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Keywords:

  • Alcohol-related problems;
  • association;
  • national drug policy;
  • substance abuse

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

The Brazilian Association for the Study of Alcohol and other Drugs [Associação Brazileira de Estudos do Álcool e outras Drogas (ABEAD)] is a non-profit entity with the purpose of encouraging discussions and exchanges on advances in the prevention, treatment and research of addition. It currently brings together 840 professionals from different areas, such as Psychiatry, Social Assistance, Nursing, Psychology, Sociology, Law, in addition to community leaders, thus having an innovative and dynamic character. It organises annual national congresses and regional meetings hosting foreign guests. The society has a style that is innovative and dynamic. After more than 20 years of work, ABEAD exerts significant national influence and its members have been invited to participate in the main decisions regarding issues linked to drug abuse in Brazil. Among other achievements, it has contributed to the proposals on prevention and treatment policies and the standardization of the different levels of assistance provided by public health-care. In addition, its members have worked closely with the initiatives made by the government and medical entities in the search for a consensus on the treatment of the different types of dependence, including alcohol dependence and smoking. ABEAD's goal for the future is to broaden its participation in the national drug policy arena and to intensify the work with other medical organizations and with the community.


ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

The Brazilian Association for the Study of Alcohol and other Drugs [Associação Brazileira de Estudos do Álcool e outras Drogas (ABEAD)] is more than a forum bringing together practitioners specializing in the treatment of chemical dependency. Over the past 10 years, it has grown into a domestic and international benchmark as a centre producing scientific knowledge. Its target now is to extend its participation in the public heath policies of Brazil and Latin America more widely.

ABEAD was established during the 1970s in response to the need among practitioners to create a greater dedication in the field to attendance at its congresses and seminars, better understanding of advances in the prevention and treatment of drug addition and of research into the complex relationships between human beings and drugs. From an initial group of no more than 40 people, it has grown to 840 members. It differs from other such organizations in its multi-disciplinary composition, with members ranging from psychiatrists, social workers, nurses, psychologists and lawyers to community leaders. The representation of such a wide variety of perspectives extends understanding of this topic, underpinning a dynamic exchange of experiences that are always up to date.

Thanks to this working philosophy and in close co-operation with other organizations, this association has been firming up its presence through significant participation in decisions on the prevention of drug and alcohol addiction and the treatment of substance users in Brazil. The members of ABEAD believe that the main challenge for the future is to turn its technical prestige into political power. Additionally, they want the association to play a more dynamic role in shaping health-care policies. One of its current battles is to achieve a ban on cigarette advertising on television through a Draft Bill currently under discussion by the Brazilian Congress. Other longer-term projects include guaranteeing a seat for this organization on the National Anti-Drug Council and boosting international exchanges. Until now, this relationship has relied on invitations to leading members of ABEAD linked to universities or hospitals. There is a possibility of ABEAD offering on-the-job training facilities to non-Brazilians at places where its members work.

ABEAD is striving to become even more professional in its capacity to meet the needs of a third world country such as Brazil. For instance, for the past 10 years it has organized the Forum on Chemical Dependence in Companies, held in Rio de Janeiro. In the opinion of its members, a problem lies in the fact that government agencies are unaware of the severity and extent of drug use in Brazil. Calculations (Ramos & Bertollote 1996) indicate that some 20% of Brazilians have problems with alcohol (either abuse or dependence). At least 20–25% of the population smokes cigarettes, mainly young people. Consumption surveys in schools throughout Brazil show that the most commonly used drugs are legal (alcohol and tobacco). Regarding illicit drugs, among girls amphetamines and tranquillizers predominate, while marijuana and cocaine are more common among boys (Galduroz et al. 1997).

The members of ABEAD work on the basis of these data in their daily tasks. They acknowledge that there is a government policy focused on treating patients suffering the consequences of cirrhosis, or undergoing psychotic episodes, but there are no investments in prevention. This is why one of the proposals urged by the association is to include chemical dependency treatment in family programs, as well as community agencies. In a society where a mother fails to vaccinate her children because of alcohol abuse, it is necessary to bring health-care policies closer to reality.

There is a long and difficult path ahead. At the same time as it is struggling to make its voice heard in decisions over medication control and other measures that will help to re-shape precarious health-care services in Brazil, ABEAD is striving to build up closer links with the community through sponsoring events, and is also developing relationships with other medical specialities such as cardiologists and chest physicians, in order to treat smoking, with a similar approach in other areas.

This non-profit organization survives on the annual fees of its members. In practice, this means coping with all the difficulties inherent to a developing country lacking economic stability. However, this does not prevent the association from investing in upgrading its proposals. In 2000 it launched its homepage, as well as a specialized journal (Jornal Brazileiro de Dependências Químicas), and we will deal more fully with both developments later in this paper. The next stage will be rewriting its bylaws in order to provide its management with a more professional approach.

BACKGROUND

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

This association began to put down roots in 1978 at a Congress on Alcoholism held in Argentina. Psychiatrists Sérgio de Paula Ramos (Rio Grande do Sul) and Vicente Antônio de Araújo (São Paulo) attended this event and noted rising interest in this matter. They saw the possibility of setting up a group in Brazil to bring together other practitioners who generally met to exchange information only at non-specialized congresses and seminars. It did not take long for new supporters to line up behind this proposal. At the Congress organized by the Brazilian Psychiatry Association (Associação Brazileira de Psiquiatria) held in October that year, they managed to bring together 20 people interested in these issues. In May of the following year, during the first International Seminar on Alcoholism held at the São Paulo Medical School and organized by Jandira Masur, the embryo of this organization finally emerged, called the Interdisciplinary Group for Studies of Alcohol and Alcoholism (GRINEAA (Grupo Interdisciplinar de Estudos de Álcool e do Alcoolismo)).

Co-ordinated by three practitioners (Sérgio de Paula Ramos, Vicente Antônio de Araújo and Jandira Masur, in addition to José Manoel Bertolote in São Paulo), this group began to disseminate the idea of setting up an entity that would draw together other practitioners interested in these topics, and which could co-ordinate national meetings that drew large audiences. Of the four members of its first board, Bertolote was selected as its Chairman (see Table 1). In April 1980, the co-ordinators of GRINEAA organized the first National Meeting on Alcoholism, attracting 40 specialists from southern Brazil. The dedication and commitment of the participants at this event provided ample leverage for the appearance of the Brazilian Association for Studies of Alcohol and Alcoholism (ABAA (Associação Brazileira de Estudos do Álcool e do Alcoolismo)) in Porto Alegre in 1981.

Table 1.  Chairpersons of ABEAD, 1981–2001.
1981–83José Manoel Bertolote
1983–85Vicente Antonio de Araújo
1985–87Ernani Luz Junior
1987–89Jandira Masur
1989–91Sérgio de Paula Ramos
1991–93Dagoberto Hungria Requião
1993–95Arthur Guerra de Andrade
1995–97Angelo Américo Martinez Campana
1997–99Evaldo Melo de Oliveira
1999–2001João Carlos Dias da Silva

Structured into an entity, is members began to mount congresses at 2-year intervals, interspersed with regional events. During this period, it became clear that it was no longer possible to restrict the discussions only to alcohol, because many practitioners were being called upon to treat dependence on other drugs as well. In 1989, during the Brazilian Congress on Alcoholism held in São Paulo, ABEAA became ABEAD, meeting a demand from its members. Some of its members were already representing it at a national level, and had been appointed by the Brazilian Medical Association to a seat on the National Narcotics Council, former CONFEN, today replaced by the National Anti-drug Bureau.

Since then, ABEAD activities stand out not only through domestic and international congresses, but also through an effective participation in the preparation and implementation of drug use prevention policies and treatment for drug use in Brazil. It ensures that its members are data empowered.

This organization has represented Brazil at specific events in this field. Backed by its track record, ABEAD has helped reduce the stigma relating to chemical dependence. However, this is not enough. If the difficulties in 1978 focused mainly on treating alcoholism, the target now is to get reach the users of other drugs such as cocaine, where use has risen to astronomic levels during the past 30 years. There is also concern over synthetic drugs (United Nations 2000).

ABEAD AS A PART OF NATIONAL POLICY

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

At the invitation of the Brazilian Ministry of Health, in 1981 the members of ABEAD took part in the preparation of Brazil's national alcoholism program (Pronal), which is one of the most complete projects providing assistance for the problem alcoholism of Brazil. This program sets up prevention units offering diagnosis, treatment and rehabilitation facilities. Pigeon-holed since then by the government, it was presented again in 1996 by ABEAD at the Latin American Congress on Public Health in São Paulo, and was widely accepted by the public—indicating that the ideas on the document are still highly up to date.

In 1998, ABEAD worked closely with the Ministry of Health to draw up the draft document for the ‘Standardization in the treatment services for disorders caused by the use of psychoactive substances’. This project is ready, and awaits only the government's decision to put it into practice. Basically, it suggests a detailed evaluation of patients in order to avoid unnecessary hospitalization (Ministry of Health 1999). The idea is to establish home care detoxification services, making good use of the staff at the medical aid posts run by the single health-care system [Sistema Único de Saúde (SUS)] and community health-care agents. This measure would have immediate effects on the population using the government health-care services, by removing patients from psychiatric hospitals and placing them into the public outpatient clinic network. This would reduce the problem of hospital bed shortages in some parts of Brazil, as well as overcoming economic discrimination—in some places, hospitals are open only to those able to underwrite treatment costs.

The implementation of these services depends on training staff and computer back-up. Before being put into practice, the intention is to hold regional forums in order to hear all segments involved (governmental, non-governmental). The Ministry of Health will organize a survey in order to map out the resources available, and register treatment facilities.

A supplementary project was set up in 1999 by ABEAD, jointly with the National Anti-drug Bureau (SENAD) and the Ministry of Health. Called the Standardization of the Psychosocial Treatment Centres (Normatização dos Centros de Atenção Psicossocial) its target is the lay, religious and philanthropic treatment communities. It also stipulates how many beds each institution may have, the distance between them, and other technical standards.

SENAD suggested that the social cost of drug use in Brazil should, for the first time, be calculated and ABEAD became involved in this initiative, helping to implement the pilot project for the Drug Use Household Survey in 1999, in Florianópolis, Santa Catarina (Campana & Neto 1998). This project is an important tool for establishing epidemiological surveillance programs on drug use and determining prevention program targets, while respecting the cultural differences found in the various states of Brazil. This survey requires the collection of data in various settings, ranging from schools through to work-places and the community. Consequently, if a drunk driver has an automobile crash, this accident may be recorded not only as another case of multiple fractures, but also as alcohol abuse or chemical dependence, thus helping to understand the complex universe involving this patient and referring him for treatment.

SENAD published the pilot project run in Florianópolis, but the survey has been interrupted since the new President was appointed to this government agency, meaning that it has not been extended nation-wide. Political uncertainty is being caused by shifts in positions and offices and the centralization of decision-making powers.

Nevertheless, ABEAD has achieved some important progress. In June 2000, ABEAD representatives helped to draw up Brazil's National Anti-drug Policy, working closely with leading specialists in this field who were invited by SENAD. From the standpoint of prevention and treatment, the concepts suggested apply to the Latin American countries in general, and indicate the best ways to work jointly with schools, the church and other institutions.

OTHER TASKS

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

Working closely with the Chemical Dependence Department of the Brazilian Psychiatry Association, basic standards are being defined that will guide decisions on drug treatment in Brazil. Discussions among the members of these two organizations have resulted in three consensual agreements. The first, reached in 1999, is on the treatment of withdrawal symptoms for alcohol. In 2000, during the Brazilian Psychiatry Congress, a consensus was established on treatment for smoking. Discussions are currently under way on reaching a consensus on the treatment of alcoholism.

The actual situations faced by members of ABEAD during their daily task with their patients were used as foundations for the guidelines stipulated in these documents. During the withdrawal period from alcohol, patients' lives are at risk. In Brazilian hospitals there is a certain prejudice against this type of patient, who is often sent afterwards to a psychiatric hospital. However, surveys prove that in Brazil, 51% of traffic accidents involve the use of alcohol; but when these patients arrive at the emergency room they receive emergency treatment and are sent back home, and there are no intervention plans to deal with this dependence. At the very minimum, such people should be advised to attend the Alcoholics Anonymous self-help groups (Oliviera & Melcop 1997).

The consensus suggested that the emergency departments should create a designated health-care post for injured accident victims, ensuring that treatment extends not only to the consequences of alcoholism, but also deals with the chemical dependence itself. The purpose is to deal with the problem as a whole (medication, type of therapeutic intervention and whether or not hospitalization is indicated).

In September 2000, members of ABEAD attended a meeting to organize the Consensus on the Treatment for Smoking proposed by the National Cancer Institute, which is an organization under the aegis of the Brazilian Ministry of Health. Its target is to train health-care practitioners in general, setting up a broad-ranging treatment network. The structure ranges from quick interventions to warning about the risk for smoking in any medical consultation, and avoiding contradictory models, such as physicians who smoke. The aim will also be to refer the patients to government treatment centers, as the recommended medication is too expensive and not available to most of the Brazilian population.

PARTNERSHIPS

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

The work undertaken by ABEAD influenced the establishment of the Chemical Dependence Department on the Brazilian Psychiatry Association during the 1990s. Working with the former Narcotics Department of the Federal Narcotics Council (CONFEN), the first National Survey on Psychoactive Substances Consumption was carried out for the population in general. Agreements have been signed with the United Nations Program for International Drug Control (PNUCID), resulting in the launching of two editions of the ABEAD Magazine on Alcohol and Drugs (Revista da ABEAD Álcool e Drogas) and the publication of bulletins brought out by ABEAD, which are also backed by the Brazilian Ministry of Health.

This pioneer program, ‘Handle your Life with Care’ (Valorização da Vida) prepared by ABEAD, was run in Rio Grande do Sul for 1992–1994, in a partnership with the Ministry of Education, the Maurício Sirotsaky Sobrinho foundation and the State's Education Bureau. Initially, 36 primary and secondary schools were selected in Porto Alegre, the state capital. The previous survey undertaken when the project began indicated that drug consumption in these establishments reached 27.4%. The schools were then divided into two groups, each containing 18 educational institutions, with a total of 40 443 students. The drug use prevention program was implemented in only one of the groups. Without necessarily mentioning the topic of drugs, the students in the selected group were provided with information on the advantages of a healthy life-style, and were offered examples of changing habits.

Thanks to this program, after 2 hours' teaching the experimental schools achieved a drug consumption level 10% below that recorded for the other schools where this campaign was not run, as shown in a follow-up survey carried out in 1994. This project was interrupted for political reasons, due to the change of government.

STANDING ACTIVITIES

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

Seven to eight meetings are organized each year by this entity, with ABEAD congresses held in the alternate years.

In 2000, the ABEAD advisory board authorized sponsorship of a congress by a pharmaceutical laboratory for the first time. Until then, members believed that it would be contradictory to agree to sponsorship of professional events by the same pharmaceutical industry that turns out the products that create chemical dependency. This shift in thinking was prompted by the launch of medications used to combat smoking and alcoholism. The board agreed to this sponsorship only for these specific medications. The last national conference, which took place in September 2001 in the city of Gramado in the state of Rio Grande do Sul, had about 700 participants from various countries and the following guest speakers: Dr Jonathan Chick (UK), Dr Brian Rush (Canada), Dr Daniel Seijas (Chile) and Dr Raul Caetano (USA).

PUBLICATIONS

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

In order to publicize the work of ABEAD, the Brazilian Journal on Chemical Dependence (Jornal Brazileiro de Dependências Químicas) was launched in October 2000. In magazine format, its 48 pages feature refereed articles that meet international scientific requirements. As a 6-monthly periodical, its first edition had a print run of 2000 copies. It is edited by psychiatrist Sérgio Nicastri, from the Institute of Psychiatry, at the São Paulo Federal University and Izabel Martins.

Members receive the ABEAD bulletin (Boletim da ABEAD) on a quarterly basis. The eight-page bulletin contains brief papers, a calendar of events and other information.

On its homepage (http://www.abead.com.br), ABEAD runs a discussion forum. The intention is to make an on-line version of the bulletin available shortly, together with articles published by the magazine. Its members will be able to access these texts through a password. This homepage will also offer links to other drug-related sites. The homepage also contains a list of names, professions and addresses of the members, making it easier to exchange experiences and refer patients, when necessary.

CONTACT INFORMATION

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES

In 2000, ABEAD had 840 registered members. It is open to anyone wishing to join, with an annual fee of R$110 (around US$55.00). All members have a vote to elect the chairman, but there is a trial period of 2 years after registration before this vote is valid.

The national secretariat of ABEAD operates in Porto Alegre, at the following address:

Avenida Taquara, 595, sala 402

CEO: 90.460–210, Porto Alegre

Rio Grande do Sul, Brazil.

The travelling secretariat is located at the following address:

Rua Dinis Cordeiro, 19

Botafogo, Rio de Janeiro

RJ, CEP: 22.281–100, Brazil.

Contact by Tel/Fax: (55 21) 539 7941

REFERENCES

  1. Top of page
  2. ABSTRACT
  3. ABEAD: AN ATTEMPT TO TURN TECHNICAL PRESTIGE INTO POLITICAL POWER
  4. BACKGROUND
  5. ABEAD AS A PART OF NATIONAL POLICY
  6. OTHER TASKS
  7. PARTNERSHIPS
  8. STANDING ACTIVITIES
  9. PUBLICATIONS
  10. CONTACT INFORMATION
  11. REFERENCES
  • Campana, A. M. & Neto, F. B. (1998) I Levantamento Nacional Sobre o Consumo de Substâncias Psicoativas na População Geral [1st National Survey on Psychoactive Drugs Consumption in the General Populatio]. Brazil: Florianopolis.
  • Galduróz, J. C., Noto, A. R., Carlini, E. A. (1997) IV Levantamento Sobre o Uso de Drogas entre Estudantes de 1st e 2nd Graus em 10 Capitais Brasilieras [IVth Survey on Drug Use Among Elementary and High School Students in 10 Brazilian Citie]. São Paulo: Centro Brasiliero de Informações Sobre Drogas Psicotrópicas [Brazilian Information Center on Psychotropic Drugs (CEBRID)], Federal University of São Paulo, School of Medicine.
  • Ministry of Health (1999) Proposta de Normalização dos Serviços de Atenção à Transtornos por Uso de Substâncias Psicoativas [Proposal of Normalization of the Care Services for Disorders caused by Psychoactive Drug Use]. Brasilia: Ministry of Health.
  • Oliviera, E. M. & 7 Melcop, A. G. (1997) Impacto do uso de Álcool e Outras Drogas em Vítimas de Acidente de Trânsito [The Impact of the Use of Alcohol and Other Drugs on the Victims of Traffic Accidents]. Brasilia: ABDETRAN.
  • Ramos, S. P. & Bertollote, J. M. (1996) Alcoolismo Hoje [Alcoholism Today]. Porto Alegre: Artes Medicas.
  • United Nations (2000) Report from the United Nations Programme for the International Control of Drugs. Geneva: World Health Organization.