Da filantropia rumo à política pública: uma genealogia das comunidades terapêuticas para dependentes de drogas psicoativas

Abstract

Social problems related to alcohol and other drugs, notably crack have gained prominence in recent years, mainly due to the situation experienced in cities like São Paulo and Rio de Janeiro. The Ministry of Health is responsible for the regulation of the healthcare actions toward users and drug addicts. However, there has been a historical gap in the public health approach to drug policies, leaving this issue to the institutions of justice and public safety organizations or philanthropic and religious associations, among them the therapeutic communities (TCs), which have become important entities of the third sector. Thus, this research analyzed the current situation of the Brazilian public policies for the treatment of drug addicts, after the Brazilian mental health reform. In order to reach this goal, specific objectives were formulated: to describe the TCs emergence process, analyzing its performance from a political, social, economic and health point of view over the years; discuss about the public policies adopted by the federal government as well as by the state government of Minas Gerais regarding the drug abuse, emphasizing policies directed to their treatment; analyze the programs "Crack, é possível vencer" from the Federal Government and the State Government program called “Aliança pela Vida” based on the guidelines of the Brazilian mental health reform; find the focus of the local researches and theses having as object of study the TCs. This is a documentary analysis of such programs for the year 2014, based on the guidelines of the Brazilian mental health reform and the criteria established by RDC No. 29/2011, the National Health Surveillance Agency (NHSA). This is a descriptive research, in addition to performing the historical reconstruction of the researched documents. It was intended, with this methodological approach, to understand how the drug issue, in particular the treatment of addicts, has become a problem that required state intervention through public policies. As well as to examine how public policies are being implemented, seeking to understand the role of TCs within the logic of federal and state public policies, from the two programs. The TCs are precariously placed on the health care network, since they can be searched directly by the addict, without attempting other resources, as stipulated by the guidelines of the Brazilian mental health reform, which sees the hospitalization as a last resource. There is certainly a clear resistance to regulation of TCs, making it necessary, therefore, to broaden the discussions on this issue, since the services are being offered and used by people who are already fragile and socially outcast. The effectiveness of TCs should be questioned, evaluated and understood. We can no longer stay in superficial and biased analysis that disqualifies the services that have been offered for several years and which have the recognition of the population. On the other hand, it is necessary to verify the allegations of human rights violations against these institutions.