A 38-year-old Yokohama native said his life entered a downward spiral when he used illicit drugs for the first time around the age of 15 at a friend’s house.
The encounter led to a methamphetamine habit he only managed to free himself from after 10 years of dependency.
“I thought I could quit anytime, and decided to quit countless times, but just five minutes later, I would find myself sticking the needle into my vein again,” the man, who wished to only identify himself by his last name Takahashi, recalled at an office of recovery support institute Nihon DARC (Drug Addiction Rehabilitation Center) in Tokyo.
Drug-free for 15 years, the man is now a member of DARC’s staff, supporting people who want to kick their drug dependencies at its facilities. He also visits prisons and other locations.
Takahashi developed a tolerance for methamphetamines in the later stages of his addiction, and when he eventually decided to quit, he said no help was available.
“I was taking more drugs to obtain that immense pleasure I had felt when I used it for the first time, but I was not able to get that anymore,” he said. “After developing a tolerance, I was taking the drug just to function normally in daily life because I couldn’t without it,” he said.
It was DARC that saved him, and the presence of the friends he has made there helps him stay drug-free, he said.
Illegal drug use has entered the spotlight in recent months because of drug cases involving Japanese celebrities.
Recent trends in treatment show that substance dependence is being viewed as a disease, experts say, and this concept is taking root among professionals in Japan, even if it hasn’t yet found acceptance by society at large.
Toshihiko Matsumoto, a doctor who developed the Serigaya Methamphetamine Relapse Prevention Program (SMARPP) for patients in Japan, has been seeking broad recognition of substance dependence as a health issue and emphasizing how important it can be to provide specialized treatment programs.
SMARPP is an outpatient program based on cognitive behavioral therapy and modeled after an approach to substance abuse treatment developed in California in the 1980s.
According to the website of the U.S. National Institute on Drug Abuse, substance dependence is a problem involving alterations of important brain areas, as most illicit drugs target the brain’s reward system by flooding it with dopamine.
But the brain adjusts to the surges in dopamine by making less or reducing the number of receptors getting signals. Consequently, dopamine’s impact on the reward circuit of drug abusers will become abnormally low and their ability to experience pleasure will be reduced. This causes them to take larger drug doses.
Long-term drug abuse impairs brain function, and potentially cognition, NIDA says.
“In a way, these individuals with drug dependence are in and out of prisons because of the disease,” Matsumoto said, emphasizing that treatment and care are in short supply. “Japan is successful in keeping the number of drug users low but is behind in treatment of drug dependence,” he said.
People who break the stimulants control law have a high recidivism rate.
According to the 2015 white paper on crime, of all inmates released in 2010, 49 percent of those imprisoned for violating the stimulant control law had returned to prison within five years, versus 36 percent for the rest.
In June, a system was launched allowing judges to partially suspend prison terms, with or without labor, for up to three years to improve the treatment of inmates in society. Previously, sentences could only be fully suspended.
According to Hisato Oshikiri, a Justice Ministry official aiding rehabilitation efforts, the system was introduced in the belief that more time for education and support in society are necessary to prevent individuals from re-offending and to bring them back into their communities.
“Substance dependence can be considered a lifelong illness and whether (drug users) are able to be involved and receive support for a long time will truly be a key,” Oshikiri said.
At probation offices, parolees and people on probation with partially suspended sentences are obliged to take a five-session core program over a three-month period and a once-a-month step-up program during probation to prevent relapse. Both programs are packaged with mandatory simplified drug tests aimed at encouraging offenders to stay clean.
Probationers with fully suspended sentences are obliged to take only the core program.
“It is essential that we develop close ties and coordination with medical institutions in communities so they can be connected with medical and other institutions as well as recovery support groups after we provide relapse prevention programs for parolees and probationers at our facilities,” Oshikiri said.
Guidelines for close coordination in supporting drug-dependent offenders in their communities, formulated by the Justice and Health, Labor and Welfare ministries, call for “seamless support” for these people to be provided by institutions such as probation offices and medical institutions. The close coordination is expected to be led by mental health welfare centers.
But only an estimated 3 percent of parolees and probationers with substance abuse problems received specialized treatment at hospitals or elsewhere in fiscal 2014, according to a Justice Ministry survey.
“The number of those institutions remains too small,” said Oshikiri, as only around 40 institutions provide specialized treatment programs for drug addicts throughout the country, while there were no such institutions in 24 prefectures as of the end of April 2015.
Yoichiro Matsumoto, a probation officer at the Chiba Probation Office outside Tokyo, said: “Probably it’s easier for institutions that already have programs for other dependency issues such as alcohol to start new substance dependence programs than institutions with no successful track records with other dependence programs to start from scratch.”
He also said that successful recoveries should be placed under the spotlight more and that former abusers who are successful in abstaining from drugs should be introduced as role models and supporters of those in recovery, since public attention tends to focus on the high recidivism rate for meth offenders.
Tsuneo Kondo, executive director of Nihon DARC and founder of the first DARC facility, echoed this sentiment. He said preventing drug addicts from becoming isolated, especially after getting out of penal institutions and completing probation, should be a priority.
“I think isolation is the major cause of relapsing into drug abuse. So getting these people connected to communities is the best prevention,” said Kondo, a former drug offender who has been clean for decades.
“To achieve that (goal), we need to utilize people who are successful in quitting to support individuals on recovery. No one can win the battle against drug dependence alone. They need someone who walks through the recovery process with them.”
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