PONTIFICAL CATHOLIC UNIVERSITY OF RIO GRANDE DO SUL -­‐ BRAZIL Local Manager: Dr Leonia Capaverde Bulla Social Worker, Master of Social Services (Université Laval -­‐ Quebec/Canada), Doctor of Humanistic Sciences (Federal University of Rio Grande do Sul/Brazil), Post-­‐doctorate in Social Services (University of Kassel -­‐ Kassel/Germany). Senior Lecturer in the Post-­‐graduate Programme and the Social Services Faculty – Pontifícia Universidade Católica do Rio Grande do Sul/ Porto Alegre / Brazil. Classed as a level I researcher by the Brazilian Board of Scientific and Technological Development. Coordinator of interdisciplinary research on Policies and Practices to Combat Drug Addiction since 2010. Author of articles and books on topics related to Social Services, Social Demands and Policies, Social Gerontology and Drug Policy. Specific features of Brazil: 2
A tropical country, 8.5 million km in size, located in the mid and eastern part of South America, on the Atlantic. Population, 200 million inhabitants, 27 federative units, 5.5 thousand municipalities, 67.4 million households. HDI 0.727; GDP 2.5 trillion USD (2012). Republic, representative democracy. Socio-­‐political context: importance and size of the “drug problem” Since 1938, Brazil has passed laws, decrees and provisional measures laying the legal foundations for public policies to combat problems related to problem drug use. Since 2000, the issue of psychoactive substance dependence has been a priority for the Brazilian government. It is considered a public health problem involving the whole of society.
The Policy for Comprehensive Care of Users of Alcohol and other Drugs (2003) emphasised integrated approaches across different sectors to take into account all that is involved in the phenomenon. In 2006, Act no. 11,343 established the National System for Public Drug Policies (SISNAD) and encouraged a distinction between use and trafficking, which made it possible to create alternative measures aimed at social reintegration of users. Through Decree 7,179 of May 2010, the country established the Plan to Combat Crack and other Drugs, which gave rise to a set of investments and actions aimed at prevention, care and repression of drug use. The Second National Alcohol and Drugs Survey 2013 showed that Brazil has the ninth-­‐highest prevalence of cocaine and crack use in the world with around 6 million people (4% of the population). As far as alcohol is concerned, the number of people who have problems with dependence or abuse rises to 11.7 million (7.8% of the population). Survey performed: “Policies and practices to combat drug addiction in Rio Grande do Sul/Brazil”. Aims: To analyse how policies to combat drug addiction and the network of health, social work, justice and public security services have treated people with chemical dependencies and their relatives in Rio Grande do Sul in order to contribute to assessing those services. Type of research: qualitative research, using complementary quantitative research tools and techniques with data triangulation guided by the critical dialectic approach. Methodology: surveys, mapping health, social work, justice and public security services and programmes; data geoprocessing; analysing the theoretical work produced on drug addiction; analysis of official documents from departments, websites and newspaper articles; interviews with managers, professionals, drug users and relatives in selected institutions. Difficulties posed by the drug policies in force in Brazil •
In recent years it has been found that combating a set of problems as complex as misuse of drugs or drug trafficking requires effective action by society. •
There has been shown to be a lack of government social policies and instruments in the least privileged regions, and in vulnerable communities, which helps entice young people into the drug trade as they find survival opportunities in organised crime to meet the needs created by the consumer society. •
The National Programme of Citizen Public Security -­‐ PRONASC set up pacifying police units and Peace Territories in vulnerable communities, but it is still too early to see the results of those experiences as they have only recently been implemented. •
There is strong political influence from the legal drug (alcohol and tobacco) industries that puts the country in a delicate position with regard to reducing supply, which is a primary prevention strategy advocated by the WHO. •
There has been found to be over-­‐prescription of psychoactive medicines and self-­‐medication of such substances, which may lead to dependence. •
There is a need for assessment of treatment, which is the main focus of policies to combat drug addiction in the country and set up the treatment network for chemically-­‐dependent people. •
It is suggested that there should be an increase in the human, material and financial resources of programmes and services that serve drug users and their relatives. 1 Political focuses and possible alternative options •
Drug addiction treatment policies in Brazil focus on the main areas of prevention, care and authority. There is a need for much more work on prevention rather than treatment and repression. •
Another possibility is linking health policies with education policies and comprehensive social protection, thus safeguarding people’s rights and their family and community lives. •
There is a great need to train professionals to work on the front line with drug users with an emphasis on prevention and treatment in interdisciplinary work involving different knowledge areas. •
The importance of publicising scientific research and successful activities as a way of minimising beliefs and myths about drugs is also emphasised. Based on the results of the research conducted by the PUCRS team with the IFCU’s support, the following is recommended: ü Assessing the work of social movements and non-­‐governmental and community organisations that expand the Government’s options for responding to the growing demands arising from drug use. ü Enhancing the management system for data concerning procedures and user care. ü Releasing information about the services of which the treatment network is made up, as well as how to gain access to the services available to users and relatives. ü Assessing and articulating the network for comprehensive care of drug addicts and their families, respecting their peculiarities and putting the policy of humanising services into practice. ü Specific health policy strategies aimed at users’ families, which is essential for managing treatment plans. ü Structural modifications to Psychosocial Treatment Centres (CAPS) ranging from expanding their hospitalisation structure in parallel with detoxification to increasing resources for assessing interventions and diversifying treatment options. ü Assessing the connection with the treatment network for treatment of patients after release on an out-­‐patient basis, as well as increasing the capacity of other services. ü Making supervision and psychological care available to the entire team of professionals struggling with the tensions arising from working with chemically dependent people. ü Expanding the technical team treating people dependent on psychoactive substances and their families and promoting interdisciplinary actions among professionals: social workers, nurses, psychologists, physical education teachers, physiotherapists, occupational therapists, music therapists and monitors, among others. Bibliography BULLA, L. C.; SOARES, E. S.; DAMASCENA, M. B.; Políticas e Práticas de Enfrentamento à Drogadição no Rio Grande do Sul/Brasil [Policies and Practices for Tackling Drug Addiction in Rio Grande do Sul/Brazil]. Article. Anais do V Seminário internacional de Política Social [Proceedings of the Fifth International Social Policy Conference]. University of Brasilia-­‐
UNB. Brasilia, 2012. BULLA, L. C.; SOARES, E. S. DAMASCENA, M. B.;AZEVEDO, V. L. S.; Direito aos dependentes químicos: políticas e práticas de enfrentamento a drogadição no Rio Grande do Sul [Rights of Chemically-­‐dependent Persons: Policies and Practices for Tackling Drug Addiction in Rio Grande do Sul]. Anais do I Congresso Internacional de Direitos Humanos-­‐ Emancipação e Ruptura [Proceedings of the First International Human Rights Congress -­‐ Emancipation and Rupture]. Caxias do Sul, 2012. BULLA, L. C.; SOARES, E. S.; DAMASCENA, M. B.; Mapeamento dos serviços de enfrentamento á drogadição no Rio Grande do Sul/Brasil [Map of services to combat drug addiction in Rio Grande do Sul/Brazil]. Anais do II Congresso Internacional de Saúde Mental e Reabilitação Psicossocial – Saúde Mental na Atenção Primária [Proceedings of the Second International Mental Health and Psychosocial Rehabilitation Congress – Mental Health in Primary Care]. ULBRA, Porto Alegre, 2012. BULLA, L. C.; SOARES, E. S.; DAMASCENA, M. B.; A legislação Brasileira e as Políticas públicas de Enfrentamento à Drogadição [Brazilian Legislation and Public Policies to Combat Drug Addiction]. Article. Anais do IX Seminário Internacional de Demandas Sociais e Políticas Públicas na Sociedade Contemporânea-­‐UNISC. [Proceedings of the Ninth International Seminar on Social Demands and Public Policies in Contemporary Society -­‐ UNISC]. University of Santa Cruz do Sul, 2012. DIEHL, Alessandra; CORDEIRO, Daniel Cruz; LARANJEIRA, Ronaldo (orgs.). Dependência Química: Prevenção, Tratamento e Políticas Públicas [Chemical Dependency: Prevention, Treatment and Public Policies]. Porto Alegre: Artmed, 2011. FIGLIE, Neliana Buzi; BORDIN, Selma; LARANJEIRA, Ronaldo. Aconselhamento em Dependência Química [Chemical Dependency Counselling]. 2nd ed. São Paulo: Roca, 2010. MACRAE, Edward; SIMÕES, J. Rodas de fumo: o uso da maconha entre as camadas médias [Smoking Circles: the use of cannabis among the middle classes]. Salvador: EDUFBA, 2000.RIBEIRO, Marcelo; LARANJEIRA, Ronaldo. O Tratamento do Usuário de Crack [Treating Crack Users]. 2nd ed. Artmed, 2012. SILVA, Gilverto Lúcio (org). Drogas: Políticas e Práticas [Drugs: Policies and Practices]. São Paulo: Roca, 2010. 2