From illicit drug to psychoactive drug: medicalization in therapeutic itineraries of young people attending a CAPSad in Salvador, Bahia
Vulnerable Populations. Substance-Related Disorders. Psychopharmacology. Medicalization
Illegal drug use is prevalent among young individuals and is often correlated with social vulnerability. Treatment for substance abuse and addiction is usually reliant on multiple psychosocial interventions. Along with possible courses of action, young patients are often referred to psychiatric evaluation and treatment; however, current evidence does not support psychopharmacological management of cannabis or cocaine-related substance use disorders. To access how medicalization impacts young illicit drug users’ treatment choices and outcomes, a qualitative case study was carried out in a public center for psychosocial care of addiction and comorbid disorders in Salvador, Bahia. Semi-structured interviews were conducted with 14 young patients and 7 health professionals. Also, auto-ethnographic field notes were taken by the main researcher, who is also the acting psychiatrist in this healthcare center. Data analysis was based on a holistic model for therapeutic itineraries developed by Trad, L. Treatment choice was shown to be dependent on multiple external factors, including income, family status, access to healthcare facilities and legal issues. Most patients had already begun using psychiatric drugs before starting follow-up in the healthcare center. Medicalization of care in many cases resulted from a substitution of the illicit drug used as a self-care measure by a pharmaceutical treatment. Interviewed subjects also held the belief that psychiatric medication is capable of directly or indirectly reducing drug-seeking behaviors. Cordial interactions with care providers and freedom to choose the course of treatment were key aspects of positive therapeutic outcomes.