Another place that thinks its fine to kidnap users…

Just thought I would put in a story i saw on the BBC website today. It has left me cold and angry. I get so sick and tired of people who just think it is ok to come and take someone away, lock them up, beat them if necessary, maybe if your lucky your parents know where you are but you don’t get out until they let you…Guatemala, ok so it is having problems with a crack surge, but for Goddsake, this is a money making scam and a human rights violation. Why do we think its ok to just take a person who uses drugs, and think that there life is so worthless, that no one really cares enough to save them, that they actually need to be kidnapped, locked up and never let out. That it is ok to ‘treat’ them psychologically with any sort of unproven bullshit  for hours and days or months at a time. That they need to be made into slaves to work scrubbing floors or cleaning toilets…It is a disgrace and a scam and we need to keep the UN, who it says, said in 2012 that these places must be shut down (enforced treatment centres)…is there something the using community can do to speed this up? 

The rehab centres that lock up addicts against their will

A man behind bars

In Guatemala, behind barred and locked doors, thousands of drug addicts are offered treatment by Protestant churches. Christianity offers salvation for some but many are held against their will, and some are swept off the street by “hunting” parties.

“They grabbed me. They found me completely out of it on the streets, and they just grabbed me.”

Marcos is a big guy. With closely cropped hair, and a huge expanse of chest, he is not the kind of man to tackle lightly. But Marcos was accosted by a group of men in Guatemala City and forcibly taken to a private, Christian rehabilitation centre.

“I was there for about a month and a half, and nobody knew anything about me. People thought I was killed or something, because that’s what happens in Guatemala.”

“I saw terrible things in that rehab – the owner used to beat up the girls. He would tie up the guys and roll them up like a taco in a piece of carpet, and leave them there for hours,” he says.

Listen to Linda Pressly’s report from Guatemala City on Crossing Continents on BBC Radio 4 on Thursday at 11:00 BST – or find it soon after on BBC iPlayer

Marcos was freed when a friend came looking for him, and demanded his release. He doesn’t think enforced rehab is the right approach and says it did nothing to help him quit his alcohol and drug habit.

“People came out madder and more furious. Instead of being rehabilitated, you just went out to get high again.”

Marcos grew up in the United States – a refugee from Guatemala’s civil war in the 1980s – but was deported back to his parents’ homeland after serving a prison sentence. With family in California, the owner of the rehab centre saw Marcos as a money-making proposition – he tried, and failed, to get contact details for Marcos’ family to ask them for money for Marcos’ keep.

All that is behind him now – Marcos is clean, and is dedicated to mentoring young people.

As there is no residential, state provision for addicts in Guatemala, private rehabilitation facilities have filled the vacuum. There may be as many as 200 Christian centres in Guatemala, possibly holding 6,000 people, estimates Dr Kevin O’Neill, from the University of Toronto, who has made an anthropological study of the centres. It is not known how many of them practice the aggressive “hunting” Marcos experienced.

A rehab centre with metal bars on the outsideOne of the private rehabilitation centres that have sprung up in Guatemala City

O’Neill believes Guatemala is confronting a surge of addiction. Its strategic location in Central America means the majority of illicit narcotics moving from South America to the United States make landfall here. And the fallout is a growing local market for highly addictive drugs like crack cocaine.

“It’s increased the number of centres in the capital city. But it’s also changed the culture inside the centres – the internal dynamics have become much more aggressive, and much more discipline-driven because of the rise of crack cocaine,” he says.

The founder and director of the Rescatados del Abismo, Rescued from the Abyss, centre is Pablo Marroquin, a born-again Christian and former drug addict.

Pablo Marroquin at his rehab centre

“I’d been in other rehabilitation centres, but I wanted to make mine more personal. I put it in the hands of God – he’s the only one who can rescue us from drug addiction,” he says.

Marroquin lives on the ground floor of an unremarkable building in Guatemala City with his family, his budgerigars, and a pack of small, snappy dogs.

On the first floor, behind a locked, barred door, 54 addicts mill around. Many of them will not be allowed to leave for at least three months – but it could be years. Only the addicts’ families or the director himself sanction the release of those interned here.

It is a confined space for so many people – the size of a large, three-bedroom flat. Off a common area, there is a bathroom, a room stacked with roughly-constructed bunks for those with privileges -most inmates sleep on the floor – and a bedroom for the six women internees.

A man sits on the floor against the wall, eating out of a bowl

Currently, the smooth running of the centre is down to Carlos – an internee who has been into rehab more than 30 times to try to overcome his addiction to crack cocaine and alcohol. Carlos imposes discipline and punishment at Rescatados del Abismo.

“When people arrive they can be very violent, and the only way to respond to that is with violence. It makes me uncomfortable, but it’s extremely important to maintain discipline here,” he says.

CarlosCarlos, an internee himself, maintains order at Rescatados del Abismo

Forcing an internee to clean the floors or to work at night are other forms of punishment.

Internees are partly controlled by compulsory attendance at meetings. They spend seven hours a day telling and re-telling each other their stories, charting their descent into addiction. These meetings are the only “therapy”.

They are not structured, there is no psychologist or doctor involved, and no one is allowed to leave the room without permission. While listening to the testimony, the residents sit in shadow – the barred windows of the meeting room are covered with thick yellow corrugated plastic.

Freddie speaking to other internees

It is impossible to see the street from anywhere inside the centre.

“The vast majority, I would say 95% of the internees are here against their will,” says Carlos.

“Now he’s there, we have a bit more peace of mind – if he were in the street, anything could happen here in Guatemala”

Carlos Ruiz

Carlos Ruiz, brother of Victor, an internee

When desperate families call the centre asking for help with a substance-abusing loved one, he often accompanies the director to go and pick an addict up.

“It’s our role to bring them here, and that can mean using handcuffs like the police. Sometimes a family will say their son is very violent and has a knife or machete. In those cases we tie him up before bringing him here.”

Carlos believes this is legal in Guatemala. A ministerial accord of 2006 states that an addict can be interned when they are not in a fit state, but once they have recovered sufficiently, they must give consent. By all accounts, this rarely happens.

At the Ministry of Health, the regulation and co-ordination of the centres comes in the shape of just one man – Hector Hernandez has worked for the last 14 years to try to improve the centres and make them more humane. He has closed some, but he says forced detention has never been proven.

“Not even the attorney for the defence of human rights has been able to establish there are people detained against their will – there’s been no confirmation of any allegations made,” he says.

During the compulsory meetings at Rescatados del Abismo, Victor Ruiz reads his well-thumbed bible. An abuser of crack cocaine and alcohol, he has been here for three months. Victor believes only God and Jesus Christ will rescue him from addiction.

Victor Ruiz reading his bible

“I think I’ll be here for another five months, it all depends what my brothers decide,” he says.

Before he came to the centre, Victor was living on the streets. One day when the family could not find him anywhere, his older brother, Carlos Ruiz went to look for Victor at the morgue.

“I was looking at the photos of dead people to see if one of them was him. It’s really shocking. These things stay with you, it’s like you die a bit too,” he says.

After Victor was attacked in the street by someone with a machete, the family had him interned in Rescatados del Abismo.

“Now he’s there, we have a bit more peace of mind – if he were in the street, anything could happen here in Guatemala.”

The director of Rescatados del Abismo, Pablo Marroquin, has little patience with arguments about whether the regime he runs violates the rights of internees, especially when they are held involuntarily.

“What about families? What we do is give families peace, so their loved one doesn’t get himself into trouble. And so that he won’t kill them,” he counters.

Adverts for other rehab centresAdverts for other rehabilitation centres in Guatemala City, with the left one titled “Warriors of Christ”

There is no data about how successful the rehabilitation of addicts is in Guatemala. In 2012, the United Nations called on all member states to close compulsory drug detention and rehabilitation centres.

“There is no evidence that these centres represent a favourable or effective environment for the treatment of drug dependence,” declared the UN statement.

Many experts believe addicts can never be forced to change – they have to want to stop. And in Guatemala there are many Christian establishments that will only take addicts on a voluntary basis.

But Pablo Marroquin, clean now for 22 years, is a testament to his own approach to rehabilitation.

“I experienced God’s mercy – he rescued me. He brought me to a rehabilitation centre where I met myself, and I met God. And these days, I’m a happy man.”

Listen to Linda Pressly’s report from Guatemala City on Crossing Continents on BBC Radio 4 on Thursday at 11:00 BST – or find it soon

Here we go again; sweeping up the junkie mess in time for the glowingly healthy & happy Olympics; Brazilian Stylee

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

February 26, 2013 | Filed underFront Page,Politics | Posted by 

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.

Officials say that most of those hospitalized for crack addiction in São Paulo since involuntary treatment was introduced have come voluntarily, or been brought by family members, photo by Marcelo Camargo/ABr.

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.

Critics of involuntary hospitalization say that without adequate treatment following detox, most addicts will begin using again, photo by Tânia Rêgo/ABr.

“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 usedcrackoxi 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

 

 

 

 

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