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SMAD. Revista eletrônica saúde mental álcool e drogas

versão On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.12 no.2 Ribeirão Preto jun. 2016 



Perception of users of psychoactive substances on damage reduction


Percepción de los usuarios de substancias psicoactivas sobre la reducción de daños



Josenaide Engracia dos SantosI; Ana Carolina Oliveira CostaII

IPhD, Adjunct Professor, Faculdade de Ceilândia, Universidade de Brasília, Ceilândia, DF, Brazil
IIOccupational Therapist




INTRODUCTION: The damage reduction (RD) minimizes risks and anomalies caused or secondary by drug use without there necessarily being the reduction of consumption.
OBJECTIVE: To understand the RD from the psychoactive substances user’s point of view.
METHODOLOGY: Qualitative study having as its methodological theoretical axis the social constructionism. Instrument: semi structured interview. Research subjects: Homeless users of psychoactive substances.
RESULTS: Reports that explain the damage reducer as innovation operator, the prevention of health, questioning and opposition with respect to RD’s actions.
CONCLUSION: The vision of users is an element that can provide subjective and collective disalienation processes, against the difficulty of standardization methods implicit in actions with drug users.

Descriptors: Narratives; Drug Users; Qualitative Research.


INTRODUCCIÓN: La reducción de daños (RD) minimiza riesgos y anomalías provocadas o secundarias por el uso de drogas sin que ocurra necesariamente la reducción del consumo.
OBJETIVO: Comprender la RD desde lo mirar del usuario de substancias psicoactivas.
METODOLOGÍA: Estudio cualitativo teniendo como eje teorético metodológico el construcionismo social. Instrumento: entrevista semiestruturada. Sujetos de la Investigación: Usuarios de substancias psicoactivas en situación de calle.
RESULTADOS: Relatos que explicitan el reductor de daños como operador de novedad, la prevención a la salud, la problematización y oposición con relación a acciones de la RD.
CONCLUSIÓN: La visión de los usuarios es un elemento que puede proporcionar procesos de desalienación subjetiva y colectiva, frente a la dureza de los métodos de normatización implícito en las acciones con usuarios de drogas.

Descriptores: Narrativas; Consumidor de Drogas; Investigación Cualitativa.




The use of psychoactive substances is present throughout the history of mankind and hence the concepts constructed by society over time with regard to these substances, have changed according to the historical moment and contexts experienced by the collective (1). The debate about drugs arouses issues of great complexity and divergence between the professionals involved in this issue. Such questions arise Manichaeism between medical discourse (health-related issue) and legal discourse (which involves legal and security aspects) (2).

Amid this debate and in an attempt to bring to light a proposal different to that recommending the abstinence at all costs, the Damage Reduction (RD) is present.

The approach of RD is considered in the provision of services that are more accessible, from an unbureaucratic, open and flexible point of view. As such, it made of actions that aim at minimizing biological, psychosocial and economic risks and damages caused directly or indirectly by the use and abuse of drugs, without necessarily requiring the reduction of the consumption of such substances(3). It allows a mobility that puts participants of the process in another form of relationship with the society and often serves as a bridge between the subject and this social relationship which they are separated from (4).

Damage Reduction began with the exchange of syringes, and users, when feeling watched, began exchanging care, requests for information and affection. These exchanges often allow the entry of a third aspect, "that breaks the dual, intense and exclusive relationship with drugs"(4). At this point, damage reducer is present and there is a greater care with the drug user.

RD is a fact-based strategy, which observes and covers both the positive and negative effects arising from drug use, considering the various levels of intensity triggered by this behavior. (2). The work happens through the damage reduction agents, which make the direct approach to the drug users in areas mapped in advance.

The displacement of this professional to where the drug users are evidences how RD can contribute to the recovery of these people’s citizenship, providing opportunities for prevention and different exchanges. But how do these users see the RD? What do they think about it? And how do they position themselves in relation to their actions? This is a complex field and the proposal is only to situate the linguistic perspective that has been used in social psychology and also in daily life, to give directions to objects and social events.

Thus, the general purpose of this research is to understand the Damage Reduction from the homeless psychoactive substances user’s point of view. One of the specific objectives is to describe the position of the subject before Damage Reduction actions, understanding the description as an attempt to portray the behavior, an idea with precision(5). Another specific objective in focus is to "explain" the thought of such actions, also understanding that this concept relates to the disclosure of the possible causes of certain behavior and positioning before events.

Descriptions and explanations of this world are forms of social action and make it possible to identify the meanings attributed in daily life(6). The meaning is a social construction, a collective enterprise, specifically interactive, through which people in the dynamics of relations, historically dated and culturally located, construct the terms from which they understand and deal with the situations and phenomena around them . They are connected with all human activities (6).

Methodological Approach

The research is qualitative exploratory and it used the social constructionism as a methodological theoretical reference that has the language as the space through which the realities are socially constructed(7). It deals mainly "of the processes through which individuals explain, describe, or somehow, realize the world where they live in and even themselves" (6).

Social Constructionism as a methodological theoretical approach makes it possible to capture the process of production of meanings within the contexts, since it is interested in identifying the repertoires and also the ways in which people describe their understanding and experience of the world (8).

The qualitative research was conducted by the Damage Reduction Program that is bound to the Management of Sexually Transmitted Diseases such as Acquired Immune Deficiency Syndrome  - AIDS and Viral Hepatitis of the Health Department of the Federal District - DF, with territorial basis in South Commercial Sector.

 The participant subjects of the research were five individual users of psychoactive substances that are served by damage reducers. Inclusion criteria were: subjects indicated by damage reducer; over the age of eighteen (18) years of both genders and who agreed to participate freely in the study.

The instrument used was a semi-structured interview, conducted from September to October 2013. In this mode some open and closed questions are combined, which allow the subject to discuss the subject in question(9). The record was executed by audio recording and later transcribed for data analysis. The anonymity of participants was maintained through the use of the abbreviation "E", interviewee, followed by Arabic numerals in ascending order, as explained: E1, E2, E3, E4 and E5.

The categorization and analysis of data was made through the association map of ideas, which "are visualization tools of theoretical dimensions and identify the dialogic interanimation processes from the visual layout of the interviews that allow to give subsidies for analysis and give visibility to results"(8). This map is a table where the columns are defined thematically, constituting a resource to make sense and understand certain passages of the interviews.

 It is also worth mentioning that the research followed the guidance of CNS Resolution No. 466 of December 12th, 2012 and it was examined and approved by the Ethics Committee in Research of FEPECS - Foundation of Education and Research in Health Sciences by opinion No. 380.578 (10).

Results- Meanings and Positioning

The explanation and description of the meanings on the damage reduction emerged in the repertoires of users are presented in five dimensions: Damage Reduction as innovation operator; prevention and health; opposition to RD; the production of pipe and questioning of Damage Reduction.

Damages Reduction as innovation operator

Damage reduction actions, referring to the account of the user, move between the two worlds. This allows the user to access what is rightfully his, free from prejudice, allowing the possibility of the existence of the person as a subject with wills and desires, recognizing the subject with regard to an important function of his psychic structure that is the feeling. This is the innovation, identified and exposed in the narratives.

E1: I think that what helps the most is the... part of the feeling... of showing interest... for something... that well ... seems to be forgotten ... abandoned so ... I think this is the issue…

E4: They are wonderful people, right? Who always come. Talk. Come to talk to someone... in particular.

E1: Yes... Yes. They are really nice people... super cool.. they know how to come... they know how to leave.. they know when not to come.

The narrative portrays the feeling as an important piece that explains the Damage Reduction, from the consideration that exists towards the subject who is in the invisibility of the streets everyday. RD image appears in the context that seduces and that precisely captures the feeling of care it offers. According to users the figure of damage reducer can be assimilated as the one that, in its structure, provides conditions and opportunities of listening, recognition of the other and acceptance of their differences(11). It is the meeting of two people who act on one another, and from this symbolic interaction intersubjective moments arise. A live work in action, which produces in each one singular effects of what is experienced (12).

Health Prevention

The explanation presented here brings the geometry of the experienced, that is, the universe of meanings of individual experiences of users with professionals of RD which are usually identified as ‘health personnel’. The Damage Reduction actions are associated with the concept of prevention with regard to targeted interventions to prevent the emergence of specific diseases. The basis of the preventive discourse and its objective can be identified as: the control of transmission of infectious diseases and the risk reduction of chronic degenerative diseases and other specific diseases. Such repertoires were identified in the narratives.

E1: Damage reduction... it is... it is prevention ... like.. even on the health aspect.

E5: ... when you talk about damage reduction people are kind of. Healthy, right.

E4: If you have sex without a condom you can acquire a disease.

E3: It is good... to protect.

The knowledge that is transmitted by health agents (Be it the work of PRD, the Clinic, in the street or other service specialized in street approach), still has a dichotomous view of health and disease and guide approaches in biomedical criteria over those existing in social sciences. An example of this is when users explain the Damage Reduction mentioning, mostly, words that refer to the biomedical world (AIDS, bacteria) and that are almost always related to a pedagogy of the conditioning imbued in their speech (13).

E3: .. they are also afraid to die... then they protect themselves because AIDS does not kill right?

E1: ... the health side ... so you... do not get sick.

E5: .. It helps not to catch a bacteria.

E4: If you pass a can to your colleague you can catch a disease too.

E1: not to share the same pipe... the same can.

The statements do not reflect the socio-cultural factors that underlie substance use and health-related practices in its holistic sense, but biomedical positivist causal relationship of the pathogen (AIDS, hepatitis) and the body (user)(13). At the moment where the user speaks about "Not sharing", there is always a mention of control over health and disease and literal reproduction of control that can be exercised by health professionals (14).

Opposition to Damages Reduction

The narratives expressed during the interviews made explicit positions against the Damage Reduction regarding some practices used during the approach to the drug user. With respect to this research, the pipe figure puts makes the moral judgment visible, the result of social impositions that the interviewee causes to emerge.

E3: No... it was your mistake to make the pipe... because what they want the most is that... pipes.

The pipe represents violence, marginality, an object that somehow would stimulate this consumption of "drugs"(15). Just as the figure of the pipe, Damage Reduction, sometimes, is seen as a permissiveness, with a moral dimension on the issue (16).

E3: The pipe... The pipe makes you use even more... Making the commercial sector worse... It gets worse... so no pipe should be delivered.

E3: A mistake ... a big mistake ... and big! Because they start negotiating for another.. getting a little bit with another because I always see them there.. That’s it! Because if there is a can.. they find a can.. What will he want a pipe for?

Producing subjectivities: The Production of the Pipe

Human beings need symbolic elements that reflect their relationship with themselves, with the space and the others(17). Such symbolism when demonstrated brings out the subjectivity, especially the identity of the subject. The lip protection, snick kit (Kit for the people who make use of snorting cocaine), the pipes, the informative material, are only some of the necessary elements, important, used for an initial approach and are resources to provide the desire and possibility of another meeting(18). It is the beginning of a connection with the individual and, from there, a relationship focused on mutual exchange is established. At this meeting there is no idea of ​​"giving", "saving", "curing"; the proposal is in fact the exchange and the construction of a single damage reduction strategy for each and every life story.

Thinking about it, the pipe appears in the narratives of the subjects as if this symbolic object was configured it in greater representation of consumption. The individual makes encodings of things through meanings and this movement elucidates their human and also social context.

E2: Oh the pipes that I make here... (took three pipes from the backpack and showed them). This one (pointed at one that was in his hands) is iron, rubber and aluminum.

E5: Then I know... that I even received the pipes you also distributed..

The relationship established between the user and the consumption and pleasure mediating object sets the main scenario of interaction and social connections. The movement itself of the damage reducer to inform about the "not sharing", arises from the assumption that there is minimal interaction with the other (15).

E4: ... and you cannot lend your pipe to anyone..

The pipe construction process allows the production of health and understanding of this object as a being that is also social and open to interaction. It is part of the intimate universe of the subject and represents this trend of including in his humanity what is important and that is a company during difficulties (15).

E2: .. And a pipe... is kind of... it has to be intimate... it is you and you... you only handle it to a person if you see that person deserves it.. I do not give my pipe to anybody... I make my pipes... This one I took for me to use (showed another pipe that was on his side). If my mother came... and said.. ‘son give it to me’... I do not give.

Questioning of Damage Reduction

By the time the interviewees ask about the effectiveness of the product, they raise a questioning that goes against the sense that the program acquires for its target audience. There is the questioning or even the deconstruction of a saving logic that RD actions will modify the subject’s behavior. The interviewee causes a reflection on the real effects and compliance of these actions for some.

E5: Condom for what mister? For jacking off and not getting your hands dirty? (laughs)

It is noted that the reports that focus on medicine as a universal truth (condom use) faced by another implicit factor that corresponds to the sociocultural aspects of health (the ‘reason why’ the subject does not find sense in a condom). While there is the identification of the distribution of condoms as something good, the assurance that this will avoid pregnancy or some disease is not palpable (13).

E3: And for others... and other drug addicts it is good too.. But sometimes they do not care about it.. like I told you.. there are the girls there who are pregnant.. there are many, right? Don’t bother.. Don’t bother about it.

The distribution of inputs by RD can become an exchange currency which removes from this input all the stability and rigidity shown in the act of distribution. The sale of the product, the exchange of the same for materials of any kind (cash, substances) produces a certain strangeness and even a questioning regarding the meaning it has to the audience to which it is intended.

E5: Oxi... Hire me then… I make pipes... Good stuff.... I make it cheap (...) Oh, I can make for you for a cheap price... 4 reais?

Connecting the Meanings and Positioning

Connecting the meaning and positioning of subjects promoted an intense dialogue and a resounding silence, inasmuch as a lot has been said and also silenced. Damage Reduction, in the view of users, produced openings in the relations petrified by the moral code, whereas the contemporary may be able to acquire a meaning when you can sustain an ethical no longer supported by tradition or by reason, but as an "artist of itself"(19).

Artists of themselves are reducers and users in a list of "exchange" which translates care seen in the street scene. RD in the figure of reducer goes beyond the link between subject and drugs, offering not only inputs, but light technology that can wake in the subject a sense of gratitude, feeling explained all by all stigmatizing reality in which they are immersed (12).

The narratives demonstrate the clear picture of the drug user as an individual of wishes and of the RD, as a differentiating device, waves at the possibility to exercise. The "micropolitics actions" emphasize a simple point: the place of the subject(20). The meaning attributed by this subject that has "no place" but that has positioning before the intervention which they ate submitted to.

From the resulting voices it was possible to weave theoretical dialogues, perceiving a suffocated cry for citizenship and inclusion of user in the same collective that somehow separates the worlds of those who use it and those who do not. These two worlds, or even the underworld, that were referred to as explanations of this reality that is woven by drug use, have in the figure of the reducer, someone who can somehow cross the exclusion and stigma carried by this specific population.


Final considerations

This construction certainly has no intention to be a finished work, but to socialize the meaning assigned by users as something that can trigger subjective and collective alienation processes facing the difficulties of the rules implicit in actions with those subjects.

The listening differs from technologies that trigger confession, resulting in the desire through the truth of the individual, in the sense to free them from submission to social obligations that reject the "singular". The users’ look led to the reinterpretation of the "no seeing", which extends our fields of feeling and perceiving. Even if only as a flash, when lighting a scene, it is pointed out here a possibility of opening, if broadening this look that intends to make the collective resistance to leave invisible and silenced what the users of psychoactive substances think. The idea is to reduce the blindness, sharpen the listening and cooperate in the discussion of professionals working in street clinics, psychologists, social workers and nurses. With no more pretensions.



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Received: May 17th 2015
Accepted: Dec. 15th 2015

Corresponding Author:
Josenaide Engracia dos Santos
Universidade de Brasília. Faculdade de Ceilândia
Centro Metropolitano, conjunto A, lote 01
CEP: 72220-900, Brasília, DF, Brasil

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