Drug addictions in Malaysia: a mini-review on drug types, rehabilitation centers and therapeutic programs

Abstract

Drug addiction remains one of the most complex social problems worldwide that has yet to be resolved. In Malaysia, abuse of various types of drugs has been reported which warrants the government to take immediate strategies in managing drug addicts. Despite implementing various strategies to treat drug addiction, statistics show the number of relapses continues to skyrocket over the years. This calls for urgent attention to improve the effectiveness of substance abuse treatment services in Malaysia. Moreover, emerging evidence shows a change in trend in the type of drug being abused. This factor could potentially contribute to the ineffectiveness of the strategies employed in the treatment of substance abuse. Therefore, this review provides an overview of the major types of drugs commonly abused in Malaysia. Additionally, in an effort to search for ways to improve the effectiveness of substance abuse treatment services, we identified the public institutions responsible for managing drug addicts in Malaysia and discussed the therapeutic programs offered at the institutions. Review findings support the need for future research on the effectiveness of these therapeutic programs and recommend the implementation of evidence-based programs to improve the effectiveness of substance abuse treatments in Malaysia.

Keywords:

• Addiction
• drug
• rehabilitation centers
• therapeutic programs
• Malaysia

Introduction

Drug abuse is the action of consuming drugs extremely and continuously for the sake of self-pleasure and reward, not for medical purposes. Loneliness, mental health disorders, peer pressure, financial problems, childhood trauma, and domestic violence are among the factors contributing to drug abuse (Pathak & Saxena, 2019). Drug abuse has been a worldwide problem affecting many countries. For instance, various drug-related incidents have been reported almost every day in Korea (Kim et al., 2023). The country has also experienced a notable upward trend in domestic drug abuse, particularly among teenagers. In 2022, 24 cases of drug-related deaths were reported in Korea, with six of them confirmed to be due to acute drug overdose (Kim et al., 2023). On the other hand, Columbia has reported a significant increase of approximately 30% in deaths due to drug overdose between 2019 and 2020 (Kariisa et al., 2022). Particularly, the study reported that the number of deaths was highest for the African American ethnicity (44%), followed by the American Indian or Alaska Native ethnicity (39%), and the White American ethnicity (22%). In 2020, the rate of drug overdose deaths for African American males aged 65 years and above was nearly sevenfold compared to White males of the same age. Meanwhile, in the United States, a study reported that drug abuse has caused an increase in assaultive violence and crime rates (e.g. burglary and motor vehicle theft) (Contreras & Hipp, 2019).

Other than these countries, Malaysia has also witnessed various drug-related crimes, offenses, acts of violence, and social problems (Ismail et al., 2022). Despite various strategies employed by the Malaysian government in curbing drug addiction, it continues to be a major challenge that has yet to be resolved (Chie et al., 2015). In this paper, we discuss the ethnic groups involved in drug addiction and the recent types of drugs commonly abused by drug addicts in Malaysia. Additionally, we provide an overview of the management of drug addicts in Malaysia. The information provided in this review is crucial in helping the public authorities formulate the best strategies for the prevention and treatment of drug addicts. To the best of our knowledge, the types of drugs commonly abused by drug addicts and the management strategies undertaken by the public authorities have not been comprehensively summarized in the current literature. Therefore, we focus our review mainly on drug-related issues in Malaysia. Moreover, there has recently been a change in drug abuse trends happening in Malaysia.

Ethnicity

Malaysia is a country with a diverse population and ethnic groups. The three major ethnic groups in Malaysia are Malay (70.1%), Chinese (22.6%), and Indian (6.6%) (Statista Research Department, 2023). Ethnicity is one of the factors that may contribute to drug abuse (Fauzi et al., 2023). The presence of unique cultural norms within different ethnic groups may influence the prevalence of drug abuse. According to the recent statistics provided by the National Anti-Drugs Agency (NADA), the prevalence of drug addiction is highest in the Malay ethnic group (80.4%), followed by Chinese (6.4%), and Indian (6.0%) (NADA, 2023). The statistics are consistent with an earlier study reporting that the total number of Malay drug addicts was higher than other ethnicities (Abdullah et al., 2021). The Malays contributed the most to these percentages maybe because they are the majority ethnic group in Malaysia. This scenario is similar to that in China where most of the drug addicts are from the Chinese ethnic group (Fauzi et al., 2023). Apart from being the majority ethnic group, the low educational levels and impoverished household incomes of the Malay may have also significantly contributed to their involvement in drug addiction (Lua et al., 2018; Lua & Talib, 2012).

Type of drugs in Malaysia

One of the factors inhibiting the government’s efforts in combating drug addiction is the availability of different types of drugs (Mat Sihap et al., 2021). For instance, a study reported that many types of drugs have been abused by drug addicts in Malaysia, such as cocaine and opiates (Fook & Adnan, 2020). This report is supported by the latest statistic provided by the NADA, showing that opiates, methamphetamine, and amphetamine-type stimulants (ATS) were among the major types of drugs abused in Malaysia (NADA, 2021). Out of these drugs, studies showed that opiates (e.g. morphine and heroin) were the primary type of drug being abused, followed by ATS, cannabis, and ketamine (Abdalrazak et al., 2021). However, the trend may have changed as the use of ATS has shown an increasing pattern in Malaysia since 2017 (Du et al., 2020; Singh et al., 2013). This change of trend was later confirmed by the latest statistical data provided by NADA, indicating that the use of opiates showed a decreasing pattern, while the use of methamphetamine continued to increase from 2016 to 2020 (Figure 1). In addition to the information provided by NADA, the data from the Statista Research Department (2022) also indicated that crystal methamphetamine was the type of drug mostly abused by drug addicts in Malaysia in 2020. Furthermore, according to the statistics provided by the Malaysian Ministry of Education (MOE), methamphetamine is the type of drug mainly abused by youths (Mallow, 2020), possibly due to its cheaper price and availability (Abdul Ghani et al., 2021). According to the latest statistic provided by NADA, a total of 103,760 drug abusers have been registered in Malaysia between January and March 2023 (NADA, 2023). From the total number given, youth (19 to 39 years) was the population group that mostly abused drugs (59.6%), followed by adults (40 years and above) (39.9%), and teenagers (13 to 18 years) (0.4%). Youths are well-known for their immaturity, innate curiosity, pleasure seekers, and a strong desire to try new things (Ismail et al., 2023). Other than these, antisocial behaviors (e.g. selling drugs, becoming drug dealers, gang fights, and stealing) may also influence youths to involve with drugs (Ismail et al., 2023). Therefore, these may be the possible factors contributing to the youth’s statistics on drug abuse. Academic stress and poor relationships with parents may also contribute to drug abuse among youths (Alhammad et al., 2022). As for the adult population, they may be abusing drugs as an escape mechanism from major life challenges and work-related stress. According to Li et al. (2021), working in stressful environments or high-stress professions (e.g. healthcare workers or military personnel) may contribute to drug abuse. On the other hand, teenagers may be involved in drug abuse due to interpersonal traumas (e.g. history of domestic abuse in childhood), trying to gain experience in new things, and peer pressure (Alhammad et al., 2022).

Figure 1. Statistical trends on the types of drugs being abused between 2016 and 2020 (https://www.adk.gov.my/trend-statistik-penagih-dadah-dikesan-aadk-mengikut-jenis-dadah-2016-2020).

From the above-mentioned studies, it can be derived that opiates are the types of drugs commonly abused in Malaysia until the year 2016. However, between 2017 and 2020, the use of methamphetamine was higher than opioids (Du et al., 2020; Mallow, 2020; NADA, 2021). One possible reason for this change in trend is the availability of these drugs to drug addicts (Abdul Ghani et al., 2021; Chie et al., 2015). However, this pattern may again change as a recent report indicates that cannabis, kratom, and ATS are the types of drugs most frequently abused by Malaysian youths nowadays (Ismail et al., 2022). To this point, it is clear that the availability of different types of drugs in the community may pose a barrier to the prevention of drug addiction. To overcome this challenge, various rehabilitation centers and therapeutic programs have been established by the Malaysian government.

Rehabilitation centers

Malaysia is well-recognized for its persistent effort to combat drug addiction and drug-related crimes (Mallow, 2020). One of the efforts is establishing NADA, a nonprofit government agency under the Malaysian Ministry of Home Affairs (MOHA), which is responsible for managing and rehabilitating non-criminal drug addicts who are teenagers and adults. Particularly, NADA evaluates and oversees drug addiction and its related problems in Malaysia (Mallow, 2020). To achieve its objectives, NADA has established 30 narcotic addiction rehabilitation institution centers (namely known as Narcotics Recovery and Addiction Centers or PUSPEN) across Malaysia (Figure 2). These centers are further categorized into three categories: (i) mandatory, (ii) voluntary, and (iii) mandatory and voluntary (Jo Jo & Ali, 2021). Drug addicts charged under Section 8(3)a of the Addiction Act Drugs (Treatment and Rehabilitation) 1983 will undergo rehabilitation treatments at voluntary rehabilitation centers. On the other hand, drug addicts charged by court’s order under Section 6(1)a of the Drug Addicts Act (Treatment and Rehabilitation) 1983 are placed at mandatory rehabilitation centers. NADA also accepts the admission of teenage drug addicts under the provisions of Section 9 of the Drug Addicts Act (Treatment and Rehabilitation) 1983 to get treatment at PUSPEN centers. Both teenagers and adult drug addicts will undergo the same rehabilitation programmes or services (e.g. group therapies, psychospiritual programmes, and counseling sessions). Services provided at PUSPEN are based on the concept and philosophy of ‘no single treatment and drug addicts are chronic patients and prone to relapse’ (NADA, 2020a). To date, NADA is the only nonprofit organization in Malaysia that is responsible for handling drug addiction management.

Figure 2. List of PUSPEN based on their categories (https://www.adk.gov.my/rawatan-dan-pemulihan/rawatan-dan-pemulihan-di-institusi).

To further improve its effectiveness, NADA has transformed its existing rehabilitation centers to an open-concept approach with five different specialized centers. These institution-based centers are Clinic Cure and Care 1Malaysia (CNC), Cure and Care Rehabilitation Center (CCRC), Cure and Care Service Centers (CCSC), Cure and Care Vocational Center (CCVC), and Caring Community House (CCH) (Chie et al., 2016). CNC is a place where drug addicts voluntarily participate in therapeutic programs, such as methadone replacement therapy (Jo Jo & Ali, 2021). On the other hand, CCRC is a place where drug addicts initially receive treatments. Once they have completed their treatment in CCRC, they then enter CCSC which focuses on conducting and providing aftercare programs through three major components: (i) psychosocial, (ii) health and medical care, and (iii) skills and vocational training (Ali et al., 2018).

Apart from the institution-based centers listed above, there are four community-based centers under NADA. These centers are the district NADA Office, NADA Service Center, Integration Center Client, and Community House. The district NADA Office is a facility that provides services to individuals facing drug addiction problems. On the other hand, the NADA Service Center is known as a halfway house that encourages individuals with drug addiction problems to come and seek rehabilitation services voluntarily. As for the Integration Center Client, it serves as a transit place for those participating in job placement programs, whereas the Community House is operated by the local community through the cooperation of government agencies or non-governmental and private agencies to achieve the same purposes (NADA, 2020b).

Regardless of the categories and specialization, all the rehabilitation centers under NADA provide opportunities for drug addicts who are without any criminal offense to receive voluntary treatment and allow them to improve their quality of life (Chie et al., 2015). Nonetheless, drug addicts with criminal offenses are not permitted to undergo therapeutic programs at any of the rehabilitation centers under NADA. They, however, are required to undergo rehabilitation programs at the Malaysian Prison Department, organized by the Prisoner Management Section. The department ensures the detainees (i.e., drug addicts with criminal offenses) undergo therapeutic programs such as cognitive-behavioral therapy (CBT), individual and group counseling, and spiritual activities during their detention period. These also include interactive programs that focus on skill building such as leadership and communication according to detainees’s needs. These skills are important for them to socialize and communicate effectively in society, after post-detention as they would potentially face challenges such as discrimination, rejection, and prejudice (Cheah et al., 2019). In addition to that, the department provides certified skills training to all eligible detainees during detention for job preparation upon release. The department also Figure 3 shows the list of all prisons in Malaysia, with only four prison centers offering drug addiction therapeutic programs.

Figure 3. Prisons in Malaysia offering drug therapeutic programs (www.prison.gov.my/images/carta/penjara-penjara.htm).

Therapeutic programs

Apart from establishing the rehabilitation centers, NADA is also responsible for overseeing all matters related to drug addiction problems including the management of rehabilitation centers and therapeutic programs (Mustapha et al., 2017). According to NADA, the types of therapeutic programs offered at the centers are based on the characteristics of drug addicts, such as drug use patterns, type of drugs taken, and addiction history. It is crucial that the therapeutic programs are tailored to the recovery needs of drug addicts to ensure the treatment goals are met. Other than treating drug addiction, rehabilitation centers also play an important role in ensuring drug addicts transform their drug-abuse lifestyle into a healthier one (Ismail, 2010). To achieve this, NADA has incorporated the i-Pulih model into the therapeutic programs conducted at the institution and community-based centers. The model proposes that therapeutic programs must be holistic and encompass biological, spiritual, psychological and social aspects to suit the patient’s rehabilitation needs (Mohd Darif, 2022).

Worthy of note, the i-Pulih model employed at the institution-based rehabilitation centers slightly differs from that employed at the community-based centers. For instance, the i-Pulih model employed at the institution-based centers constitutes nine therapeutic programs (Figure 4). The programs offered are medical and healthcare, guidance and counseling, psychospiritual, psychoeducation, social support, skills and vocational training, recovery coaching, sports and recreation, and special intervention (NADA, 2020a). While for community-based rehabilitation, there are also nine therapeutic programs in the i-Pulih model (Figure 5). These programs are guidance and counseling, social support, psychoeducation, psychospiritual, health education, family programmes, skills training, job placements, recovery coaching, sports activities, and recreation (NADA, 2020b).

Figure 4. The i-Pulih model employed in institution-based rehabilitation centers in Malaysia (https://www.adk.gov.my/rawatan-dan-pemulihan/rawatan-dan-pemulihan-di-institusi).

Figure 5. The i-Pulih model employed in institution-based rehabilitation centers in Malaysia (https://www.adk.gov.my/rawatan-dan-pemulihan/rawatan-dan-pemulihan-di-institusi).

The therapeutic programs outlined in the i-Pulih model have several benefits worthy of discussion. For instance, individual counseling sessions are vital in helping drug addicts overcome their addiction by reforming their thinking patterns, making behavioral changes toward a healthy life, and teaching them ways to prevent relapse (Pathak & Saxena, 2019). It was found that the session is more effective when it is carried out by professional counselors, who are mostly former drug addicts themselves (Pathak & Saxena, 2019). One of the reasons is that professional counselors better understand drug addicts and could assist them in resolving their personal issues. This intervention would help drug addicts to prepare mentally for the life that they will be leading once they complete the therapeutic programs (Chie et al., 2016; Salleh, 2012). More importantly, professional counselors can help drug addicts to manage their addiction to drugs effectively (Sereta et al., 2016).

Apart from being involved in individual counseling sessions, drug addicts can also participate in group therapy. It is a program where drug addicts are assigned to certain groups based on their type of addiction or behavioral problems. The purpose of group therapy is to provide an opportunity for drug addicts to share their problems and resolve them as a team (Chie et al., 2016). Group therapy also helps drug addicts form good friendships with one another and supports themselves in faster recovery (Ali et al., 2018; Salleh, 2012). As drug addicts typically are not good at forming interpersonal relationships (Sereta et al., 2016), group therapy serves as an important platform for them to establish meaningful and strong relationships with other individuals.

Lastly, psychospiritual programs have been shown to be effective at instilling moral values and increasing self-awareness in drug addicts (Salleh, 2012). Examples of psychospiritual activities that are commonly carried out at rehabilitation centers are prayers, religious teachings, recitation of the Holy Book, and remembrance of God. These activities help drug addicts to change internally (Chie et al., 2016). Despite the implementation of various preventative measures (e.g. rehabilitation services and aftercare programmes) by the Malaysian agency (i.e. NADA), the number of relapses among former drug addicts continues to increase (Wan Sulaiman et al., 2021). From this review, we have identified that one factor that may have contributed to this concerning trend is the lack of studies that have comprehensively assessed the effectiveness of these implemented programmes. Among the few studies investigating the effectiveness of rehabilitation programmes on drug addicts have mainly focused on religious approach programmes and psychospiritual therapy for treating Malaysian drug addicts (Ahmad Nasrulddin et al., 2020; Mohd Khairi et al., 2019; Zainal Abidin et al., 2022). Due to a limited number of studies, less is known about the effectiveness of these rehabilitation programmes in treating drug addiction. Thus, it remains a challenge to precisely identify the main problems underlying the high relapse rate. Future work on the effectiveness of different rehabilitation programmes is warranted to ensure that the programmes are effective in reducing the relapse rate.

Conclusion

Drug addiction is a problem affecting nations worldwide, including Malaysia. This problem continues to exist despite the various measures undertaken by the government to curb drug addiction. The availability of different types of drugs in the community may contribute to this problem. Statistical reports indicate that opiates and ATS are abused mostly by drug addicts in Malaysia. However, the use of cannabis and kratom among drug addicts is also on the rise nowadays. It was also reported that drug abuse is highest among Malaysian youths. Consequently, youth who persistently abuse drugs often experience an array of problems, including health-related problems (both physical and mental health), poor peer relationships, juvenile delinquency, and poor quality of life. Subsequently, Malaysia will also be affected in terms of tourism and criminal rate. Tourism plays an important role in boosting economic growth and an increasing criminal activity may reduce the number of tourists visiting Malaysia. In this brief review, we have identified the rehabilitation centers responsible for managing drug addicts in Malaysia. The rehabilitation centers under NADA (i.e. PUSPEN) manage non-criminal drug addicts, while the Malaysian Prison Department is responsible for handling those drug addicts with criminal offenses. Several therapeutic programs were also discussed based on the i-Pulih model. However, the literature on the effectiveness of these programs on drug addiction remains to be limited. Therefore, future works are warranted to evaluate the effectiveness of these programs in the long-term prevention of drug addiction.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work is supported by the Department of Higher Education, Ministry of Higher Education under the Fundamental Research Grant Scheme (FRGS/1/2022/SKK06/UNISZA/02/2)