EDITORIAL
DOI: 10.11606/issn.1806-6976.v12i1

 

The Prohibitionist Discourse and Practices in the Field of Alcohol and Other Drugs

 

 

Clarissa Mendonça Corradi-Webster

 

 

Associate Editor of the SMAD, Revista Eletrônica Saúde Mental Álcool e Drogas, Professor of the Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto at Universidade de São Paulo, Ribeirão Preto, SP, Brazil, e-mail: clarissac@usp.br

 

 

Throughout all of human history, use of psychoactive substances has been reported. These substances have been used basically for three purposes: religious, therapeutic, and social. They way drugs and their uses are regulated varies according to historic and cultural context. In Brazil today, there is a strong influence of the American prohibitionist discourse, which has the ideal of achieving a "world without drugs". This discourse is reflected in policies that aim to reduce the supply and demand of drugs by repressing production, commercialization, transportation, and consumption of substances.¹ Historically, this discourse was anchored in a moral discourse, which depicts the user as someone with character flaws. The only path for this user would be total abstinence from consumption, which should accompany changes in their personality.

These constructions have an impact on the way the practices in this field develop. In the seven articles published in this number, the influence of the prohibitionist discourse can be observed in different areas. One of the articles discusses the difficulties that women who use drugs face when seeking treatment. One of the barriers identified by the authors is shame. Despite the fact that prohibition is directed at everyone, the impact of this discourse on women is stronger, since they are expected to have control over their behavior and, when they do not, are considered to have failed. The fear of punishment, of losing custody of children, of losing their significant other (who many times is also a drug user), and undergoing long hospital stays leads women to restrict drug use to more private and hidden situations and take longer to seek help.² Thus, it is important to deconstruct stereotypes related to drug users who seek treatment, since the media tends to associate consumption with criminality. In this number, one of the articles discusses this by presenting the socio-demographic aspects of crack users.

The prohibitionist outlook also impacts the way health professionals deal with users: many times these professionals present moral discussions and have difficulty to care for people that seek services for problems related to drug use.³ Thus, one of the articles discusses the importance of offering spaces where professionals of the nursing staff can train and reflect, so that they can be taught how to treat people seeking care with symptoms of alcoholic withdrawal syndrome.

In work with adolescents, under the influence of the prohibitionist discourse, the fear that teenagers use drugs is so great that many times institutions such as schools opt to not address the theme, concerned that if they create spaces to talk about these topics they will be incentivizing drug use. When the theme is mentioned in general – in a terrifying manner, as the drug is seen as an agent of destruction – this focus generates ambivalence in the adolescents, who may have had different experiences with psychoactive substances through their own use or by that of family members or friends who use drugs. It can be noted that prevention efforts often do not come close to the daily lives of these young people. In this number, two articles discuss topics related to drug use among students, where one article points out the almost non-existence of prevention efforts among pre-adolescents. When the treatment offered to adolescents who use drugs is analyzed, it can also be noted that many treatments are provided without any evaluation. One of the resources that have been sought frequently in Brazilian society today is long-term hospitalization in Therapeutic Communities (TCs). Due to pressure from different social actors (parents, politicians, health professionals, and even the drug users themselves in desperation), the TCs have gained integration in public policies as part of the psychosocial care network. There is great divergence regarding the inclusion of these institutions in the network, since they work with principles that are contrary to the psychiatric reform, such as long-term hospitalization and separation from family and the social environment, as well as the lack of dialogue with other resources in the network.⁴ Added to this is the precarious supervision of the quality of the services offered, as they have grown significantly over the past years and only a minority of them are monitored by regulating agencies such as Health Surveillance. In this scenario, denunciations of mistreatment of users that are hospitalized at these locations are abundant. Thus, studies that look into the hospitalization of adolescents at such places are extremely important. In this number, one of the articles had the objective of undertaking a systematic review of the topic, mainly finding studies produced in other countries. As the authors express, the characteristics of the TCs vary greatly among the countries, making it difficult to apply findings from other places to our reality. Thus, the authors encourage the development of more studies in our country.

 The prohibitionist discourse, despite being very influential, has been questioned over the past years as it has been noted that, despite all the investments made in the "war on drugs", the drugs are still being produced, commercialized, and consumed.¹ Different segments of the population (educators, researchers, members of the judicial branch) have pointed out how this discourse can provoke more losses than gains, and numerous countries have sought changes in the way they regulate drugs, be it by changing production and distribution methods, or by making consumption control more flexible.⁵ Marijuana was the drug chosen by different countries to begin these changes. Thus, one of the articles in this number investigated the opinion of university professors regarding the legalization of marijuana. From the results found, the sample shows that there is still a strong influence of the prohibitionist discourse.

The discourse of the theoretical-practical model of damage reduction has been indicated as an alternative proposal that does not consider abstinence as the only viable outcome. It approaches the assumptions inherent to human rights by considering the existence of human diversity – people whose only desire is to continue drug use; people who, although they want to reduce use or stop, have difficulties and require help to achieve their goal; and people who, even with support, will not be able to stop using drugs.

Damage reduction considers that the prohibitionist discourse has failed, and that it is therefore necessary to develop alternatives, or at least make the alternatives from other theoretical models more flexible to deal with this issue. Studies in the field are important to aid in the development of alternatives that are effective for and respectful to users of psychoactive substances.

 

References

1. Alves VS. Modelos de atenção à saúde de usuários de álcool e outras drogas: discursos políticos, saberes e práticas. Cad Saúde Pública. 2009;25(11):2309-19.         [ Links ]

2. Corradi-Webster CM. Consumo problemático de bebidas alcoólicas por  mulheres:  discursos  e  histórias. [Tese]. Ribeirão Preto: Faculdade de Filosofia, Ciências e Letras da Universidade de São Paulo; 2009.         [ Links ]

3. Vargas D. Nurses: personal knowledge and their attitudes toward alcoholism issues: A study of a sample of specialized services in Brazil. J Nurs Educ Practice. 2014;4:123.         [ Links ]

4. Corradi-Webster CM. Consumo de drogas: considerações sobre a clínica no contexto do SUS. Saúde Transform Soc. 2013;4:10-20.         [ Links ]