Attention to problematic drug use Tensions, power struggles, and conceptions of evidence

Abstract

The problematic use of psychoactive substances is understood worldwide as an issue for the mental health system. In Brazil, however, historically the "drug problem" has been treated as both a health issue and a penal issue. These tensions and the power struggle in the field of care for problematic use of psychoactive substances have increased with the "psychiatric counter-reform" process, with an increased focus on strategies of confinement, abstinence as the only solution, and medicalization of problematic use. This focus is always accompanied by a discourse on the evidence for the efficacy of these strategies. We demonstrate that the current evidence favors an integrative model, based on care in freedom and the promotion of the subjects' autonomy, to the detriment of the strongly biomedical focus on the rise of the "counter-reform" movement. Moreover, the very concept of "evidence" that circulates in the biomedical discourse is limited, and should be expanded to include ethical-political dimensions structured around values such as autonomy and freedom. It is necessary to double the pace and strengthen the resistances against the biomedical model on the rise in the "psychiatric counter-reform" movement, reaffirming the commitment not only to scientific evidence, but also to the ethical-political dimensions of care.