Hey readers, just check out this news article from Brazil. Enforced treatment not only goes against every tenet of the therapeutic relationship which has at its crux that one can’t force change on anyone who isn’t a willing, consenting partner -let alone the ethical issues at the heart of this. Enforced treatment rears its ugly head over and over again, emerging often in all manner of forms from the mildly menacing “‘we’re not forcing you exactly but if you don’t do xyz you won’t get help/housing/support/treatment etc” to the outright being kidnapped in the middle of the night and locked up in a ‘treatment facility’ with no recourse or redress. Yes, this all happens -but it is yet another story. This one is about Rio in Brazil, which has followed a programme first implemented in Brazil in Sao Paulo -and although there is clearly no evidence base for this kind of incarceration as a ‘treatment’, Rio nevertheless rolls out the rehab carpet. Go directly to rehab. Do not pass go. Do not collect $200. Being brought by ones parent’s or family members, which is often offered up to us as reasonable force or ‘encouragement’ can also be highly dubious, more realistically occurring as a punishment for the wayward child, who attends as a display of remorse or guilt to the family rather than a real desire or ability to get off drugs at what is often a crisis in that persons life that precipitates the heated fights and tears of the ‘pre rehab familial tsunami’. Breaking point for one side or the other ensues and rehab is raised, the bags packed. Of course as the article states, there is NO evidence for this kind of treatment approach, which isn’t to say it is all about baby steps and lots of cuddles (although that would be more effective than the former, I’m sure).  It is a convoluted mixture of approaches, which need to be guided by the individual who needs to believe in their own power to create the changes that lead to a better life; but to have some options of a better life being a possibility. And some support if needed to get there. After all, as one junkie I know said, “When you’re on the bottom rung of the ladder, everything is above you”. Firstly though – we have to stop treating drug users like they can be just swept away when the Olympics or some such event passes by our cities. Treated like they are the dirt on the new shoes of the up and coming new city suburbs. To believe in themselves, we have to believe in them. They are, after all -our sons, our daughters, mums, dads, grandpas and grandmas, our cousins and our husbands and wives. A selfish society or an impatient one, is destined to fall on its face in the muddy streets of its crime filled cities. No help to anybody. Yes it gets messy, yes there are countries, cities and towns where the picture is more harrowing than one could ever imagine. But our old approaches just arent working anymore. How many times must we throw money and our heads against brick walls? Involve people who use drugs to find out new answers, ask them their thoughts and opinions, provide the mechanisms to get their voices heard and their ideas developed. Engage the community you are targeting, it works – don’t just lock them up out of sight.

Issue CCXII – Weekly Edition: April 3 – April 9, 2013

Forced Treatment for Brazil Crack Addicts

By Lucy Jordan, Senior Contributing Reporter

BRASÍLIA, BRAZIL – In an attempt to tackle Brazil’s growing crack epidemic, the city of Rio de Janeiro has begun a program of involuntary hospitalization for users, one month after Brazil’s biggest city São Paulo began a similar program. At least 99 addicts have been hospitalized, 29 involuntarily, since the program launched one week ago, according to local media tallies.

With its long, porous border adjoining the world’s top three drug producers – Bolivia, Peru and Colombia – Brazil has historically been a transit country for drug trafficking to the U.S. and Europe.

Yet increasingly, Brazil has become a drug destination, with a Federal University of São Paulo study released last year showing that Brazil is now possibly the world’s largest market for crack-cocaine, with as many as one million users.

Some feel it it the approaching 2014 World Cup and 2016 Olympics that has prompted officials to ramp up efforts to present a clean, safe, tourist-friendly image.

Critics say that forcing addicts into rehabilitation treatment is ineffective, as the vast majority of users will quickly start using drugs again once discharged.

“When an addict is interned unwillingly, he can remain abstinent as long as he remains hospitalized,” Psychiatrist Dartiu Xavier da Silveira, who coordinates the renowned Guidance and Treatment of Addiction program of the Federal University of São Paulo (Unifesp), told The Rio Times.

“When he returns to his normal life (and his usual problems), the vast majority of users go back to using the drug as before,” Professor Silveira added. “Proposals for compulsory hospitalization as a measure of public health has no support in scientific evidence.”

Ronaldo Laranjeira, who heads up Unifesp’s Research Unit on Alcohol and Drugs and is a leading authority on the subject, said that the nature of crack addiction is so extreme that ordinary addiction treatment is inappropriate, and patients should be treated as psychiatric patients.

“In terms of crack users, the cases are so severe, people are so aggressive, so impulsive, sometimes psychotic, for me they are [not just addicts but] severe cases of psychiatric diseases,” he told The Rio Times. “That’s why for many people we have to use involuntary admission.”

“The clinical structure we have is basically only outpatients’ clinics and they cannot cope with these more severe cases,” he added. Long-term, Professor Laranjeira says that more specialized clinics for chemical dependency are required.

Professor Silveira agrees that involuntary hospitalization is appropriate for some patients who present psychiatric problems, but says these patients make up less than fifteen percent of crack addicts.

Brazil is by no means the first country to try coercive treatment for drug addiction. It is particularly common in Asia, and in the United States, some studies have shown that as much as fifty percent of publicly funded drug treatment referrals come from the criminal justice system. Coercive treatment for psychiatric treatment is common in much of Europe and the U.S.

In Dec 2011, the federal government launched a R$4 billion program to tackle the spread of crack-cocaine, focusing on prevention, care and policing. Health Minister Alexandre Padilha called the problem an “epidemic” and said drug addiction in Brazil had increased ten-fold between 2003 and 2011.

However, Professor Laranjeira said that very little of that money has actually reached state governments, and that this could adversely affect Rio’s ability to cope with demand for beds. “São Paulo has nearly a thousand beds for chemical dependency treatment; Rio doesn’t have even fifty,” he said.

“The huge contrast between Rio and São Paulo is that in São Paulo they are using state money to finance this service while in Rio they are relying too much on the federal government, and the money the federal government is putting on this treatment of crack is very small.”

Since São Paulo started its program in mid-January, 223 people have been admitted to hospital, but only seventeen of the admissions were involuntary.

END

Note: here are a few snippets from the recent Sao Paulo Study;

Altogether, more than six million Brazilians have tried cocaine or its derivatives at any point during their life, research by the Instituto Nacional de Pesquisa de Políticas Públicas do Álcool e Outras Drogas (National Institute for Public Policy Research on Alcohol and Other Drugs, INPAD) at the Federal University of São Paulo showed.

Of this group, two million have at some point usedcrack, oxi or merla – two other highly destructive derivatives of cocaine, usually cut with gasoline or other household solvents – while one million had used at least one of these three drugs during the past year.

The research also showed that in the past twelve months to between January and March 2012….2.6 million adults and 244,000 young Brazilians consumed cocaine in some form.

Of these, 78 percent sniffed powdered cocaine, five percent smoked derivatives, and seventeen percent used the drug in both these ways. Some 27 percent of these used daily or more than twice a week and fourteen percent said that at some point they had used the drug intravenously