(It's) a moral
judgment that, because these people have injected drugs themselves,
they don't deserve treatment. The services are inadequate, full stop.''

Dr Nick Crofts agrees, but said Australia had to be realistic about
what treatment could achieve: ``People generally spend 10 to 15 years
(on heroin) and treatment has no impact on the length of that dependence.

``The new pharmacologies (Victoria is trialling three new treatments),
we don't know what they do yet. Naltrexone for kids with two or three
years (of heroin dependency) looks hopeful, but we don't know.
Therapeutic communities have no impact on the length of time that a
person is dependent.''

Therapeutic communities are most successful with those coming to the
end of their 10 or 12 years of heroin use and are motivated to get off
the drug. ``They do provide some breathing space, some semblance of
dignity,'' said Dr Crofts, ``(but) taking them as a measure of
abstinence, they just do not work.''

People don't give up because they think they have a medical problem:
``It's ordinary problems like the mortgage, the kids; basically,
they're sick and tired of the grind that having a heroin dependency
involves in this community. They finally find something in their life
that has more meaning than heroin.'' Current programs might not
achieve a drug-free society but they do reduce heroin-related harm.
The main treatment is methadone maintenance, which does not aim to get
people off drugs but to enable them to live more stable healthy lives.

An overview of methadone therapy prepared by the national research
centre's Mr Richard Mattick and Professor Wayne Hall summarised
research: ``Methadone maintenance therapy is associated with a lower
risk of death ... lowered rates of HIV infection... reduced (heroin)
use, reduced criminal behavior and improved social
functioning.''

Californian research also found that for every US dollar spent on
methadone treatment, the benefits to the community were valued at
between $4 and $5. But even the best treatment does not guarantee
abstinence. A 1996 Turning Point study of 195 methadone users found
42per cent had used heroin in the previous month.

Methadone is the cornerstone of our harm minimisation system, with
more than 23,000 Australian heroin addicts on the drug, a figure that
increases annually. But it's not without critics. Many users dislike
the fact that it doesn't offer a ``quick fix'' and is itself highly
addictive and difficult to quit. Others, such as the Salvation Army's
Major Brian Watters, who acts as Mr Howard's key adviser on illicit
drugs policy, dislike the fact that users are encouraged to stay on it
for an average of about two years, in accordance with the evidence
quoted by Mr Mattick and Professor Hall that ``restrict-ing the
duration of treatment is associated with relapse to drug use''.

Major Watters told The Age he was enthused by the arrival of
Naltrexone as another treatment for helping some people get off drugs.
Research has shown Naltrexone works best for the small number of users
who are highly motivated to give up heroin.

Dr James Bell, director of the Langton Centre, a Sydney drug and
alcohol treatment service, said studies showed that ``after induction
on to Naltrexone the rate of dropping out of treatment is high, and
most people who drop out will relapse on to heroin use ... claims of a
miracle cure are simply not substantiated''.

It's a depressingly familiar story. But those running treatment
programs have aims other than abstinence. Mr Paul McDonald, executive
officer of the Youth Substance Abuse Service, which has eight
residential detoxification beds for dependent users aged 12 to 21,
acknowledges that half the people who enter the program don't even get
through withdrawal. The nausea, cramps, cravings, sweats and insomnia
prove too much to bear.

Of those who complete withdrawal, ``100per cent use again, that's
realistic''.``We actually see kids returning as a good news story
rather than a failure ... the hard work is the kid saying they want to
come back and give it another go,'' Mr McDonald said.

He and other experts are wedded to Australia's official ``harm
minimisation'' policy. The philosophy is that Australia accepts that
drugs are in the community and has as its primary goal reducing the
harm, rather than reducing drug use. Harm minimisation, adopted in
1985, was a victory for the health professionals who argued that drugs
were a health issue rather than a criminal issue - even if the public
has never fully understood what the term meant, nor wholeheartedly
agreed with its goals. As Margaret Hamilton and Greg Rumbold put it in
the book Drug Use in Australia, it is supposed to take a ``morally
neutral'' stance to drug use.

But heroin has always had a moral dimension in Australia, with drug
users seen as weak-willed or morally deficient. The ambivalence about
the policy has meant Australia's heroin response is a constant
philosophical struggle. If harm minimisation is to remain credible, it
is inarguable that Australia needs to increase treatment funds, even
beyond the present round of funding. Mr Crosbie gives the Prime
Minister credit for his Tough on Drugs strategy.``If you judge people
by his actions, he's put more money into drug education, treatment,
trialling of drug treatment than any other government.''

But it's the balance that matters. A United Nations World Drug Report
found that Australia in 1997 spent 84per cent of drugs money on law
enforcement and just 6per cent on treatment, with 10per cent for
prevention and research. Those in treatment argue that the balance is
too far in favor of law enforcement.

Victoria is progressive by Australian standards in its approach to
illicit drugs. The Premier, Mr Jeff Kennett, has been at the forefront
of the campaign urging the Federal Government to try heroin
prescription and, more generally, to rethink its approach.

But Mr Crosbie's work shows that, at least in 1996-97, Victoria spent
less per capita than any other state or territory on all drug programs
(legal and illicit). Victoria received $823million from drug taxes
(mainly alcohol and tobacco), and returned just 3per cent to treating
the harm.

Mr Crosbie concedes that Victoria has improved since then and, by
mid-2000, there will be another 142 rehabilitation beds (currently
there are 396).

At the moment, the average waiting list for treatment is two to three
weeks.

The courts, too, are overwhelmed by dealing with heroin and looking to
treatment as an alternative to jail. They now rarely sentence a person
to jail just for possession of heroin. But Australia's first response
is still to arrest and punish, because that's the law. More than
10,000 heroin arrests were made of users and providers of heroin in
1997-98, a 42.4per cent jump from the previous year. And consumer
arrests are still growing faster than those of dealers - 7088 arrests,
or seven out of 10, are of heroin consumers. Victoria makes more
heroin arrests than any other state. More than 5500 people were
arrested, with the majority of arrests (3636 in total) for heroin use.

It frustrates those who see kids, not criminals. ``That is our
response,'' said the youth service's Mr McDonald. ``We are actually
locking them up at the ripe age of 16, 17, 18. Is that our commitment?
Is that the way we are treating the follies and the frailties of youth?

``As adults we're impatient about young people, we're lazy about young
people, we lack commitment. ... We are abandoning our (belief) that
young people are still dependant on society to get them through to
adulthood.

``Working in this business you have got to be comfortable with
compromises.''