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A new approach to addiction

Substance abuse and mental health problems often go hand in hand. As a Government inquiry looking at both gets underway, Teuila Fuatai examines whether a more rehabilitative legal system is the answer.

New Zealand’s mental health system has received plenty of attention in the past year. Scrutiny around access to treatment, the country’s high suicide tally, as well as a raft of high-profile individuals speaking out has made it a more acceptable, and less daunting, topic of conversation.

But what about addiction? If there’s a stigma around mental illness — which only just seems to be softening in some circles — what are the attitudes around addiction in New Zealand?

Speaking to Newsroom a day after the Government released its terms of reference for its mental health and addictions inquiry, psychologist and addictions specialist Dr Vanessa Caldwell outlined how health and social outcomes could improve with a more holistic approach to addiction.

“There is a sense that addiction is self-inflicted because people chose to use drugs and they chose to engage in a behaviour which was criminal," she said.

That perception, and the separation of addiction in terms of funding, treatment conditions and regulations, has made it difficult to manage substance abuse as a genuine health condition — even though “from a diagnostic point of view, it is technically a subset of mental illness”, Caldwell, who recently stepped down as co-chair of the National Committee of Addiction, said.

At the moment, anyone with a primary diagnosis of addiction can not be considered under the Mental Health Act — the legislation used when compulsory assessment and treatment is needed for an individual — even if they have a mental illness. On the other hand, the Substance Addiction Compulsory Assessment Treatment Act, passed last year and due to come into play next month, is available — however it has been designed for people who have severe addictions.

The gangs  ... actually approached us to help with methamphetamine because they were worried about it.

— Dr Vanessa Caldwell

Recommendations from the inquiry, which are due to be presented at the end of October, will be considered by the Government when making decisions regarding regulations that impact mental health and addiction systems. A thorough analysis of how current laws impact New Zealand’s status quo when it comes to addictions must be a pertinent part of the inquiry, Caldwell emphasised.

“The criminalisation of the use of drugs, and what that has meant for the stigmatisation of drug users, and ergo their treatment, has meant that it's always been not on the same-level playing field as mental health,” Caldwell said.

“People are actively excluded from services if it is known that they have a methamphetamine addiction. It’s all through different areas of health. And access to various services can be quite difficult if people have an addiction.”

Research examining the impact of punitive drug laws on communities shows they severely lessen the likelihood of those with substance abuse problems gaining access to treatment. It also marginalises individuals with addiction as a recognised health condition.

Locally, one of Caldwell’s big disappointments was the shutdown of the “hugely successful” Hauora Programme. Established in 2009 by the Salvation Army and the Notorious chapter of the Mongrel Mob, the programme — supported by drug addiction services — helped methamphetamine-dependent people.

“The gangs ... actually approached us to help with methamphetamine because they were worried about it,” she said.

“We developed a partnership that was incredibly successful, but the backlash from the community for the government spending a fraction of money on addressing this core group of people — largely because of the criminal element that was associated with it — was too much and that is why the government withdrew funding.”

“From an addiction perspective, the whole idea of decriminalisation means that there’s an opportunity for us to move beyond that and see people having a health condition which they need to address,” Caldwell said.

“It’s a roundabout thing, but it all contributes to that.”

Notably, latest figures from the Health Ministry put the cost of illicit drug use in New Zealand at $1.8 billion in 2014/15. The figure is based on the health, social, and economic harm caused by drugs.

However, even within the judicial system itself, there has been a significant shift towards health and rehabilitative-orientated measures.

Barrister Ali’imuamua Sandra Alofivae was among the first cohort of lawyers to practise in the Alcohol and Other Drug Treatment Court in Auckland.

Alofivae, who has been a lawyer for more than 20 years, believes wholeheartedly in the effectiveness of the special court — now in its sixth year.

Those who do complete the programme are completely changed. And in most cases that do come through, we find the root of substance abuse is deep-seated trauma from the past.

- Alcohol and Other Drug Treatment Court barrister Sandra Alofivae

Four main criteria determine whether an offender is eligible to appear in the court: if the individual is Māori or Pāsifika, whether they have a history of family violence, if their offending is fuelled by addiction, and if the length of their final sentence is less than three years' imprisonment.

“If you choose to come into this Court, you’re actually choosing to undergo quite an intense therapeutic programme,” Alofivae said.

“If you fall off the wagon, the Court will always give you a chance based on your circumstance ... but it is really tough. Saying that, it does work hard to understand the context and the circumstances in which you backslide.”

While the options available to judges in the Alcohol and Other Drug Treatment Court are not that different to those in the mainstream court, it provides a specific mandate to hold offenders accountable if they fail to complete a programme.

Offenders progress through three different phases over 12 to 18 months. During the initial phase, they must report to court every fortnight for monitoring. In the third and final phase, court monitoring occurs once a month. Those unable to adhere to conditions of the Court are sent to prison.

“In the mainstream court, if you don’t go, you don’t go,” Alofivae says. “You can fall out of the system and the next time you might be picked up is on a warrant — which isn’t of any benefit to anyone.”

While an initial 2014 evaluation of the Court found it was too early for a conclusive assessment, the decision to extend its operation beyond the initial five-year trial period indicates it is doing well. About 100 offenders were seen in the Court in its first year.

“Those who do complete the programme are completely changed. And in most cases that do come through, we find the root of substance abuse is deep-seated trauma from the past,” Alofivae says.

“Addiction is chronic care management of an illness. You need a systematic approach like that to help you claim your power back, and if the situation suits, a rehabilitative approach like the one available through the Alcohol and Other Drug Treatment Court is much better than a purely punitive approach.”

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