Drug rehabilitation in Thailand: Treatment or punishment?

By Jirapart Limaksorn, IDPC volunteer

The war on drugs waged by our government for over 30 years has had disastrous consequences, as shown by the over-incarceration rate in prisons and detention centres, including those in the guise of 'drug rehabilitation centres'. Thailand has the highest share of people in prison for drug offences in the world. We lock up so many people who use or sell drugs, young and old but mostly poor, in places where we cannot see them suffer. To make matters worse, we lock them up in overcrowded facilities with poor conditions and call it a 'drug rehabilitation' programme. People who are seeking drug dependence treatment should not be coerced into any programme, nor detained. People should not be punished and incarcerated for using drugs or being dependent on drugs.

In discussing Thailand’s approach to drug dependence, this article highlights some of the outcomes in terms of people in prison and the drug rehabilitation (shortened to ‘drug rehab’ in this article) system. It will also reflect on its impacts by outlining the experiences of some people who have completed drug rehab programmes in recent years. Finally, it will offer recommendations for the consideration of authorities with responsibility for the government’s response to drug dependence in Thailand.

According to a report from the Department of Corrections, a total of 247,727 people were in prison for drug-related offences, making up about 80% of the total number of people in prison in the year 2020 alone (from January to October). Thai prisons, which rank sixth in the world for having the highest number of people in prison and the highest in ASEAN, can only house around 120,000 people and accordingly, had an occupancy rate of 200% in 2020. In the same year, Kittipong Kittayarak, then director of the Thailand Institute of Justice said:

'Although Thailand has the largest number of inmates among ASEAN countries, this does not mean it has the highest crime rate. Instead, this reflects some problems in the justice procedure. The increase in the number of inmates stems from the amendment to the drug law, which has become so strict that anybody with any relation to methamphetamine is landed in jail.'

A ‘solution’ that opens the door to another problem: drug rehabilitation methods

By 2001, the government attempted to solve the problem of over-incarceration by moving people who use drugs to ‘drug rehabilitation centre which reduced the number of people in prison from 240,000 to 160,000. Since then, further problems have arisen with there being too many people in the drug rehabilitation system: in 2019 226,002 people were in the rehabilitation system. In some centres, especially those under the supervision of the police and military, patients don't even get any form of treatment from doctors or public health officers. Instead, patients are merely put under the supervision of an assigned warden, where they are treated as if they are punished with a term of imprisonment. In some centres, there is only 1 trained health care worker amongst the staff.

When a person is seeking access to a government-provided drug treatment programmes, or arrested for drug use and/or related activities such as possession, there arethree types of drug rehab that the person may enter:

1. Voluntary rehabaccepts people via two channels:
   a. people who come by their own will or family intervention, who will then be cared for in a medical setting, or
   b. people who are arrested by police with possession of drugs or following a positive urine test for drug use, and then ‘chose’ toenter a government-provided drug rehab programme, resulting in no criminal record, instead of prosecution and potential criminalisation. This process is known as ‘Kor Sor Chor 108’ (in Thai language: คสช 108) which arguably renders the entry into drug rehab compulsory rather than voluntary. The patients subjected to the Kor Sor Chor 108 process are usually admitted into a centre in the compulsory rehab system.
2. Compulsory rehab is where people detained and arrested under the Rehabilitation Act 2002 are held after being forced into a drug rehabilitation programme, following prosecution and court order, without receiving a criminal record.
3. Prison rehab is where people who use drugs end up being arrested, taken into legal custody and sentenced with a term of imprisonment together with an order to enter a drug rehabilitation programme in prison. After completing the programme, the person may have his or her prison sentence reduced.

According to Prachathai, there are 90 rehabilitation centres funded by the government: 57 are supervised by military and police officers. Only 20 centres are run by the Ministry of Public Health (MPH), which are supervised by specialists in drug dependence treatment. According to reports on the MPH’s website, as of 2019, the 20 centres run by the MPH were more effective with a 60% ‘success rate’ while the compulsory rehabilitation centres had a success rate of 45%. While the definition of ‘success rate’ was not explained, it is likely that the provision of drug rehabilitation services can only be more effective if delivered by health specialists rather than military and police officers. The methods adopted in the military and police-run drug rehab centres are based solely on abstinence and discipline. Also, the Department of Corrections only has 29 psychologists serving people in 142 prisons around Thailand.

Drug rehab or treatment programmes that solely focus on abstinence of drug use result in limited effectiveness. An evaluation and review of Thailand’s drug rehab system concluded that the implementation of such services has not been useful in even achieving abstinence. While the numbers of people enrolled in drug rehabilitation programmes are high, relapse rates have remained high, motivation to access drug treatment remained low, and discrimination and abuse are a frequent occurrence. Compulsory detention in the name of treatment has been identified by UN agencies and experts from across Asia as ineffective, unsafe for clients, and costly.

‘Even if the Ministry of Public Health were to intervene and plan the treatment for all the different centres, in the end, each centre can still only operate by its own capabilities. Centres run by the military will only focus on discipline. Sadly, when it comes to treating drug dependence, it doesn't mean that all you need is discipline to stop the withdrawal symptoms,’ said Dr. Lumpsum, Deputy Director of Academic and Medical affairs at Thanyarak Hospital in an interview with Prachatai in 2018.

The need to reform Thailand’s methods of forcing people into drug rehabilitation programmes

One of the main problems with Thailand’s drug rehab system is the first step of screening who should enter which type of drug rehab. The government has created ‘quotas‘ for police officers on the number of drug cases that they need to solve within a certain period, resulting in the targeting of people who use drugs, including through setting up checkpoints and ordering people to undergo urine tests throughout the country. If a person tests positive for traces of an illegal substance in their system, the police could arrest him or her, or offer the ‘choice’ of entering a drug rehab programme, otherwise face prosecution for the criminal offence of consumption, where the penalty could be a fine and/or a 1-year imprisonment sentence.

Kanin and Leo each experienced drug rehab programmes in the police and military-run centres, and shared that most people including themselves did not tell the truth during their screening process under the korsor chor 108(คสช 108) process. Furthermore, people who use drugs can become more involved in illegal drug markets when they are detained with people already involved in the market. This happened to Kanin who quickly doubled his drug trade business after he went through the juvenile drug rehabilitation programme in Klong Prem Central Prison (read more about his experiences below).

In an interview with Prachathai in 2018, Dr. Lumpsum shared his research findings showing that about up to 300,000 patients are in the drug rehab system each year. In 2019, data from the Ministry of Health showed that 107,363 of those patients (47% of the total) entered a drug rehabilitation centre to avoid prosecution for a drug-related case, therefore on a coercive basis, while the numbers of people who voluntarily joined a drug rehab programme amounted to 55,569 people (24.7%). This means that in 2019, 75% or 169,312 people in the drug rehabilitation centres did not enter the programme voluntarily, but to avoid criminal charges.

Kanin: a ‘vicious cycle’ that started at the juvenile drug rehab centre at Klong Prem Central Prison

‘I do not know what is the right way of treating drug dependence, but the treatment in Klong Prem is not effective at all,’ said Kanin (not his real name), who went through a juvenile drug rehab programme in the Klong Prem Central Prisonin 2018. At that time, Kanin was 18 years old, and using cannabis and MDMA to cope with his underlying family issues.

His family reported him to the police for selling cannabis and he ended up being ordered into the drug rehab programme. In the drug rehab centre, he experienced the corruption of the warden in exchange for privileges and received no medication for his withdrawal symptoms, nor any sessions with a psychiatrist or counsellor. After his experience, Kanin believes that forcing people into prison for 42 days does not lead to a commitment to change, but instead a vicious cycle of repeated arrests. ‘I have known many people who would come out and then a few weeks or months later, they’d be back there again,’ said Kanin.

Kanin recalls the cruel treatment in Klong Prem; the warden held the most authority and abused the system as he pleased: ‘He’s like a god. He could beat us however he liked. But if we bribe him, then we would get better treatment from him and also be protected from other patients in there. The warden encouraged us to transfer the money directly to him, claiming that it would get to us faster than through the prison’s official account...we would receive better treatment in return: better food, better snacks, and the warden would tell the others detained inside to not harass us. We still had to share our stuff with other inmates though. The warden would then use the rest of the money for his own use, usually soccer gambling.’

Kanin feels that his experience in Klong Prem didn’t help him nor others to address the issues behind their drug dependence. ‘If possible I’d like the whole system to be reformed, what I went through is not considered therapy. It’s a disgusting cycle. If people who use drugs do not want to stop using, then nobody else can make us,’ he said with his voice cracking.

From Kanin’s experience, he did not receive educational information about drug use and dependence, nor any form of therapy. There was no guidance or instruction, just mere imprisonment. Kanin has been cynical about government rehab centres since then. He hasn’t stopped selling drugs either, and his drug business has managed to grow even more from the connections he made while inside Klong Prem. His experience has only taught him to be more careful not to get caught a second time; to the point of isolating himself in a tiny room, away from everyone, especially the police.

Leo: Forced rehabilitation in the guise of ‘voluntary rehabilitation’

In 2019, there was a surge in the numbers of people entering drug rehabilitation centres after the annual military conscription process began to drug test people for tetrahydrocannabinol (THC), the psychoactive substance found in cannabis. Leo (not his real name) was one of them. Even though Leo was categorized as entering voluntary drug rehabilitation under the 'kor sor chor' 108 legal process, it was not genuinely voluntary because the only other option was criminal prosecution and imprisonment. People who enter drug rehab under the 'kor sor chor' 108 process are usually in centres that are run by the police or military.

‘I guess I could say that most people there are poor. It’s as if the centre was built specifically for them. But if you ask me whether they deserve this or not, I don’t think they deserve to be in there no matter what their social status. People have preconceptions about people who use drugs as being poor and unemployed. which is not always true. We can be just as successful and ambitious as anyone else’ says Leo. He had been using cannabis on a recreational basis to cope with his depression and loneliness.

‘I sat down with an officer to review my options: if I accept going into drug rehab, it means I will avoid prosecution and not get a criminal record. What choice do I have? I was lucky that there was a space for me in the drug rehab centre in Bangkok, because the centres in the countryside are notorious for physical abuse.’

Leo recalls the first day he stepped into the centre. He went through a screening process, and was asked where he bought his drugs and for how much. ‘Nobody reports the truth. Even if they ask me where I’m studying, I wouldn’t tell the truth.’ says Leo.

Leo does not consider his experience to be ‘rehab’. ‘It did not help at all. Each day we would have a session led by a teacher that taught us how to string beads. They thought we could sell them when we left the centre. They also lectured us about drugs, with cliche information about drugs being bad. Nobody listens to them though. They also made us remember the names of famous soldiers by pointing at their photos and making us chant their name 3 times, like ‘Preedeepanomyong Preedeepanomyong Preedeepanomyong.’’ Leo laughs.

‘Every 2 or 3 days we would get our temperature checked and asked how we were doing. Even if we said we are having a hard time, the doctor didn’t do anything. It was just part of their routine to ask. They didn’t dig deeper or ask why we used drugs.’

Luckily for Leo, he wasn’t physically abused like Kanin at Klong Prem. He mentioned that the soldiers inside were kind and treated him with respect, because they themselves were drafted years before in the same process as Leo and were able to empathise. He also said that the soldiers were less susceptible to bribes however patients were still treated poorly by the supervisor.

‘His perspective towards us was very degrading; he didn't even consider us as human. He would usually use us as buyers for his gift shop. When he bought us new clothes instead of handing them to us, he’d just throw them to the ground and tell us to pick them up. When he handed out snacks he’d give off that smile a kid would have while feeding an animal in the zoo… like he was playing god. But at least he didn’t beat us up like in other centres outside Bangkok. Usually, when it comes to physical abuse, it would be the patients fighting among themselves. I heard through the grapevine that the soldiers in my camp possessed and used drugs as well.’

On his overall experience, Leo concluded: ‘looking back it was terrible... a very terrible experience. It’s a pretty horrible 10 days. We were counting down the days every single day. The people in charge need to realise that people who use drugs are not always unemployed. People who use drugs are capable of having steady jobs. Moreover, locking us up means we’re losing our income. Sending them to a private rehab centre with a competent health care worker could be a better solution.’

After his rehab experience, Leo graduated from one of the most prestigious colleges in Thailand and is currently working at a tech company as an application and website developer. He still uses cannabis to wind down after a long day of hard work.

Maya: A positive experience with rehab in a medical setting

Maya Piyapan is a producer at a company known as Bang Baht and the founder of Warp Gang, a YouTube channel covering hip-hop-related news. He has always been open about his drug use and mental health issues. When his music started to attract attention, he decided it was time for him to try to overcome his drug dependence. He chose to enter an in-patient drug rehabilitation programme at the Phra Mongkut Drug Rehabilitation Centre.

‘When my hobby started to become a job, it required more responsibility and I felt that I can’t be like this, I don’t want to produce ‘half-assed’ work. Which is why I decided to go into a drug rehab programme.’ Maya said. ‘The staff there were all soldiers who have a medical background. They work with a university to develop and implement the programme. At the end of each day, a psychiatrist would come to talk to us for half an hour or an hour. It was helpful.’ Maya further said that the staff were really supportive, and he was treated with respect and care.

Maya said his recovery was made possible because ‘an effective rehab is listening and understanding. I was lucky that the doctor and nurse were very understanding. Unlike those government drug rehab centres that my friend went through, those centres would turn off their surveillance camera and beat patients. When I was in there, there was a guy in my ward who had a major crush on me. He was too aggressive toward me, so I decided to leave one week later.’

Maya was satisfied with his experience, saying ‘it’s a success, I occasionally smoke now compared with smoking all the time before. The only thing I would like to change is that there needs to be more staff or they would not be able to take care of all the patients.’

After decades of criminalisation and incarceration, is it time to take a new approach to drug use and dependence?

Rehabilitation may be beneficial to people who are experiencing drug dependence, but it doesn’t mean that everyone who uses drugs requires intervention from the government. The UNODC reports that only 10% of all people who use drugs are drug dependent. As a result, only a minority of people who use drugs may need or benefit from drug treatment or rehabilitation.

It is the decision of people who use drugs whether they want to stop using or not, whether they need some type of drug rehabilitation or other service. For Maya, it was his own decision to resolve his drug dependence; the decision to stop using drugs should be made by the user, not by anybody else.

The experiences of Leo and Kanin shows that forced rehabilitation is simply another form of incarceration, and ineffective in helping them address their drug dependence. As a matter of fact, they would have been better off without it as Kanin subsequently went further into his drug trade business from the connection he made inside, and Leo never had any issues with his drug use, he used it recreationally after a long day of programming and studying so it was a waste of our tax money and his time.

When drug use and possession for personal use are criminalised, large amounts of taxpayer money go into supporting the criminal justice system and law enforcement interventions, even though those methods have repeatedly proven ineffective in preventing the use and supply of drugs. The International Drug Policy Consortium recommends that drug policy should be based on the strongest evidence available. As a result, the government of Thailand should base its decisions on an objective assessment of the evidence of the impact of laws and policies and practices, by considering factors such as the relative cost and cost-effectiveness of different approaches to drug control, the distinction between the needs of people dependent on drugs compared to those who use drugs occasionally and recreationally, the need to offer a range of drug dependence treatment options (including detoxification, rehabilitation, psychological care and peer support).

As discussed by government stakeholders including the then Minister of Justice in 2016, Thailand needs to consider decriminalising the use and possession of drugs. It reduces government waste of taxpayer money and the damaging impacts of criminal justice systems, especially law enforcement, on people. The cost savings can be invested in ensuring adequate provision of drug treatment, harm reduction and other health and social services for people who use drugs and their communities. This is what we truly need in Thailand, and would benefit everyone in the society.