Addiction is a public health issue that affects the globe. By sharing good practice between countries, there’s huge potential to improve treatment outcomes, public health and improve community approaches.
In 2024, “228,450 individuals were arrested for drug-related offenses” in Sri Lanka. This is out of a population of almost 22 million. In England and Wales, there’s a population of almost 61 million, and in the same year only 58,275 individuals were arrested for drug-related offences. This is huge difference.
It’s important to understand what’s going on in each country and to see how the UK’s best practice could be used to improve addiction and treatment outcomes in Sri Lanka
The UK Approach: A Snapshot
The UK’s addiction policies come from a history of governmental reactions to increased awareness in public substance habits. Interestingly, the government ignored much of the advice provided by the Advisory Council on the Misuse of Drugs (ACMD) through the early years of increasing awareness, instead creating fear tactic campaigns. As time has gone on, however, education has been at the forefront of campaigns.
In 1971 the Misuse of Drugs Act received Royal assent. Two years later, it became operational. There was a campaign to restrict barbiturates in 1975 but they didn’t become controlled substances until 1984. 1977 saw one of the biggest drug busts in the UK, ever, where 700,000 LSD microdots were seized.
In 1981, recorded heroin deaths rose higher than 100 for first time. By 1984, there were over 6000 reported heroin users and recorded deaths reached the thousands. This was the year, the ACMD advised the government that scare tactic campaigns didn’t work. It was also the year stop and search powers were granted to the police.
1985 saw the first drug-related HIV case reported in Scotland. The Scottish campaign “choose life not drugs” came out and really stuck in the British public conscience with the release of novel and film adaptation, Trainspotting. This was the year life sentences for drug offences were introduced.
In 1986, the first needle exchange in the UK was opened in Scotland. The government continued ignoring ACMD advice to not use scare tactics in campaigns and in 1988 ignored advice to focus campaigns on harm reduction, especially in light of HIV crisis. Following the crack-cocaine epidemic in the US in the late 80s, the UK was hit in the early 90s.
In 1991, mandate treatment for offenders was legislated and in 1992 drug services started offering harm reduction advice. It was in 1993 that a police commander proposed addressing addiction as a health problem rather than a criminal one.
Though the UK treats many addiction-related behaviours as criminal, it does so with an awareness of the fact that it’s a health problem. Agencies work in a joint way around individuals to support people to reduce, use in safer ways when they do (i.e. needle exchanges), to stop using substance, and to not repeat offences.
Sri Lanka’s Current Landscape
In Sri Lanka, addiction is also seen through a criminal lens, but without the allowance for the fact that it’s a health problem. Over there, the Treatment and Rehabilitation Act means that when a person is reported as a dependent substance user, the police can arrest them. The person is then examined and if they’re deemed as having addiction are put before a Magistrate who can sentence compulsory treatment. These people are then sent to state centres managed by the army or to one of the prisons where compulsory treatment is facilitated.
It’s reported that on entry to these establishments, people aren’t given psychological assessment, harm reduction advice and personalised care plans also don’t exist. All those at the centre are expected to take part in programmes, even in light of severe withdrawal symptoms. Treatment isn’t overseen by medical practitioners and medications aren’t given to ease withdrawal. Neither is counselling offered.
Addiction is treated as a moral failing rather than as a health concern.
Drawing Parallels: Where Do Both Countries Stand?
What’s interesting is that despite there being differences in how the two countries address addiction treatment, there are quite a few similarities in social attitudes.
Both countries have largely treated addiction as a criminal concern meaning many substance users have been convicted in relation to their behaviours. As well as this, culturally, there’s a lot of stigma attached to addiction in both countries.
Though addiction is becoming more widely accepted as a health issue in the UK, historically, it was very much seen as a moral failing and this still exists through much of society. Therefore, stigma maintains, though isn’t as rife as it is in Sri Lanka.
Differences exist in how funding is used to treat people. In the UK, more is done around raising awareness of addiction, prevention of use, harm reduction, and access to evidence-based treatment. In Sri Lanka, people are dealt with at the point they’re dependent and are then treated like criminals rather than as being mentally and physically unwell.
Lessons from the UK: What Could Sri Lanka Adapt?
1. Policy Reform
The Sri Lankan government could base addiction policies around evidence-based interventions. Considering what treatment works in other countries and applying this to their own legislation has potential to make a huge difference to those with addictions and society as a whole (i.e. in being cost effective and supporting people to have more economic input).
Integrating addiction treatment into mainstream healthcare would improve outcomes so that people are treated under the care of a doctor and have their symptoms medicated and mental health addressed effectively. This would have longer lasting, more meaningful health effects.
2. Improving Treatment Access
By improving access to treatment, Sri Lanka would improve addiction outcomes. They could do this by developing community-based help, bringing services together to support people, and training professionals.
In the UK, there are community-based drug and alcohol services which have a great influence and impact on people who have addiction. They offer a safe, non-judgemental environment for people to access help and to learn how to reduce and stop substance use.
The multidisciplinary approach to support (combining mental health, medical, and social support) means that addiction is tackled from all angles. Being the complex disease that it is, it’s critical that a person’s mental, physical and social health, are addressed in order for sustainable sobriety to occur.
Increasing training around addiction for healthcare professionals in Sri Lanka, so that it’s treated as a health concern and so that professionals understand how to support addicts using medication and counselling.
3. Harm Reduction Strategies
Harm reduction makes a huge difference in managing addiction for individuals and in societal outcomes. Sri Lanka could develop needle exchange programmes, offer opioid substitution therapy, and naloxone distribution. This is not only cost-effective in the long-run, it greatly reduces the spread of HIV and Hepatitis C.
Developing community education and awareness campaigns helps to bring understanding into the community. This is both preventative around people experimenting with substances and helps to reduce stigma, further supporting people to access help.
By monitoring and evaluating tools that improve health in relation to addiction, Sri Lanka could also use this to continue to improve services and health outcomes.
Concluding thoughts
While there are similarities in some of the societal attitudes towards addiction in the UK and Sri Lanka, the UK has taken a much more health-focused response to managing addiction. Not only does it offer voluntarily-accessed alcohol rehab facilities for people with severe use, there are successful community-based services.
Sri Lanka takes a militant approach arresting people with dependencies and sending them to prison for compulsory treatment.
The statistics speak for themselves. The UK has a much lower rate of arrests. People are supported when they are arrested through a multidisciplinary approach to treat addiction as a health concern.
Now is the time for Sri Lanka to move from awareness to actionable steps, to begin a dialogue and collaboration around how to support its population more effectively in treating addiction.
