Stigma about drugs and its impact on health care
No vision of drug addiction is complete without taking into account social stigma.
Drug use is a phenomenon that has been analyzed from various angles: political, legal, social, historical, medical, educational, psychological, psychiatric, anthropological, etc.
Each of these fields of knowledge has attempted to explain the causes and consequences of the use of various drugs, as well as to provide answers to the question of why they are spreading. In this sense, it is important to adopt a broad approach that includes social variables in order to understand one of the experiences most closely linked to drug use. one of the experiences most closely linked to addiction: stigma..
Drug addiction as a social problem
While it is true that the history of drugs and their uses is as old as humanity, It is from the 20th century onwards that drug use is identified as a social problem, an identification that brings with it significant obstacles.an identification that brings with it significant obstacles.
What is said about drugs and drug users is enveloped in a web of ideological discourse that has made the figure of the drug user a network of ideological discourses that has made the figure of the consumer to be associated with delinquency, social deviation and pure vice, which is read from a strictly moral point of view.The drug user is read from a strictly moral point of view.
This view has influenced the way in which drug users, whether seen as problematic or not, are treated in social and family spaces, but also in the political and public spheres.
Until less than a decade ago, there was no public care network in Ecuador for problem drug users and those suffering from addiction. Most of the supply of care services was provided by the private sector and only one type of intervention became normalized and universalized.
It was the forced internment in so-called addiction clinics, mostly run by "rehabilitated" ex-consumers, without any professional experience or any serious endorsement to address this problem, and with minimal regulations from the State, offering apparent rehabilitation services that had little or nothing to do with the psychological, medical-psychiatric, occupational, social and educational care that this problem requires.
Thus, for decades, drug users and for decades, drug users and those suffering from addiction were exposed to inhumane treatment and constant violations of their rights. ranging from internment against their will with capture practices to physical and psychological mistreatment as "reductive" measures to reverse addiction.
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The political dimension of the problem
Now, all this could not have been carried out for so long without a policy that supports and tolerates these practices. Since the 1990s, in Ecuador and, thanks to the so-called war on drugs (orchestrated in the 1970s by the United States of America, which came to Latin America with force in the 1980s and 1990s), one of the most draconian drug laws in the region was created, the so-called Law 108, which placed drugs and drug users in the criminal sphere.
In addition, there was the influence of religious discourse.The new law, which places drug use in the order of sin, gave way to the construction of strong stigmas that guided prevention and treatment policies and, consequently, clinical practices.
The stigma of addiction
Despite the fact that since 2008, the Constitution of the republic considers addictions as a public health problem, and that there are public treatment centers both residential and outpatient professionalized, social stigmas still prevail in certain health practices and, above all, in the social imaginary..
It is enough to listen to some colloquial discourse on drug users to understand how these stigmas operate. Thus, drug users are often identified as sinners, criminals, vicious, deviant, deviants, etc.etc. What is common to all these identities is that subjectivity is left out, that is, the human being who uses drugs or has an addiction.
In terms of health care, these stigmas result, on the one hand, in problem users not seeking care, because they themselves and their families do not believe that they should be treated or cared for by professionals, and, on the other hand, in health professionals themselves making their interventions based on stigma.
Thus, we find biased interventions, poorly indicated treatments, people who have been hospitalized without needing it, little interest in the construction of other devices such as risk and harm reduction.There is a long way to go and an immense debt to drug users, to people who suffer from addiction and to their families; institutions and treatments that are dogmatic and universal, indicating the same treatment both for someone who uses marijuana once a month and for someone who has a chronic dependence on several drugs; little professional training in this field, and exclusion from some services, such as hospital services, for detoxification or in cases of relapse.
There is a long way to go and an immense debt owed to drug users, to people suffering from addiction and to their families, insofar as the restitution of their rights is concerned. The restitution of their rights, the construction of appropriate policies and the establishment of sufficient treatment alternatives in accordance with the complexity of the problem and with ethical principles.
Author: Lorena Villacís, clinical psychologist and member of Con-Dicción, Ambulatory Device for Problematic Consumption of Alcohol and other Drugs, of Superar Centro Integral de Psicología.