vulnerability among vietnamese illicit drug users in australia: challenges for change

International Journal of Drug Policy 13 (2002) 127136

Vulnerability among Vietnamese illicit drug users in Australia:challenges for change

Gary Reid *, Peter Higgs, Lorraine Beyer, Nick CroftsThe Centre for Harm Reduction, Macfarlane Burnet Institute for Medical Research and Public Health, PO Box 254, Fairfield,

Victoria 3078, Australia

Abstract

A broad range of vulnerabilities, risk factors and challenges for change were examined in order to better understand why ethnicVietnamese have the highest profile in Australia in relation to illicit drug use. A literature review of vulnerability and risk factorsexperienced by ethnic Vietnamese people in Australia was conducted. Emerging themes and concepts were tested against the 1996Australian Census (Victoria), databases specific to illicit drug use, and the outcomes of key informant interviews and communityconsultations. Vietnam-born Australians are the third largest ethnic community in Australia. Due to high unemployment, poorEnglish proficiency, experiences of racism, social and economic difficulties, inter-generational conflicts and acculturation, theethnic Vietnamese community has become vulnerable to involvement with illicit drug use and distribution. Addressing drugproblems among the ethnic Vietnamese community in Australia is hampered by a lack of structured, appropriate education andemployment programs, biased media reporting and poor utilisation of drug treatment services. Socio-economic disadvantage andlevel of exclusion from the legitimate economy heighten involvement in illicit drug use and its associated harms. 2002 ElsevierScience B.V. All rights reserved.

Keywords: Illicit drug use; Socio-economic factors; Vietnamese community in Australia

www.elsevier.com/locate/drugpo

Introduction

The study Drugs in a Multicultural CommunityanAssessment of Inolement was a research program intothe involvement of ethnic communities in Victoria,Australia, with illicit drugs (particularly heroin, am-phetamines, cannabis and ecstasy) which began in 1998(Beyer & Reid, 2000). The objective of the research wasto provide a framework in which the cultural attitudes,experiences and expectations of ethnic communitiescould best be understood in the context of Victoria(Australias second most populous and arguably themost culturally diverse state).

During the course of the project, it became clear thatethnicity and illicit drugs are linked in ways which haverarely been addressed in previous research (Reid,Aitken, Beyer & Crofts, 2001a). The literature on eth-nicity and/or illicit drug use contains few studies whichidentify or examine particular ethnic groups within

broader populations of illicit drug users (Smith & Citta,1994; Pearson & Patel, 1998). However, within theAustralian context, the ethnic Vietnamese communityspecifically (and the Indo-Chinese community morebroadly) has over the past 5 years become the mostresearched ethnic group in Australia in relation to illicitdrug use (Beyer & Reid, 2000).

It is the aim of this paper then to outline why is itthat in the case of a particular sub-sector of ethnicVietnamese Australians, their exposure to the illicitdrug trade, drug use and the associated risks havebecome such a focus of attention for researchers, policymakers and funding bodies. The paper will show thatmuch of this attention is the result of the complexsocial and economic problems which the communityhas experienced both prior to and since arriving inAustralia (Ezard, 1997; Jordens, 1996; Viviani, 1984).The paper also considers how environmental conditionsand different risk environments impact upon the vul-nerability of those using illicit drugs. Compoundingthis, is the likelihood that illicit drug use, particularlyamong vulnerable youth, is linked to social factors such

* Corresponding author. Tel.: +61-3-9282-2219; fax: +61-3-9482-3123.

E-mail address: [email protected] (G. Reid).

0955-3959/02/$ - see front matter 2002 Elsevier Science B.V. All rights reserved.PII: S0955 -3959 (02 )00012 -9

G. Reid et al. / International Journal of Drug Policy 13 (2002) 127136128

as isolation, trauma, language barriers, unemployment,experiences of racism, inter-generational conflicts, ac-culturation, family breakdown, poverty and homeless-ness (Chueng, 1989; Romios and Ross, 1993;Kuramoto, 1997, Reid et al., 2001a).

Vietnamese ethnicity

Before 1971, there were 717 people born in Vietnamresiding in Australia (Coughlan, 1992). By 1991 therewere 121 000 Vietnamese-born people residing in Aus-tralia and by 1996 largely a result of family reunionprograms (Viviani, 1996) this had risen to 151 100(Australian Bureau of Statistics, 1996a). By 1996, theethnic Vietnamese community was the third-largestnon-English speaking migrant group in Australia (Aus-tralian Bureau of Statistics, 1996a). The 1996 censusshowed that there were around 55 000 Vietnamese-bornpeople in Victoria, of whom almost all spoke Viet-namese, though a small number were ethnic Chinese.Of Vietnam born people living in Victoria, 22% of themwere between the ages of 15 and 24 (Australian Bureauof Statistics, 1996a). In Victoria in 1996, 744 446 (17%of the total population) people were from a non-En-glish speaking background (NESB), of whom 7% wereVietnamese (Multicultural Affairs Unit, 1997).

In this article we use the term Vietnamese to meanthose people born in Vietnam, and the paper has as itsfocus people aged 14 years and above. The 1996 Aus-tralian census showed that amongst those second gener-ation of Vietnamese parentage, 93% were aged between0 and 14 years (McMurray, 1999) and it is unlikely,given their young age, that many would be involvedwith illicit drugs.

Methodology

A comprehensive literature review formed the initialstage of Drugs in a Multicultural Community, en-abling the setting of directions for the research compo-nent. It became clear that within the Victorian contextthe documentation of ethnic Vietnamese was the mostextensive among the 17 ethnic groups identified to bestudied. The research consisted of an examination ofexisting data on ethnic Vietnamese and illicit drug use;interviews with 25 health, welfare and drug treatmentservice workers; and the conduct of three focus groupswith the ethnic Vietnamese community. AustralianCensus data for 1996 were used to identify and delin-eate the ethnic groups represented in Victoria, as wellas their geographic and socio-economic characteristics,for example English language proficiency and employ-ment characteristics. Databases relevant to illicit drugswere selected and analysed to supply useful informationabout drug related arrests, methadone treatment andaccess to other drug treatment services.

Estimating the extent of illicit drug use

While there is evidence of illicit drug use within theethnic Vietnamese community (Maher, Sargent, Higgs,Crofts, Kelsall & Le, 2001; Higgs, Maher, Jordens,Dunlop & Sargent, 2001; Epidemiology and SocialResearch Unit, 1997), it is difficult to quantify theextent of this drug use when compared with otherethnic communities and indeed the general community(Beyer & Reid, 2000). The lack of adequate definitionsof ethnicity, and the absence of variables used todefine ethnicity in most databases concerned with illicitdrug use are major obstacles to accurately estimatingthe extent of illicit drug use among ethnic VietnameseAustralians (Reid et al., 2001a; Beyer & Reid, 2000).

There remains a perception, especially reinforced bythe mainstream print media, that those of ethnic Viet-namese background are more heavily involved in illicitdrugs (Carruthers, 1997; Quek, 1997) and that ethnicVietnamese IDUs may be greater in number than otherNESB groups (Epidemiology and Social Research Unit,1997; Ezard, 1997). Dealers in Death (Moor, 1997)read one front page headline with half the page takenover by a large photograph of two obviously South-East Asian young people selling heroin to a undercoverpoliceman.

Government collected prison data show that 65% ofAustralian-born prisoners had drug trafficking charges,compared with 82% for Vietnam-born prisoners; Aus-tralian-born prisoners whose most serious offence was adrug offence indicated their use of illicit drugs was 70%,compared with 83% for Vietnam-born Australians(Beyer, Reid & Crofts, 2001). Recent Victoria Policestatistics show that Vietnam born Australians (mostlymale) represent the largest number of non-Australian-born arrests for drug related offences in Victoria. It isunclear whether this means that more ethnic Viet-namese people are involved in illicit drug use orwhether it shows a police focus on ethnic Vietnamesepeople (Beyer et al., 2001)

Offence rates for both trafficking and drug use areextremely high for the Vietnamese compared with thosefrom other countries of birth (Table 1), however, of-fenders identifying with ethnic groups, in particularthose of second and third generation, are hidden in theAustralian-born category. Amongst the Vietnamese,rates of trafficking offences have gone from 622 per100 000 in 1995/1996 to 998 per 100 000 in 1997/1998(Victorian Police, 1997, 1999) (Table 2).

The Drug of Dependency Information SystemMethadone Registry (Victoria: 1998/1999) has the vari-able ethnic/cultural background (self-identified) in-cluded on the methadone permit forms. It could besuggested this database is a more accurate indicator ofethnicity and drug use, and the analysis proves note-worthy. Of the 6019 registered methadone users in the

G. Reid et al. / International Journal of Drug Policy 13 (2002) 127136 129

12 months to February 1999, 1845 (31%) indicated theywere from a non-English speaking ethnic or culturalbackground, the most common being Vietnamese (400,22%). Ethnic Vietnamese registering for methadonerepresented a larger proportion of the overall popula-tion than would be expected by their population num-bers alone (Reid, Beyer, Aitken & Crofts, 2001b).

It is difficult to draw clear conclusions from theanalysis of the above data because of the inconsistentand variable data collection techniques and hence cau-tious interpretation and further research should be en-couraged. But it is certain that illicit drug use is evidentamong the ethnic Vietnamese community and that theharmful consequences such as increased police attentionand imprisonment for example, are now a substantialconcern (Maher & Dixon, 1999; North RichmondCommunity Health Centre, Kerr & Crofts, 2000)

Drug use patterns

Swift, Maher and Sunjic (1999) report that ethnicVietnamese heroin users appear more likely to initiateuse by smoking than their Anglo counterparts. This issupported by Maher et al. (2001) who report thatpatterns of drug use among their sample of 184 (re-cruited in both Sydney and Melbourne) appear to bemore complex than a progression from non-injecting toinjecting. Twenty-seven per cent of the sample inter-viewed reporting a reverse transition from injecting tosmoking/chasing at some stage since their initiation toheroin use. This is different from those of Anglo-Aus-tralian users among whom both smoking and reversetransitions have been rarely reported (Loxley, Car-ruthers & Bevan, 1995; Crofts, Louie, Rosenthal &Jolley, 1996; Crofts & Aitken, 1997).

Peer based research with ethnic Vietnamese heroinusers also identified the injecting of benzodiazepines,and specifically temazepam gel capsules (Kelsall, Higgs,Lam & Crofts, 1999). That it appears to be morecommon in this ethnic group is cause for concern

(Aitken & Higgs, 2002). In one study, Kelsall, Higgsand Crofts (2000) reported that of 106 current Viet-namese injectors in the sample, more than half reportedinjecting temazepam in the 6 months prior to interview.Almost all used temazepam in conjunction with heroinin a cocktail solution. Most claimed to know the risksassociated with injecting temazepam with only 14 peo-ple reporting adverse affects as a result of injectingtemazepam.

There is a danger in focussing specifically on ethnicVietnamese drug users to explain their drug takingpractices by focussing on their culture. In describingpatterns of illicit drug use we are also identifying risktaking behaviours (see Maher et al., 2001). But whenwe identify risk here what we are actually referring to isinequality. As outlined earlier, these inequalities arecomplex and require researchers and service providersto work creatively and intensively to engage these drugusers so that the environments they are living in are assafe as practicable (Higgs et al., 2001; Maher, 1998).

Factors increasing ulnerability to illicit drug use

Recently there has been more focus towards having abetter understanding of the risk environment to appre-ciate how harmful consequences of drug use do inter-sect with broad based health and vulnerability factorsmore generally (Rhodes, 2002). As has been suggestedby Ezard (2001) factors underlying risk and in turninfluencing vulnerability need to be carefully consid-ered. Vulnerability restricts the individuals capacity torespond to adverse events and through complex under-lying factors (such as cultural and socio-economichandicaps) heightened harmful outcomes are likely(Ezard, 2001, Reid et al., 2001a).

Psycho-social factors

In the early 1980s approximately 50% of Vietnameseimmigrants were married but many had arrived inAustralia without their spouses and as a result often

Table 1All drug offences by country of birth of alleged offenders of all ages in Victoria, 1997/98

Country of Birth

Australia Greece Italy Lebanon Somalia Turkey Vietnam Romania

43701228Drug cultivate, manufacturing, traffick 26444135291267.6148.6565.0185.144.466.3109.7Per 100 000 popa 895.0

341 38 54 41Drug (possess, use) 4 38 552 20Per 100 000 pop1 259.4 61.4 54.5 291.9 282.5 256.7 998.2 416.0

63Total 11870 79 98 67 12 60 12532265.8369.1 1310.6127.7 98.8 477.0 847.5 405.4Total per 100 000 popa

Source: Victorian Police, 1999.a Crude rates per 100 000 head of population from the country of birth.


Table 2Unemployment, English proficiency and incarceration rates by country of birth for selected countries

Country of Unemployment (1524 years), Poor Proficiency in English (arriving in Aust Prisoners per 100 000 by COB,Victoria, 1996Birth (COB) Victoria, 1997199819911996), Victoria

43%Vietnam 40138%Romania 37% 12% Not available

43% Not availableLebanon 38%59%38% Not availableTurkey26%Italy Not available17%39%18% Not availableGreece

1%Australia 2415%

Sources: Australian Bureau of Statistics, 1996a; Victorian Police Statistics 1998/1999; Beyer and Reid, 2000.

experienced extreme isolation and loneliness (Burley,1990). Family members did not accompany large num-bers of Vietnamese people arriving in Australia and theexperience of separation for many was deeply traumatic(Zulfacar, 1984; Cuong & Bertelli, 1990). Viviani,Coughlan and Rowland (1993) report that when ethnicVietnamese people arrived in Australia there was a highproportion of single parents and, because of their de-pendent children, their participation in the workforcewas obstructed and their reliance upon welfare supportincreased.

The 1986 Australian census reveals that there were26% more males than females in the Vietnamese com-munity, and that few Vietnamese (5%) married non-Vietnamese spouses. As suggested by Coughlan (1992),this gender imbalance exacerbated existing social prob-lems. An estimated 12% of the Indo-Chinese (mostbeing Vietnamese) came to Australia without a parentand many expected to survive with whatever precariousfamily support was available (Zulfacar, 1984; Cough-lan, 1992; Viviani, 1996).

Zane and Kim (1994) reported that a substantialnumber of Vietnamese parents wanted to advance eco-nomically. The imperative to seek economic securitycompetes with the emotional demands of parenting,particularly in a pared down family unit stripped of thetraditional extended support networks. The ethnic Viet-namese community consultations suggested that parent-ing styles among some Vietnamese people areemotionally remote and/or accompanied by unresolvedpast issues possibly, affecting their children:

There is no emotional involvement with their chil-dren. The families are working too hardand basi-cally they do not have the energy to provide thatemotion for their children. I am looking after 16parents [with drug-affected teenagers] and they donot know about emotional involvement with theirchildrenyoung people want more from their par-ents. (Vietnamese welfare worker).

Many people have had very bad experiences oftorture and losing loved ones, of being raped, oflife-threatening situations Many have never foundout what happened to the rest of their family, andmost have never resolved all the issues in theirpastthese things make parents vulnerable. (Viet-namese community consultation).

Vietnamese born refugees arriving into Australia re-lied heavily on resettlement agencies to find inexpensivehousing, with many settling in underprivileged neigh-bourhoods where rents were cheaper but the manifesta-tions of poverty were pervasive. The impact ofacculturation for some young ethnic Vietnamese re-sulted in active association with the prevailing widerculture, including the use and distribution of illicitdrugs (Van & Holton, 1991; Nguyen, 1995; Bankston &Zhou, 1997; Ethnic Youth Issues Network, VictorianCouncil of Churches & Royal Melbourne Institute ofTechnology Centre for Youth Research and Develop-ment, 1998). Deteriorating social circumstances providethe catalyst to propel young Vietnamese people furtherinto social and economic marginality and inequity,thereby increasing the likelihood of experimenting withillicit drugs (Jordens, 1996; Maher & Dixon, 1999).

Education

Nguyen (1995) suggests many ethnic Vietnamesedrug users are young and that their education has beendisrupted, their education or training programs wereinappropriate and achievement was low, increasing thelikelihood of incomplete schooling. A recent study ofyoung Indo-Chinese heroin users (85% of whom wereborn in Vietnam) showed that most respondents hadsome secondary education, but only 13% had com-pleted secondary schooling (Maher et al., 2001). Someauthors have suggested that educational attainment andage of leaving school are inversely related to use of


illicit drugs (Alcabes, Vlahov & Anthony 1992;Gfroerer, Greenblat & Wright 1997; Obot, Hubbard &Anthony 1999; Bray, Zarkin, Ringwalt & Qi, 2000).Consultation with Vietnamese community leadersfound education problems were often major issues andthe process of adjusting to a new education systemcould often be arduous, to the point of leaving somecommunity members illiterate:

The greatest cause of the problems we are havingwith our young people is the education and schoolingsystem has been inappropriate for the Vietnamesechildren. They are put into classes according to theirage, not their ability, so they are always behind andcant catch up. They lose heart and they get verybored because they cannot understand. (Vietnamesecommunity consultation).

There is a high proportion of young Vietnamesedrug users who are illiterate both in their mothertongue and the English language. This of coursesignificantly impedes their ability to seek employ-ment, gain further education and training (Viet-namese youth worker).

While an increasing number of ethnic Vietnameseschool leavers are entering University, there remainslittle emphasis on vocational training (Coughlan, 1992;McMurray, 1999). Attendance at university or othertertiary institutions is proportionally greater amongethnic Vietnamese than among Australian-born (25%and 14%, respectively) (Beyer & Reid, 2000). However,the low levels of vocational training have contributed tohigher levels of unemployment and an under-represen-tation in skilled trades and technical areas among eth-nic Vietnamese Australians (McMurray, 1999).

Also evident among ethnic Vietnamese in Australia isthe bifurcation of those who become high achievers,and those who have little education and no specialskills, consequently likely to become marginalised. Amanifestation of this bifurcation has been media repre-sentation, featuring either successful Vietnamese stu-dents gaining entrance into elite universities, or thoseinvolved in illicit drug use or delinquent street gangs(Rodd & Leber, 1996; Bankston & Zhou, 1997).

Growing up in a Vietnamese family you are con-stantly reminded you left the country and you needto establish yourself in order to combat things likeracism. You need to show you are successful thereis a real emphasis on being real achieversbeing anillicit drug user can result in being seen as a realfailure on behalf of the community. (Key informant:Vietnamese youth worker).

Employment and income

The pressure to provide for families both in Australiaand in Vietnam has meant that many Vietnamese mi-grants have become employed in unskilled or semi-skilled jobs (Van & Holton, 1991; Viviani, 1996). In the1996 census, the proportion of ethnic Vietnameseclassified as Labourer or Related Workers was 19%,twice as high as among Australian men (McMurray,1999). The low level of English proficiency among asubstantial number of Vietnamese, and the filial duty tohelp their families (either in Vietnam, Australia orboth), has also often impeded the ability of Vietnameseto train for more skilled jobs (Coughlan, 1992). ManyVietnamese have tended to find employment in manu-facturing, which is precarious during times of economicdownturn and restructuring (Van & Holton, 1991;Coughlan, 1992; Duke & Marshall, 1995; Viviani,1996). The loss of many industrial jobs has had asignificant impact upon more recent settlers, of whomethnic Vietnamese are a dominant group in 1966 themanufacturing industry accounted for 28% of Aus-tralias employment but by 1998, it was 14% (Viviani,1984, 1996; Healy, 1998). The high concentration ofVietnamese in low paid positions was evident in 1996,with many receiving an income of under $300 per week(63%), a higher percentage when compared with allother overseas born migrants (53%) and all Australians(51%) (McMurray, 1999).

Analysis of the 1996 Census (Victoria) shows theunemployment rate for NESB youth (1524 years) was29% (compared with the English speaking backgroundrate of 16%) but unemployment among ethnic Viet-namese Australians, although decreasing, was still 38%.The unemployment rate for Australian-born youth was15% (Beyer and Reid, 2000).

A large number of NESB youth and Australian bornyouth were not in the labour force at all. This high rateof non-participation may be a result of people beingengaged in education, home duties or family responsi-bilities. However, it can be equally assumed there maybe hidden unemployment among this group, wheremany would like to work but are no longer activelyseeking work and therefore not in the governmentunemployment statistics (Australian Bureau of Statis-tics, 1986, 1996b). While the 1996 Census (Victoria)showed 21% of Australian-born youth were not in thelabour force, the figure was closer to 60% among thosewho were born in Vietnam (Beyer and Reid, 2000).

Research has found, not surprisingly, high rates ofunemployment among ethnic Vietnamese IDUs (Louie,Krouskos, Gonzalez & Crofts, 1998; Kelsall et al.,1999). When added to their heroin dependency a num-ber of ethnic Vietnamese young people becoming in-volved in street level drug distribution and theassociated harms which come with this (Maher, Dixon,


Swift & Nguyen, 1997; Ethnic Youth Issues Network etal., 1998; Maher & Dixon, 1999). This is increasinglycommon with disadvantaged and marginalised popula-tions where chronic unemployment and poverty amongethnic communities can be the catalyst for involvementinto an informal black economy (Van de Wijngart,1997):

I have spoken to Vietnamese people and they willtell me traffickingis a vital sense of employment, itis a business. Often I will traffick because I need themoney. (Key informant: Community settlementworker speaking on the Vietnamese)

Proficiency in English language

Inability to communicate effectively in the languageof the majority is clearly a major social and economicdisadvantage. Acquiring the skills to enter the competi-tive job market usually requires a relatively good levelof English proficiency (Stevens, 1998). In Australia (asalmost invariably occurs elsewhere with other migrantgroups) ethnic Vietnamese immigrants tended to settlein areas where other Vietnamese already resided, andthis meant reduced imperative to learn English (Viviani,1996). It has been suggested that the changes in Aus-tralian government policy in the mid-1980s regardingaccess to English language classes resulted in manynewly arrived migrants searching for work at the ex-pense of becoming proficient in English (Taylor andMacDonald, 1994; Viviani, 1996). The 1996 census(Victoria) showed 20% of NESB youth arriving inAustralia between 1991 and 1996 had poor Englishproficiency; among Vietnamese youth it was 40%(Beyer & Reid, 2000).

The 1996 Census (Victoria), examining proficiency inEnglish by labour force status, shows the ability tospeak English well or very well correlates with beingemployed; consequently poor or no English substan-tially increases the likelihood of unemployment. Of thetotal NESB youth with poor or no English, 15% wereunemployed; this was in contrast to the 26% amongethnic Vietnamese youth (Beyer & Reid, 2000).

Drug related harms

Barr and Crofts (1998) report that between 1992 and1997, out of a total 550 heroin-related deaths, 13 wereof people of ethnic Vietnamese background. WhileVietnamese people in Victoria comprise 1.3% of thetotal population (Australian Bureau of Statistics,1996a), they accounted for 2.3% of heroin-relateddeaths. The same Coronial data on fatal overdoses

show on average ethnic Vietnamese were younger thantheir Australian-born counterparts (26 vs. 32 years),and had greater exposure to hepatitis C on autopsy (85vs. 31%) (Barr & Crofts, 1998).

There is evidence that ethnic Vietnamese IDUs arebecoming infected with blood borne viruses, in particu-lar hepatitis C (Kelsall et al., 1999; Louie et al., 1998;Kelsall et al., 2000). Testing for HCV anti-bodies inthese three studies ranged from 56 to 100%. In Aus-tralia, on average, 50% of IDUs are infected withhepatitis C (Crofts, Thompson & Kaldor, 1999).

As part of the study, the Victorian HIV surveillancedatabase covering the period from 1983 to the end of1998, was analysed. Amongst those notified with HIVwho reported injecting drug use as their main exposure,and who also provided country of birth information(152 people), the majority was from an English speak-ing background (87%). Of the 20 individuals from aNESB, those born in Vietnam represented the largestproportion (Beyer & Reid, 2000). More recent analysisof the HIV showed that since 1996 there have been 38notifications of HIV infection in individuals reportingIDU as their risk factor; of these eleven (29%, all males)were ethnic Vietnamese and significantly younger thanother IDUs notified in this time (Hocking, Higgs, Ken-nam & Crofts, 2002).

Utilisation of drug treatment services

Ethnic Vietnamese Australians are relatively new mi-grants and until recently they have resisted publiclyacknowledging their illicit drug using problem (Duong,1995; Vietnamese Students Association, 1999). As canbe common with other NESB communities, failure toaccess drug treatment services may be one way ofpreventing wider exposure of the problem (Beyer &Reid, 2000; Reid, Crofts & Beyer, 2001c).

However, attempts to access treatment have grownamong ethnic Vietnamese (Reid et al., 2001b; Beyer &Reid, 2000), but a perceived lack of culturally relevantdrug programs, accompanied by language barriers,poor communication skills and often cultural insensitiv-ities on the part of services have resulted in fewerVietnamese participating in treatment programs (aswith other NESB migrants) (Nguyen, 1996; Open MindResearch Group, 1997; Mudaly, 1997; Hynes, 1997;Swift et al., 1997; Dare, 1998; Beyer & Reid, 2000). Anexamination of the Alcohol and Drug InformationSystem (ADIS), the largest data information base fordrug treatment services in Victoria, showed that in1997/1998 there were 300 (2%) episodes of care forthose born in Vietnam who were receiving treatmentfor heroin use. Further analysis of the informationindicated that among all the episodes of care for thosefrom NESB, ethnic Vietnamese were the most sizeable


and represented a larger proportion than it ought to beexpected for their population size. This was also thecase with ethnic Vietnamese identified clients of themethadone registry in Victoria (Reid et al., 2001b).However, cautious interpretation of the ADIS data isrequired because the ethnicity variables it used areflawed as an episodes of care does not refer to anindividual case but rather to the number of clientcontacts with a treatment agency (Beyer & Reid, 2000).

There was an expectation by many ethnic Vietnameseclients and their families that the services they accesswill provide a quick fix solution and many did notview substitution programs such as methadone mainte-nance, as a long-term option (Vo, 1998; Ethnic YouthIssues Network et al., 1998; Beyer & Reid, 2000).Indeed recent reports of rapid opiate detoxificationprograms show high numbers of ethnic Vietnameseparticipants (Monheit, Jogada & Diner, 2000). In com-mon with much of society, ethnic Vietnamese Aus-tralians have a poor understanding of Western conceptsof therapy maintenance and recovery and, conse-quently, a mis-match of expectations between those ofthe ethnic Vietnamese community and western psy-chotherapy is widespread (Romios & Ross, 1993). Fur-ther compounding the problem of treatment services isthat many ethnic Vietnamese heroin users are lost tofollow-up from initial treatment, and so providing con-tinuity of care is impracticable (Ezard, 1997).

Bertram and Flaherty (1992), Ezard (1997) reportthat Vietnamese heroin users access doctors for drug-related information and help but not to the same degreeas Anglo-Australians. Young ethnic Vietnamese drugusers often show a reluctance to approach a Vietnamesedoctor for fear of shame and being exposed in theirown community (Nguyen, 1996; Ethnic Youth IssuesNetwork et al., 1998). Bertram, Flaherty and Evering-ham (1996) report that even with access to doctors asignificant proportion of Vietnamese respondents (21%)did not know how to access service information incontrast to 8% among the general population. Commu-nity consultations with ethnic Vietnamese showed manyhad little or no knowledge of the existence of specialistdrug services in Melbourne and hence sending heroin-dependent children back to Vietnam was not an un-common practice (Beyer & Reid, 2000).

I have heard of many parents sending their childrenback to Vietnam to detox in the last two to threeyears. (Vietnamese community consultation).

Conclusions and recommendations

In common with other NESB communities, Viet-namese migrants have experienced communication, un-employment and social problems to varying degrees.

While many people within the larger ethnic Vietnamesecommunity have adjusted well to Australian society, asubstantial numberparticularly among the younghave experienced major problems in achieving socialacceptance and inclusion. Youth unemployment andpoor English proficiency have contributed to social andeconomic disadvantage. As a result of these circum-stances, an increasing number of Vietnamese youthhave been involved in subcultures where illicit drug useand drug related crime are some of the manifestationsof the problems they experience (Ethnic Youth IssuesNetwork et al., 1998).

The perception that the Vietnamese are more heavilyinvolved than other ethnic groups with illicit drug useand distribution seems to be supported by the availableevidence, particularly that compiled by the police. Assuggested by Maher, Dixon, Swift and Nguyen (1997),Maher and Dixon (1999) and key informant interviewshowever, this probably reflects policing style ratherthan offending behaviour:

I am sure that police are not focusing on particu-lar ethnic groups. However, the larger proportion ofAsians (Vietnamese) in the statistics points to a fun-damental operational reality about policing policefocus on the highly visible offenders and they tend toretrace the steps where they have had previous suc-cess (Academic/criminologist key informant).

Police statistics over a number of years would beneeded to assess whether there was an increasing trendin annual drug offence rates amongst the Vietnam borncommunity and how these rates compare with thoseamongst individuals born in other non-English speak-ing countries of birth. Further research in this areashould be encouraged.

There are a number of key areas where major socialproblems exist within the Vietnamese community. Suc-cessful strategies can be achieved when Vietnamesecommunities themselves start to develop responses,which are appropriate; these may be very different fromthose being used with mainstream heroin users. Pro-gram planners must continue to think as laterally aspossible about the ways of working with and for thoseVietnamese individuals and families for whom heroinhas become very much a part of their everyday life(Higgs et al., 2001) (see Table 3). Issues of gender fromthis research have yet to be analysed but will become asubject of analysis in the future.

The role of the media and how it influences the waythe wider community perceives some sectors of theVietnamese community cannot be underestimated, andthis needs to be addressed (Beyer & Reid, 2000). Mostdatabases require more comprehensive ethnicity vari-ables; until this is implemented, it is impossible to


Table 3Problems and solutions for key areas to be targeted

Key areas SolutionProblem

Education of editors and journalistsMedia SensationalismPromotion of positive coverageSimplisticForums and programs to counteract negative stereotypesNegative

Databases COB variable excludes Australian born second and third ethnicity variables (ie. self identification; language spokenat home; and mother and father birthplace)generation ethnic identifying individual

Lack of accurate ethnic dataBlood Borne Hepatitis C epidemic Education about BBV

Viruses (BBV)Information cultural and age specificHIV/AIDS riskPeer and outreach programsPromotion of harm reductionNon-judgemental support

Shame associated with drug use despair: child sent back toFamily support Family mediation processes Family counselling Partnershipswith Vietnamese and welfare organisationsVietnam

Barriers to seeking assistance Improve understanding of Vietnamese drug users and theirTreatmentprovision families

Improve information dissemination as to where to seek helpLanguage and communication difficultiesServices to be more culturally sensitiveNot know where to seek helpForm inter-agency partnerships with Vietnamese welfareorganisations and treatment services

High youth unemployment availability of English language coursesSocial andeconomicissues

Pre-vocational training programsPoor english proficiencyPoor self-esteem, boredom recreational activities

Develop youth activities

confidently say to what degree Vietnamese involve-ment with illicit drugs in Australia is higher than thatof other communities. However, what can be saidwith confidence is that there is a perception of a highdegree of involvement in the visible use and distribu-tion of heroin in public spaces by some segments ofthe Vietnamese community in Australia (Parliamen-tary Joint Committee on the National Crime Author-ity, 1995; Maher, Dixon, Lynskey & Hall, 1998).

The prevalence of blood borne virus infections(particularly hepatitis C and potentially HIV) amongethnic Vietnamese drug users is cause for alarm andrequires a culturally focused education based response(Higgs, Nguyen, Ezard, & Crofts, 1999). Currently,there are too few such programs, with too little reachand coverage, to affect the problem (Maher, Sargent,Higgs, Crofts, Le, Kelsall & Kerger, 2000). It can besuggested that the greater the disadvantage, thehigher the likelihood of an illicit drug problem. As acommunity, the ethnic Vietnamese in Victoria experi-ence a higher degree of socio-economic disadvantagethan the general Victorian population. Vietnameseyouth have high levels of unemployment and a sub-stantial number lack proficiency in English. As hasbeen suggested by Rhodes (2002) there is a need toconsider what are described as non health orientated

interventions if issues of vulnerability to drug use areto be addressed adequately. It is crucial that the vul-nerability situation experienced by ethnic Vietnamesereceives considered attention for the deleterious mani-festations of these problems to be reversed.

Acknowledgements

Drugs in a Multicultural Communityan Assess-ment of Involvement was carried out for the Victo-rian State Government, Australia by MacfarlaneBurnet Institute for Medical Research and PublicHealth (The Burnet Institute) with assistance by theNorth Richmond Community Health Centre(NRCHC). The research was funded under the StateGovernments Turning the Tide program, supervisedby the Department of Human Services (DHS) andbased at the Centre for Harm Reduction at The Mac-farlane Burnet Institute for Medical Research andPublic Health. Although funded by the Victorian gov-ernment the views represented here are by the authorsand are not government policy. We would also liketo thank Jean Wyldbore and Jenny Kelsall from TheBurnet Institute for their comments on a previousdraft of this paper.


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Vulnerability among Vietnamese illicit drug users in Australia: challenges for changeIntroductionVietnamese ethnicity

MethodologyEstimating the extent of illicit drug use

Drug use patternsFactors increasing vulnerability to illicit drug usePsycho-social factorsEducationEmployment and incomeProficiency in English language

Drug related harmsUtilisation of drug treatment servicesConclusions and recommendationsAcknowledgementsReferences

vulnerability among vietnamese illicit drug users in australia: challenges for change

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