Chasing the Scream
Page 29
In the months that followed, there was an eruption of debates and demonstrations and an unleashing of all the pent-up hopes of decades gone by—a festival of democracy. It was as though the dams his father built all those years had burst, all at once.
And so Portugal was learning a lesson that would flood into this story. Nothing has to stay the same. If a dogma is not working, no matter how strong and immovable it seems, you can cast it aside it and start anew. Two and a half decades later, at the start of the twenty-first century, João helped lead Portugal to do something remarkable, and unprecedented. “It is,” he tells me when we meet in 2013, the “result of all the processes that began in ’74,” the day he saw flowers overwhelm a tyranny.
The Algarve stumbled from the sealed-off silence of the dictatorship into a head-banging 24/7 beach party. The southern shores of Portugal are dreamscapes of yellow sand, yellow sun, and blue waters, but they were effectively shut away from the world’s tourists by the old regime for fifty years. By the 1980s, however, tourists from across Europe were cooking themselves by day and downing vodka by night on its shores. João was a family doctor by then, and he saw that for a few months of the year, all the locals made pillows of cash and joyfully joined in the sozzled international conga line of tourists, making it the high season in every sense. Then the tourists would go home, and the Algarve would be left empty and jobless.
It created a bipolar region, where collective mania was followed by collective depression. “Of course I saw many people using ecstasy, cocaine, and so on—party drugs—but the big problems of addiction,” he explains, “were through heroin.” It was by trying to solve this problem that João may have stumbled onto another part of the solution to drug prohibition. This is his story as it was told to me in 2013 by João himself, his colleagues in the Portuguese drug treatment sector, several addicts he has treated, and the news reports about him.
Portugal had, by the 1980s, one of the worst heroin addiction problems in the world. One day, a young musician and poet named Vitor came into João’s office. He was “a very intelligent guy,” João recalls, “very sensitive, [and] we had big discussions.” The young man believed that drugs unleashed his potential to create art. João disagreed, and over time, in the midst of this great national spike in heroin use, he successfully persuaded Vitor to lay down the needle, and he watched him achieve a “wonderful recovery” that served as an example to the people around him.
And then, two years later, Vitor came back to João with a mysterious illness. He died at the age of twenty-three. “It was very tragic,” João tells me. “Yesterday, his mother called me, just to wish [me] a good season. Every year, before Christmas, his mother calls me, and she starts crying.”
Portugal had virtually no experience with these drugs before this. The 1960s were canceled here5 by the dictatorship, so the country was starting with a blank slate on drug policy. While the use of drugs like cannabis and cocaine was low by international standards, the use of heroin6 was off the charts and rising. The government was desperate to respond—and the international prohibitionist playbook was waiting for them. It offered a clear recipe: criminalization, crackdowns, punishment. Portugal adopted it all enthusiastically.
But, to their puzzlement, the problem just kept getting worse. João was seeing more and more heroin addicts in his practice, and more and more AIDS cases. “Heroin use started among marginalized people but then it came to middle classes and even high classes,” he says. “At that time it was almost impossible to find one Portuguese family that had no problems inside the family or in the close neighborhood.” By the early 1990s,7 fully one in one hundred people in the country were addicted to smack.
People were scared to come forward for help, even when medical services were offered. Often, addicts stumbled into João’s clinic in a desperate state but refused to give their last names or any contact information. They knew there was a war on, and they were the enemy.
“We were out of options,”8 João told one journalist about this period. “We were spending millions and getting nowhere.” So he set up the first drug treatment center in the Algarve’s history, based on the belief that addicts need help, not contempt. His teams treated hundreds of patients, and they began to observe what works, and what doesn’t. So in 1997, he was put in charge of the treatment of addicts for the whole country, and in 1999, he was asked by the government to serve on an independent commission made up of nine doctors and judges, with an impartial academic researcher as the chair, to draw up a comprehensive plan to really deal with the drug problem.
They had free rein to think this problem through, starting from scratch. This meant they could acknowledge some fairly obvious facts that had long been ignored in most countries. The first was that the overwhelming majority of adult drug users had no problem: they used for pleasure and did not become addicts. The authorities, they decided, need not concern themselves with these people, except to offer safety advice. The second point was that when it came to addicts, the country had already tried, João says, the “terroristic” approach pioneered by Anslinger: threaten drug addicts and impose severe pain on them if they continue. In his experience at his clinic, this was “the best way to make them wish to keep using drugs. To deal with it by chaining, by humiliating—it’s the best way to make them angry with the system, to not to wish to be normal.”
They wanted instead to look at the problem in a more sophisticated way. João had seen from all his patients that the addicted person “is always divided between the . . . desire to use drugs, and the desire to stop.” Yet the prohibitionist system keeps kicking the recovering addict back to the ground, making it harder for the part of him that wants to walk away from drugs. “It was very frustrating,” he says, to see a patient fight really hard to get clean only to hear him say: “What kind of life am I going to have now? I am unprepared, I have no place to go.”
So he and his colleagues proposed to build a system based on a radically different notion: they should offer addicts “the possibility of having a new life,” and give them “pleasure” instead of pain. His goal as a doctor was always “trying to identify what happened in the past” of an addict that made them find everyday life unbearable, and to help them overcome it by offering compassion and helping them to build a good life as an alternative. Now they were asking: If this is the goal of all good doctors, why can’t it be the goal of government policy?
So when the panel reported, it made recommendations based on these insights. It said that “drug users should be treated9 as full members of society instead of cast out as criminals or other pariahs.” Instead of “striv[ing] toward an unachievable perfection such as zero drug use,” they would decriminalize all drugs. Choosing to put a chemical into your body should not be a crime, and being addicted should not be a crime. Instead, all the money spent on arresting, trying, and punishing addicts should be transferred to educating kids and helping addicts to recover.
To the astonishment of many people, the Portuguese parliament debated it thoroughly. There was a very senior figure in the government who had a brother addicted to heroin,10 João took him to visit many places across Europe where drug addicts were treated less cruelly. That politician became one of the great champions of this new approach. The sheer scale of the problem in Portugal meant that it was easier to persuade the public than many people had expected. As João says: “The feeling that a drug addict is a sick person rather than a criminal was already present in the society. People knew—‘well, my son is a good guy, he’s not a criminal, he’s someone who needs help.’ ”
So in 2001, in Portugal, the persecution of drug users and addicts officially ended. The new law stipulated that recreational drug users “should, above all,11 not be labeled or marginalized,” and addicts should be approached by the state exclusively “to encourage him or her to seek treatment.” It was no longer a crime to possess enough drugs for ten days’ personal use.
It’s important to understand that while it was no l
onger illegal to use and possess drugs, it was not legal to sell them. To legalize and regulate their sale would have required Portugal to become the first country ever to renounce the UN conventions authored by Anslinger. That is a step that could have triggered sanctions and crackdowns from other countries. This meant that the control of drug trade was still in the hands of armed criminal gangs, but the panel and the parliament felt they were being as bold as they could: no other country had gone this far since the start of drug prohibition.
There were widespread predictions, from parts of the Portuguese right and across the world, that this would trigger a catastrophe.12 The chief of the Lisbon Drugs Squad, João Figueira, believed there would be “an explosion of consumption [where] lots of people start consuming, and then we lose control of the situation.” In the writings of prohibitionists everywhere at this time, there was a clear tone of “Just you wait and see.”
In his office, Goulao told me there were two dimensions to Portugal’s drug revolution. The panel didn’t simply lift the legal penalties and leave people to it. They took the big, lumbering machinery of the drug war and turned it into an equally big, active machine to establish a drug peace. “The big effect of decriminalization,” he said, “was to make it possible to develop all the other policies.” In the United States, 90 percent of the money spent on drug policy goes to policing and punishment, with 10 percent going to treatment and prevention. In Portugal, the ratio13 is the exact opposite. Back on Chino’s block in Brownsville, Brooklyn, the state spends one million dollars14 for every five people it arrests and convicts of midlevel drug offenses: that’s what it took to get the Souls of Mischief off the streets for a while. What João did in Portugal was to use all that money in a very different way.
He believed that if you15 removed the stigma and shame caused by making addiction a crime, it would be possible to invite addicts into a welcoming web of care and treatment and support. I wanted that to be true. But was it?
Opposite a Santander bank on an overcast day, I find a bare unmarked building, and in one of its hallways, a seventeen-year-old boy with spiky hair, swaddled in a big parka, is waiting. He has just been interviewed by a psychologist for an hour, and now Nuno Capaz—a tall sociologist in his midthirties—is calling him into a small conference room.
The system built by João and his colleagues had a distinction at its heart, between the 90 percent of drug users who have no problem and should be left alone, and the 10 percent who are addicts and need help. They had to figure out a mechanism to sift the addicts from the users. This small room, and the dozens like it across the country, is the solution. It is called the Dissuasion Commission. The police don’t go looking for drug users anymore, but if they stumble across you, they will write you a ticket that requires you to come here the next day. The job of the Dissuasion Commission16 is only to figure out whether you have a drug problem. You can be honest with them, because nothing you say or do here will ever get you a criminal record.
If the interview with the psychologist in the next room reveals that you are a drug user who doesn’t have a problem, they will bring you in here, warn you about the risks, tell you how to make your use as safe as possible—don’t use alone, for example, in case you have a bad reaction—and send you on your way.
Nuno, who oversees the informal hearings, stresses that the vast majority of the people he sees here are using drugs “just because they like it. They do not have a problem with it, they just do it because it makes them feel good. In those cases they don’t actually need treatment [or] imprisonment. They might eventually need to be careful, but they don’t need a medical doctor or a jailer or a legal intervention.” He tells me, for example, about a typical guy who worked in a bar and used cocaine on the first Saturday of every month without fail—and never on any other day. He loved it; and because he loved it he knew he had to restrict his use tightly so he was able to resist temptation the rest of the time. Nuno tells him: “Be careful. Stick with it. Just do it once a month, in the company of some people who are not doing it, because you might have a seizure.” This kind of advice is the end of your contact with the state for nine out of ten people.
I watch as Nuno has a twenty-minute conversation with the teenage boy in his parka, who was found smoking cannabis on the street. Nuno explains that it’s bad for your memory and concentration, and that you need both to do well in your studies. The boy agrees, asks for some literature that explains more, and leaves. That’s it.
“In a lot of cases of underage people,” Nuno tells me once the boy is gone, “what we do is try to reduce the anxiety of the parents. Because the kid was caught with 0.3 grams of hashish, we have parents going, ‘He’s going to be a drug addict! He’s going to ruin the family!’ We say—‘Let’s calm down a bit . . . In the majority of cases he will eventually quit using hashish and he will not use anything else [or] have any psychological and physical problems from it, so let’s not make a big deal.’ . . . Especially with minors, we have to work more on the parents than on the kid, because the kid is much more well-informed than the parents.”
Nuno continues, “Unless you are very, very unlucky or unless you are trying to be caught,” as a nonproblematic user, you won’t come back to the Dissuasion Commission, because the police “will not stop you in the street out of nowhere and say, ‘Let me see what you have in your pockets.’ ” The drug users get picked up only when they are using blatantly in public, or when the drugs are found by chance, like in a search of suspects after a street fight. “It’ll be very difficult,” he says, “for you to be caught” twice. If you are, though, the Commission can level small fines—80 euros is the norm, making it “the most expensive joint the guy ever had, but you could say it’s a fairly symbolic thing,” Nuno says. If, however, the interview reveals that you are using your drugs dangerously—by, say, sharing needles—they will direct you toward the needle exchanges and other places that will make you safer from disease and death.
When it comes to the 10 percent who are addicts, Nuno’s job is to offer “information without judgment” and ferry you toward the services that are there to keep you alive and get you well. “We can’t oblige anyone to do anything” when it comes to treatment, he says—but when they are ready for help, it is there right away. “If the person shows up at ten o’clock in the morning,” he says, “we can schedule them for one o’clock in the afternoon at the treatment facility in order for them to start the analysis.”
From Nuno’s office, any addict who wants to stop17 will be booked, for free, into the Taipas Treatment Center. It is at the edge of a large pink hospital, on yet another hill.
Six addicts are lying on a mat in a gym, being gently massaged. Some have their eyes closed; some are looking sideways, with a little smile. These massages help them to cope with the withdrawal pains, one of the nurses tells me, but it has a more important function. It helps them learn how to calm down without a chemical cocktail, often for the first time.
The program here, I am told, is built on João’s belief that “using drugs is only a symptom of some suffering, and we have to reach the reasons” that make addicts want to be out of their heads much of the time. “You can stop using drugs for a while, but if you don’t solve the problems you have in your mind, things will come back. We have to work [on] the trauma in your life, and only then can you change the way you deal with it.”
So this institution is here,18 as he puts it, to help addicts “to increase their insight, to analyze themselves—helping them to understand themselves [and] the way they react.” Over your year and a half being treated here for addiction, the team will try to build a safe, trusting environment where you can do something you have been running away from for years—express your emotions, and tell your story truthfully.
This often starts with basic steps. The recovering addicts play a game based on Pictionary, where they have to make a face that expresses an emotion, such as anger or sadness. At first, many of them refuse: it is too frightening. They can�
��t bear to let these emotions show, even in a game, for a moment. This is one reason why they have needed to be intoxicated for so long: to escape the terror and lack of control that comes with emotions like these.
In another game, they have to let themselves fall backward, knowing the group behind them will catch them as they fall. The addicts find this inconceivable, and they often refuse. They can’t trust anyone—but slowly, over time, they learn here that these emotions can be explored, without the need to be chemically numbed. To João, this is what recovery means.
I watch them playing these childlike games, trying to learn how to feel, and I think of the women I left behind at Tent City and in prisons across the United States, who are learning nothing except how to cut off their feelings. I try to picture Chino’s mother here, learning to figure out how she feels, at last.
But this is—I was going to discover—only the first layer of support for addicts in Portugal, and not the most important.
João believes that addiction is an expression of despair, and the best way to deal with despair is to offer a better life, where the addict doesn’t feel the need to anesthetize herself anymore. Giving rewards, rather than making threats, is the path out. Congratulate them. Give them options. Help them build a life.
That was his reasoning behind the second and most important phase of treatment for addicts in Portugal. Once you take those first courageous steps to Taipas or a center like it, the government will prioritize getting you a job with a decent wage, away from the world where you used drugs. “They want to be a part of the society,” he tells me. “We can’t [tell] them to behave as a normal citizen and deprive them . . . of a role in society: having a job, having work, having a salary.” His aim is to give them something to lose.