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Ways of prevention

A study from Cebrid helps to distinguish myth from reality in the panorama of drug use in Brazil

Good prevention programs in the use of narcotics depend, in the first place, on a precise diagnosis of Brazilian reality. The Brazilian Information Center on Psychotropic Drugs (Cebrid in the Portuguese acronym), of Sao Paulo, has produced, over the last few years, a collection of scientific papers that have managed to unveil myths and to show unsuspected nuances in the country’s drug problem. One can take the most recent example: the Quinto levantamento sobre o uso de drogas  entre estudantes do ensino fundamental e médio em 27 capitais brasileiras (Fifth survey concerning the use of drugs among primary and high school pupils in 27 Brazilian State capitals), released at the end of May. The survey shows that the experience with psychoactive substances, legal or illegal, is more and more precocious among students. The average age of the first contact with alcohol and tobacco was 12.5 years and 12.8 years respectively. Among those who have experienced marijuana, their first use came, on average, at 13.9 years and in the case of cocaine at 14.4 years. The statistics confirmed the impression that heavy drugs are rarely the first step on a trajectory of dependence. “Prevention must begin before 10 years of age and go hand in hand with efforts to put off the first use of alcohol and tobacco”, says the psychiatrist José Carlos Galduroz, a researcher at Cebrid and the coordinator of the survey.

Something else new: the survey contradicts the idea that solvents, a vast spectrum of substances that run from car gasoline to shoe glue and nail polish, are preferred by street kids or poor children. These narcotics know no social class barrier and are the illegal drug that students most experiment within their lives. Brazil revealed itself to be the world champion in the use of solvents, with 15.4% of the young having used them at least once. In second place came Greece with 15%, followed by the United States with 12.4%. “There’s an enormous challenge to overcome, since access to solvents is easy”, says psychiatrist Galduroz. The survey also brought good news. In comparison with previous surveys, for the first time a reduction in the percentage of the young who have already experimented with drugs was registered in capital cities such as Curitiba, Fortaleza, Porto Alegre and Salvador. In the other cities the general tendency was towards stability.

Linked to the Psychobiology Department of the Federal University of Sao Paulo (UNIFESP), the old São Paulo School of Medicine, the Cebrid was established in the middle of the 1980s with the objective of producing scientific studies concerning drug abuse and propagating the results. It consolidated itself thanks to the regularity with which it divulged its survey results, which allowed for the monitoring of behavioral changes. One of its pièce de résistance is the thesis that Brazilians have a distorted image of the drug problem. The researchers have convinced themselves that society overestimates the danger of illegal substances, such as marijuana and cocaine, and plays down the importance of an even greater problem, that of the abuse of legal drugs, such as tobacco and alcohol. The numbers of the wide-ranging national survey concerning the use of drugs, which during 2001 interviewed 8,000 people in 107 Brazilian cities with more than 200,000 inhabitants, shows up this distortion. In the United States, 34.2% of people have already used marijuana and 11.2% cocaine. However, in Brazil the rates are much lower, being 6,9% and 2.3% respectively. But 11.2% of the population is dependent on alcohol and 9% on tobacco. The question of alcohol is measured by other numbers. It is responsible for 80% of the cases of hospital stays for chemical dependency. A study carried out in Salvador showed that 37 % of drivers involved in accidents reported that they had been under the effect of alcoholic drinks.

According to the Cebrid researchers, the distortion resulted, in good measure, from the influence of the anti-drugs policies of the United States and is reflected in the coverage that the press gives to this question. Studies coordinated by the researcher Ana Regina Noto have accompanied what the Brazilian newspapers and magazines publish with respect to drugs. One of these studies, which analyzed 502 articles given out in 1998, showed that the psychotropics most widely covered in headlines were the cigarette (18.2%), the derivatives of coca (9.2%), marijuana (9.2%), alcoholic drinks (8.6%) and anabolic steroids (7.4%). However, solvents, the illegal narcotics most consumed in the country, merited only one article. “The data indicates a disproportionate balance between journalistic focus and epidemiological profile”, says Ana Noto.

Concern with media coverage has a justification. At the end of the 1970s, the country’s press took flight over a supposed explosion in the use of illicit drugs, such as marijuana and cocaine. The first studied with students carried out by the Cebrid, at the end of the decade of the 1980s, showed a very different reality: the consumption of psychotropics prohibited in Brazil was small and stable. However, throughout the 1990s, the number of consumers in fact began to increase, although it was still light years away from North American standards. The number of users of cocaine among students, which was at 0.5% in 1987, passed to 2.0% in 1997. There was also growth in the contingent of marijuana consumers in Brazil, from 2.8% in 1987 to 7.6% in 1997. It is possible that the press has precociously registered a phenomenon that only much later would be captured by statistics. But, say the researchers, it is also possible that the exaggeration of information, influenced by the North American policy to fight drugs, had stimulated the interest for the substances.

If there is a risk of the mirroring of other countries, there is also the challenge of creating prevention strategies in different points of the national territory. Each region of the country suffers a problem in a peculiar manner, as the major national survey released by Cebrid in 2001 revealed. The North and Northeast regions have the highest levels in the country for alcohol and tobacco dependency. But the North was low when looking at banned drugs, while in the Northeast almost one third of the population had already used marijuana, cocaine or tranquilizers, among others. The Southern region concentrated negative records. It brought together the highest percentage in the country for tobacco dependency (12.8%) and the largest contingency of individuals who used marijuana at least once in their life (8.4%) and cocaine (3.6%). In the Southeast, the number of cigarette dependents (8.4%) and marijuana (0.7%) is proportionally the lowest in Brazil, but there were powerful occurrence in the use of cocaine (2.6%) and crack (0,4%). In the Central-West region, a highlight is the opium-based analgesics, experimented by 4% of those interviewed.

The Cebrid has already managed to map out promising routes for prevention. The work, coordinated by the researcher Solange Nappo, interviewed 62 young people living in shantytowns in the city of São Paulo – 30 of them were chemical dependent and 32 had never consumed psychotropics. The objective was to understand what leads an individual to avoid drugs even when they are living in an environment in which access is easy. The research, which resulted in the master’s degree thesis of Zila van der Meer Sanchez, managed to establish a type of ranking of the protection factors. The most important, according to 78% of the non-users, was the influence of a well-structured family, capable of imposing rules of conduct and of giving support at difficult moments. Among the 30 drug users, the data repeated itself: 21 said that a well knit family could have avoided their involvement with psychotropics. In second place, with 75% of the answers, came religion, propagated by different churches. On the other hand, the performance by schools failed. Only 6.7% considered the counseling received from educators to be useful. “School information does not have credibility, since the young person testifies to the consumption of drugs in the playground and sees trafficking at the door of the school”, says Solange Nappo.

The protection factors are the target of detailed investigations. In the case of religion, a study with ex-addicts to understand what made them change the concrete appeal of the narcotic for the immaterial promises of faith, is under way. In the case of the family, there is evidence that a good relationship between parents and children plays a role in prevention. “In a survey with students, the heavy use of alcohol and of other drugs, had been associated to relate to a poor relationship of the youngsters with their parents, and the disharmony between mother and father”, stated psychiatrist Galduroz.

The father and drink
Also it is common that family conflicts have a linkage with the use of narcotics by the parents. With FAPESP’s support, a team from Cebrid analyzed the profile of those involved in cases of domestic violence in 27 cities in the state of São Paulo. It was verified that half of them are associated with the use of alcohol. In 52% of the situations, the aggressor had been under the influence of alcohol. The main victims of violence are women, in general married to the aggressors. There was no variation among the social classes. It happens on the periphery and in the upscale neighborhoods.

“The role of the family does not limit itself to offering information”, suggests psychiatrist Galduroz. “Prevention begins with the example that the father gives. The worst thing that a father can do is to explain to his son that ‘I smoke because I’m a fool’. The child cannot mirror himself on a fool”, he says. According to Galduroz, a recipe does not exist, but many things can be done. “A good strategy is to accustom the child to a healthy way of life, which values outdoor activities. If the child gives importance to breathing pure air, it will be easier for him to keep away from the appeal of the cigarette”, he adds. “A father who arrives home and always has a drink is giving an example that can have effects on the behavior of his son.” As well, there is no denying the pleasure of drugs. “Messages that only deal with harmful effects lose credibility with adolescents”, he says.

For the Cebrid researchers, it is utopia to imagine a world free of narcotics. “Man has always turned back to them to alter his psychic state and to alleviate tension”, says Cebrid’s director and founder, medical doctor Elisaldo Carlini, a retired professor at UNIFESP. “There is no radical solution. But one can’t permit that the problem overflows and turns pathological.” With this as a base, Carlini and his team defend, among other strategies, the so-called policies of damage control, with the polemic offer of syringes to drug users in order to avoid the contamination of AIDS. If the general data strips away the panic, the Cebrid studies show that in some sectors of the population the situation is, yes, worrying. Research into the use of narcotics among street children and adults, carried out in 27 Brazilian State capitals, showed terrifying data: 12.6% had attempted suicide.

Another high-risk group are crack users. Burned in a pipe, the cocaine derivative in the form of a stone produces vapors that are absorbed by the lungs and rapidly reach the brain. A Cebrid study interviewed women from the cities of São Paulo and Sao José do Rio Preto who sell their bodies in order to buy the drug. The price they charge varies according to their need to use crack – in an abstinence crisis, a “program” could be given for R$ 10.00. Some of them accept having sex with the traffickers in exchange for the drug itself. The use of condoms is irregular, which exposes them to unwanted pregnancies and AIDS.

The Cebrid is now beginning to investigate the profile of the crack consumer, ten years after the drug’s arrival in Brazil. It is already known that, in spite of the disintegrating character of the drug, there are users who have escaped from an early death and found strategies for smoking the stones and continue living, in general by way of associations with other narcotics. Naturally there are situations of high risk in the highest sectors of society. The research Murilo Baptista, from Cebrid, is preparing to revisit the university users of ecstasy whom he interviewed during the year 2000 for his master’s degree thesis. At that time, the stimulant pills were restricted to the environment of parties.

The trustworthiness of the data concerning drug use depends on the regularity with which investigations are made. It is common that, over short intervals of time, research gives distinct results, hence the need to take as true data historical tendencies and not isolated results. For methodological reasons, there are differences in the research results that the Cebrid obtains with students and the survey in homes carried out in 107 towns. The students fill in a secret questionnaire. Whereas with the household survey the researchers knock on the door of the people and ask them questions. It is possible that some of them tend to feel uncomfortable when answering.
Another cause of oscillations is the dynamism of the narcotics market. Demand, so say the specialists, is influenced by news of large drug apprehensions and by the appearance of a new fashionable drug. One needs to be attentive to the new. An example is      trihexyphenidyl, sold under the name of Artane, indicated for the treatment of Parkinson’s disease. Some time back, in interviews with users of marijuana and alcohol, references came up about this pill. The Cebrid researchers resolved to investigate.

Thirty-seven users and ex-users who had used the drug at least ten times in their lives were listened to. It was observed that the substance was used in association with others. Trihexyphenidyl brings about hallucinations that are sometimes agreeable, sometimes terrifying. It is cheap and relatively easy to obtain. Around 1% of Brazilians have already tried it.