Forcing ice users into rehab won't solve the problem – here's what we need instead

Tasmanian Independent Senator Jackie Lambie this week revealed her 21-year-old son’s problem with ice. She plans to introduce a private member’s bill to enable parents to force their drug-dependent children into treatment. Unused immigration detention centres, Lambie suggests, could be turned into detox facilities.

Assistant health minister Fiona Nash said the Coalition would wait for the National Ice Taskforce to release its final report later this year before deciding whether to support the proposal.

But Australia already has a number of effective options to divert dependent users from prison and into treatment. And there is no evidence to suggest mandatory treatment outside of the criminal justice system would work. Instead, we need to increase funding for treatment, including early intervention programs and “aftercare” services to reduce the rate of relapse.

How big is the problem?

Ice is the crystalline form of methamphetamine. Speed is the powder form of methamphetamine and base is a paste form of the drug. But they vary in potency, with ice being the strongest. It’s like comparing light beer and extra-strength rum: it’s all alcohol, but the latter is much stronger, so you don’t need as much to get the same effect. Or if you use the same amount, you’re more likely to be intoxicated and become dependent.

Around 2% of Australians use methamphetamine, with half of those preferring ice over speed or base. It’s hard to know how many people are dependent on methamphetamine but around 15% of those who took the drug in the past year used weekly, which is much more likely to cause dependence.

Long-term methamphetamine use can significantly change the structure and function of the brain, which takes a long time to recover. So, although the rate of dependence is relatively low, once users get hooked, it can be really hard to get off, and the relapse rate back to drug use is very high: more than 70%. This can be very frustrating for users and the people close to them.

Drug diversion programs

Australia already has a number of types of mandated treatment. These all operate through the police and justice systems. The main aim is to reduce reoffending through reductions in drug use.

Police can refer people into treatment as an alternative to the justice system. All states have some kind of “police diversion” initiative, most commonly for cannabis. In South Australia, police are required to refer people who are arrested for simple possession of any drug to treatment as a first-line option instead of to the justice system. Police diversion to treatment has been shown to be effective in reducing crime.

Drug courts are special courts where users who have committed non-violent crimes can opt for an intensive treatment program if they plead guilty. Similar to police diversion, courts divert users to treatment instead of the justice system. Drug courts operate in most states and have been found to be effective.

Police and court diversion all still have an element of choice: the main incentive to choose treatment is to avoid prison or criminal justice system. These programs have shown good results and treatment mandated through the courts can be as effective as voluntary treatment when the practitioners are skilled and well-trained. Our study of voluntary methamphetamine users showed that even when people were not very motivated for treatment they could still achieve good outcomes.

There is one compulsory treatment centre in Australia in New South Wales for drug users who repeatedly commit crimes. The program has undergone evaluation and shown good health outcomes for participants but we do not know what impact it has on reoffending.

We do not have any treatment facilities in Australia that make treatment compulsory for drug users without criminal charges. There is no evidence that compulsory treatment outside the criminal justice system is effective.

In some countries, including in East and Southeast Asia, people who are suspected of using drugs can be placed in compulsory drug treatment centres, which are essentially prisons for drug users. They may not have committed any other crimes.

These facilities are internationally opposed on ethical and human rights grounds. They have been criticised for lack of both due judicial process and medical or health assessment prior to a person entering compulsory treatment.

Why mandatory treatment isn’t the answer

Drug use is complex and different things work for different people. But not everyone who uses drugs needs treatment. If someone is a danger to themselves or others as a result of their drug use, there may be an argument for forced treatment. The problem is that a person can be ordered to a treatment facility but they still have to want to take in the information once they are there.

Drug dependence is a chronic health condition and qualified medical and health practitioners are best placed to make recommendations about treatment options, in conjunction with the user.

There are a range of effective treatment options for methamphetamine dependence, including residential rehabilitation and cognitive behaviour therapy (a type of counselling), which, even in small doses, can have an impact.

But the relapse rate is high. One study showed that after three years, people who had been through residential rehabilitation reported similar levels of use to those who had not had treatment: more than 70% were no longer abstinent. However, relapse rates are likely to be lower when people receive ongoing support.

Withdrawal on its own, either at home or in a treatment facility, is not considered effective as a way to reduce drug use in the long term without further treatment.

In Australia, a large percentage of methamphetamine users use less than once a week and are not likely to be dependent but may experience problems with their use, such as mental health issues and other harms, that would benefit from early treatment.

There is a gap in funding for early intervention programs to help methamphetamine users before they become heavily dependent and also for aftercare support services to assist in relapse-prevention in the long recovery time post treatment.

Families and friends can be significantly affected by a person’s drug use and may need support themselves. Family support services can assist parents, partners and other family members and friends to understand how to respond and help methamphetamine users cut down, quit or get professional help. Family support services can help families and friends set boundaries, learn how to provide support and find effective treatment options.

In emergency situations, if you or other family members feel threatened, call the police or if someone is showing symptoms of psychosis or overdose, call an ambulance.

Nicole Lee receives funding from a range of government and non-government organisations as a consutant to help services respond to ice users. She is Director of The LeeJenn Group consultancy and President of the Australian Association for Cognitive and Behaviour Therapy.