Processes, practices and politics in the treatment centers for addictions and problematic consumptions: an analysis of the perspectives and practices of the professionals in a treatment center in the Autonomous City of Buenos Aires
Contextual Information: Historically in Argentina, as well as globally, the politics regarding the use of “drugs” have been prohibitionist and treatment centers have implemented these politics with models of abstinence. More recently, the need for both the politics and the treatment to prioritize the rights and health of the drug uses has become more widely recognized in both social and political contexts, as much as among professionals in treatment centers. New laws have been passed proposing the implementation of harm reduction strategies in the treatment of addictions and problematic drug use. In the Autonomous City of Buenos Aires there are several distinct types of treatment centers that differ in both their practices and their ideologies. One of these treatment centers is the Center Xavier*. The Center Xavier is a center of low threshold requirement that offers outpatient treatment. This study analyzes the type treatment offered by the public health system through the Xavier Centre, to provide care for drug users; and the changes that these new policies aimed at addressing the problem of problematic drug use may have generated in this center and others. Methodology: The research objectives were met through 8 in-depth interviews with 9 total individuals. One investigator not associated with the Center Xavier was interviewed; the interviewees at the Xavier Center included: the head of the center (also a psychiatrist), five psychologists, a gynecologist, and the secretary. The results were coded into 7 categories for analysis. Results: The Xavier Center implements strategies from the perspective of harm reduction and the treatment realized there is based in psychoanalysis. In general their work is limited by the resources they have. In this particular center there have not been many changes in response to the new laws, in part because the center was already complying with these laws before they were approved. While there is a stronger movement away from the prohibitionist policies, these policies and the contradictions that they create, still remain and cause many problems. *Fake names are used in order to maintain confidentiality
Sustancias consideradas adictivas: prohibición, reducción de daños y reducción de riesgos
Latin America is currently the region with the highest rate of homicides worldwide, and a large part of the killings are linked to so-called organized crime, especially drug trafficking. The trafficking of drugs is a consequence of the illegality of certain substances which - at least presently - is based in and legitimated by biomedical criteria that turns the production, commercialization and often the consumption of certain substances considered addictive into "offenses against health." This text briefly analyzes the two policies formulated and implemented thus far in terms of prohibition and harm reduction, considering the failure of prohibitionism as well as the limitations of harm reduction proposals. The constant and multiple inconsistencies and contradictions of prohibitionism are noted, indicating the necessity of regarding cautiously repeated comments about its "failure." The text proposes the implementation of a policy of risk reduction that includes not only the behavior of individuals and groups, but also the structural dimension, both in economic-political and cultural terms.
The Use of Confrontation in Addiction Treatment History, Science, and Time for Change
The use of confrontational strategies in individual, group and family substance abuse counseling emerged through a confluence of cultural factors in U.S. history, pre-dating the development of methods for reliably evaluating the effects of such treatment. Originally practiced within voluntary peer-based communities, confrontational approaches soon extended to authority-based professional relationships where the potential for abuse and harm greatly increased. Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. There are now numerous evidencebased alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate.