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[Coursework] Addiction Intervention Proposal: A Theory of Change and the Case of Portugal (BBH 101)

     We can't deny that we're currently experiencing an increase in Drug trafficking and its effects. One could say we're at the highest point in human history regarding the amount of drugs circulating worldwide, the amount of money and deaths it generates along with its geopolitical, financial and overall social relevance.
Many advocate for continuing the current "strategies" to combat drug trafficking, aiming to perpetuate the war on drugs to, ironically, subdue the so-called organized crime. On the other hand, there are those who propose to give a radical turn to our current approach to this problem through the legalization of certain substances known as “illegal drugs”. On this spectrum there's Portugal, a country that doesn’t seem to get the attention it should - especially from mainstream media. In 2001, Portugal decided to legalize the possession and consumption of some substances (including marijuana, cocaine, and heroin) in response to the increased in deaths linked to the consumption of these and other drugs, most notably among the younger population, What until then had been considered a judicial problem was being recognized and designated as a health problem, and the reaction of the State to that problem would be of help, not punishment. This country has established a strategy that focuses on decriminalization, along with treatments and rehabilitation for "healing" and social reintegration, and educational campaigns as a preventive measure.
According to a detailed report prepared in 2009 by the CATO Institute, entitled "Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies", the legal strategy adopted by Portugal in 2001 as a resource to combat the high consumption of drugs can certainly be described as successful if considered as an isolated case and compared with the miserable results obtained by other nations that have opted for other strategies.
When the Portuguese government implemented this new legislation, the main criticisms and concerns were the assumption that drug use levels would rise and that Portugal would end up being a paradise for addicts from all over the world who would travel, syringe in hand, to poison their bodies and fulminate their lives. And although these were somewhat rudimentary arguments, the truth is that no one could deny them with certainty until such time as the result of the measure could be evaluated with figures.
During the first five years after decriminalization, the use of substances such as cocaine, LSD, alcohol and ecstasy in the student population notably decreased, while there were also significant decreases in the use of marijuana and heroin. That, among other things, tells us that education can do more than punishment. The imprisonment linked to narcotics fell drastically. In the case of traffickers, although the number of prosecutions was maintained until 2003, as of 2004 this type of activity stopped growing and, with such ‘market’, it went extinct. In this sense, not only consumption decreased and thematic education was increased, but the government spent less than half of resources in legal, administrative, and prison procedures than in 2001  (Domoslawski, 2011; Greenwald, 2009).
Among many of the favorable aspects of the Portuguese strategy is also a decrease in cases of HIV, mainly transmitted through needle-sharing, with a drop of 75%; the number of overdoses recorded on the street decreased in 40%; deaths generally related the traffic or use of narcotics fell by approximately 60%. Use and abuse of many illegal substances have decreased markedly since 2001 (Szalavitz, 2009; Greenwald, 2009).
The Portuguese case stands out especially since its work of awareness and educational campaigns have made recovery possible for many. Consequently, Portugal is among the countries with the lowest prevalence of cocaine users, ranking sixth in the European Union with less than 1% of its addicts consuming it throughout their lives, compared to a 6% in the United Kingdom; as for marijuana, they rank seventh place, behind Sweden, Finland, and Iceland (Domoslawski, 2011; Greenwald, 2009; Szalavitz, 2009).
Thanks to cases like Portugal's, we can compare the effectiveness, or lack thereof, between the two basic stances of anti-drug struggle: increased punishment vs legalization and regulation. It’s no secret that the current fight against drug crimes it has been gradually lost practically in all fronts. Just visit any world press website and see the thousands of deaths that occur annually caused by this phenomenon, especially in "transit" countries such as Mexico and the United States (and that's including, of course, Puerto Rico and USVI); or the large amounts of money generated by the black market along with the increased substance abuse in our cities and increased violence.
The level of ineptitude and ineffectiveness of strategies to combat drug trafficking from countries such as the United States, Mexico and dozens of other countries/territories around the world is reflected in its approach to the issue with the use of force, power and authority, which hardly aspires to achieve a minimum probability of success. Meanwhile, deaths, killings, extortion, and other illegal activities caused by unregulated use and consumption will prevail - implying a political, economic, and social cost which will surely take many years to recover.
As part of the Portuguese intervention plan, programs include the detection and early channeling of cases of substance abuse; special attention to physical and psychological care; different therapeutic approaches to the addict and his/her loves ones; detoxification, medication management, coping strategies, support measures for the process of abandoning and abstaining from drug use and abuse, and prevention of relapse and social insertion programs for the individual to achieve a positive lifestyle in society.
Prevention is a priority strategy within health policies and its purpose is to communicate messages and develop actions that not only provide objective and adequate knowledge about drugs and the effects of their consumption, but also facilitate the development of attitudes and behaviors towards health, generating healthy lifestyles. The priority populations for the prevention of addictions are children and young people, who are at greater risk of consumption and abuse.
To achieve favorable results and modify the trends observed in recent years, prevention must be coherent in different areas, such as family and community, school and work, in a dynamic and permanent exercise of constant participation, coordinated and frequently evaluated. Although the goal of prevention is to discourage the initiation of drug use, it also includes actions aimed at detecting early use, abuse and addiction, as well as certain interventions that aim to reduce health deterioration related to drug abuse.
The effectiveness of the preventive action depends not only on the definition of achievable objectives, and on the population to which it’s directed and on its socio-cultural reality, but also on the coherence, integration and coordination between the activities carried out. If these requirements are not met, the population is disoriented and efforts go to waste. This strategy includes awareness and educational communication which goal is to promote and facilitate awareness in general, as well as encourage participation in preventive actions. Mass, local and media play an important role in both the transmission and handling of news on the subject and in information dissemination to the public, influencing their perception of this phenomenon.
Despite not getting the attention and consideration it deserves, Portugal's pioneering work on decriminalization during the last decade and a half says a 'good lot' about of its free, public health system and its multiple assistance and treatment programs. This experience also reflects the effect of legislation on the overall behavior of a society. That is: a society where drugs are less stigmatized and users with substance abuse problems will have less difficulty in seeking help than in a society where they are only perceived as an outcast and a criminal.
Addiction intervention strategies in countries like Portugal serve as a model to develop actions that allow for sufficient resources and the most appropriate therapeutic modalities for the biopsychosocial needs of those who abuse drugs with respect for human rights and integrity.

What do you think of Portugal's drug strategy? Should the U.S. follow suit? Comment below.

Thanks for reading.

Suggested Readings

Comparing Portugal's Drug Policy to the U.S., and Why It's Working (Drug Addiction Helpline)
Drug Decriminalization in Portugal: A Health-Centered Approach (Drug Policy Alliance)
Opinion | How to Win the War on Drugs (New York Times)
Portugal Cut Addiction in Half by Connecting Drug Users With Communities Instead of Jailing Them (YES! Magazine)
Portugal Drug Report 2017 (European Monitoring Centre for Drugs and Drug Addiction)

Works Cited

Chang, Ava (2017 August 14). Theory of Planned Behavior & Smoking.

Domoslawski, Artur (2011 June). Drug Policy in Portugal: The Benefits of Decriminalizing Drug Use (Translated from Polish by Hanna Siemaszko). Open Society Foundations.

Greenwald, Glenn (2009). Drug Decriminalization in Portugal: Lessons for Creating Fair and Successful Drug Policies. Cato Institute.

Oreg, Shaul; Kratz-Gerro, Tally (2006 July 1). Predicting Proenvironmental Behavior Cross-Nationally: Values, the Theory of Planned Behavior, and Value-Belief-Norm Theory.

Szalavitz, Maia (2009 April 26). Drugs in Portugal: Did Decriminalization Work? Time Magazine.$FILE/13HseJud0226AttachD.pdf

This post first appeared on Into My Broken Mind, please read the originial post: here

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[Coursework] Addiction Intervention Proposal: A Theory of Change and the Case of Portugal (BBH 101)


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