From the Secretariat for Addictions to the experiences of Rome and New York

What is it like to hold a position as important as that of National Secretary for Addictions, and what political support have you received?

Holding a public office at this moment is something rather atypical. In general, officials have visibility over time. I think that we, on the contrary, have an unpredictability of time; faced with that, there are two things to do: one is to despair, the other is to act as if this independent variable did not occupy the place it really occupies. Every day we have some uncertainty, there are nights when one doesn’t sleep thinking about what one should have done. This administration may last a few more weeks, or last, as is actually proposed and as the most optimistic among us think, until the next governmental transition, without interruption.

Paradoxically, the political support is massive. I was proposed by Eduardo Amadeo, who is one of the most representative figures of a position that is socially aware of the country’s problems and a bearer of some of the solutions that must be brought to them. With his team, he covers the Ministry of Social Development, the Culture sector and our Secretariat.

Tell me about this “landing”: was it easy?

In reality, one lands in enemy territory, in the sense that there is a whole conservative structure of management positions. The President is quite aware of this and asked me: “What happened with the geological layers of political appointees?” The question seemed intelligent to me, because one sees that Duhalde recognizes that, in all these structures of the public administration, we have a common problem: the residual layers of successive administrations. During this landing, we managed to terminate the functions of all those we could part with, that is, contract staff and scholarship holders, which left us a certain number of positions to fill, and we brought in between thirty and forty people chosen by us. There remains a group of people who opposed my arrival at the Secretariat, through fraudulent denunciations and those things that happen in this country.

What had happened last year was repeated, with the same materials, through the circulation of a defamatory e-mail.

The President, consulted on the matter by Amadeo, said that he did not read anonymous letters, which seemed to me a very dignified answer. Moreover, his support has been somewhere between the humorous and the effective. On the humorous side, the day I was sworn in before the President at the presidential residence, he was looking at the budget and, when I came in, he said to me: “Nine million three hundred, that won’t be enough for you; now, if you want to swear, swear.” Which also implies a certain recognition that the situation is not a privileged one. It’s not that we are administering misery either, but resources are extremely limited and may shrink further.

How does the Secretariat work today?

We are running an administration by bringing to it a few decades, I said three but it’s four, a few decades of experience in the treatment of serious psychiatric pathology, in the preventive approach to addictions and in the therapeutic approach to addictions in day hospitals, which are three of the things I have done over a history that has at least the merit of duration. For many years, I devoted myself to psychosis and to the transformation of asylum structures, which have demonstrated that they have a power of conservation superior to mine. The same asylum structures survive with different people but with the same criteria: mistreatment of patients, civil condemnation, conversion of hospitalization for psychosis into the loss of what could have been the capacity for recovery. We are forty or fifty years behind in institutional psychiatry, except in a few places, such as certain psychiatric emergency services at the Borda or the Moyano, which really function as model units overall.

From the overall perspective of the country, we still have some 30,000 people hospitalized and, for these 30,000 people, who represent one per thousand of the country’s population, there is no public policy. There is no longer even a National Directorate of Mental Health. Moreover, we have also had the misfortune of the incompetence of certain officials of the City of Buenos Aires.

It seems to me that the administration of public policies in recent years has been poor. There is a photo I was remembering today: Graciela Fernández Meijide in front of the Obelisk and, behind her back, a kid sniffing glue. I think we have all seen it, and that was the reality. Social policies were turned away from, there was no management at the Ministry of Social Development, there was no management at the Secretariat for Addictions for many years, and there was no management in what interests us, which is mental health.

And what is to be done, faced with the panorama you describe?

The appointment of an official like Soriano, who is taking over the field of mental health for the City of Buenos Aires, is a good omen. He is an intelligent, hard-working professional, very committed to care and to training.

Where does one begin? I met with competent professionals, old friends, Camilo Verruno for example, head of the care service at the Lanús hospital, a very committed person, and with various people who recognize themselves as having taken part in something that was once called “the struggle for public mental health,” that is, conceiving mental health as a State policy, as a public policy.

When we speak of State policies, we notice that there is something we state backwards: the state of politics. And since the state of politics is what it is, State policies are what they are. I mean that the deterioration of the political class in Argentina has contributed to public policies not being implemented. Not even thought.

For the first time in many years, we have a Minister of Public Health, Ginés, who is a public health specialist, who understands what he is doing, what he wants to do, and who also knows that he will be able to carry some things through and others not.

Tell me about some proposals under way.

Our situation is exceptional: with a limited budget, we manage to bring together people who want to work. If we are allowed to, we are going to have a certain impact and set in motion a series of actions designed over one year. Part of these actions consists in placing the Secretariat within a unification of the alcohol problem inside the field of drugs. I think that ignorance, or ill will, or certain interests, have meant that neither psychotropic drugs nor alcohol have been included among the components of addictive disorders, when in reality they are fundamental components of them. Why don’t advertising campaigns touch on the subject? Because the winegrowers and the laboratories would get angry. How can we ask ourselves whether the laboratories and the winegrowers are going to get angry, when in reality what we are doing is creating conditions that favor the chemical destruction of our adolescent children’s brains? Integrating alcohol into drug policies is one of the fundamental things we want to develop.

Another thing is to pay attention to the abuse of psychotropic drugs. Breaking dependence on psychotropics is very often more complicated than breaking dependence on substances like cocaine. If a patient is ready to stop cocaine, he can stop it, and what he will have is a certain oscillation of his mood for a while, which can be medicated in some cases, handled in psychotherapy in others, but which does not cause him disorders, because there is no withdrawal syndrome. Cocaine has no withdrawal syndrome; whoever says otherwise has seen something else, if we call withdrawal syndrome what Jellinek refers to for alcoholism, that is, the inability to abstain, the inability to stop and the inability to eliminate consumption. The most advanced cocaine addicts demonstrate that they can cut off consumption overnight, provided they are given a space where they can be contained, eliminate anxiety and work through other things.

Moreover, we are fortunate not to have opiates, even though we could have them, because Latin American geopolitical conditions tend to unify consumption. Colombia specializes in processing the drug that arrives in the form of base paste from Bolivia and Peru and passes through Colombian laboratories. They specialize in transforming the coca leaf, via base paste, into the final product, the hydrochloride, and, lately, they are planting much more to produce heroin; they produce a heroin of fairly good quality that transits through Argentina. The other day, three kilos were seized in Mendoza, which constitutes a significant shipment; the person who transports that gets 2,000 dollars, plus travel expenses, accommodation, etc. It’s very tempting. On the other hand, we have producing enterprises. Drug traffickers are not gentlemen who grow shrubs because they have a back garden, nor kids who put little marijuana plants in pots, that is harmless. These gentlemen free up territories on the basis of agreements of convenience between a guerrilla guided by its ideological principles and a drug trade guided by its economic interests. One might think that is incompatible; I always thought the guerrilla would never protect the cocaine hydrochloride processing laboratories. Today, it is obvious that the Colombian guerrilla groups are determined to protect the laboratories, because they draw profits from the persistence of the drug traffickers, their laboratories, etc. Afghanistan, for example, is the world’s leading producer of heroin, and the last war took place in Afghanistan; I don’t think the presence of drugs as the Afghans’ main manufactured product is unrelated to that circumstance; someone studying geopolitics could see what correlations there are, why it started, when it started, etc. Many countries produce heroin quotas regulated by the International Narcotics Control Board, for the preparation of medicines.

The role of religious institutions in drug addiction

What role do religion and its institutions play in this field?

The number of communities run by priests in Colombia and Ecuador is surprising. The role of social commitment of the Catholic Church in Italy is striking. I worked at the CeIS in Rome from 1990 to 1994, in training and prevention, and, of the sixty program directors I worked with, more than forty were priests. The Italian priest has an insertion in social reality that here would have gotten him labeled a Third-Worldist. These are people who go into the shantytown and work with the drug addict, receive him for an interview, prepare themselves to know how to conduct an interview, how to conduct a family interview, how to help him, how to motivate him to start treatment, and then they develop a therapeutic system.

Curiously, that is precisely what happened in New York and in Rome. The two figures who started this are Mario Picchi and Monsignor O’Brien. The first is a very well-known priest in Rome, who advised several popes and refused to make a career as a cardinal. His concrete task was to create the Italian Center of Solidarity, with which Argentina has had a great many relations, because eighteen people trained there at the outset, who then ran therapeutic communities in 1988. They trained as practitioners in Italy and came back here. Of that group of people who came back and created therapeutic communities, many still survive and are among the best known.

On the other side, in New York, there is Monsignor O’Brien, who is still president of the World Federation of Therapeutic Communities. He is eighty-two years old and he managed to organize in his church daily meetings of addicts who wanted to move to abstinence and who slept in the seminary, which had emptied out. As you know, the Catholic Church has seen its number of priests and nuns decline for decades; the place where priests were trained was therefore left free, and it was precisely there that this priest housed the addicts. As a result, he was arrested for “producing addicts,” according to the press. They published this: “Monsignor O’Brien was arrested because he was housing addicts whom he was feeding,” as if to say he was feeding them drugs. In reality, he was feeding them soup, hot food, he was giving them shelter. A scandal occurred very similar to the one that happened to Mario Picchi in Rome. Thus, Mario Picchi in Rome was doing something very similar to what Monsignor O’Brien was doing in New York. Through those phenomena of the evolution of knowledge that occur simultaneously, they were doing the same thing, at the same time. They were trying to understand what Maxwell Jones, whom we knew from social psychiatry, brought them: what he brought to the treatment of addicts, and how the addict recovers when he lives in community, and how the community must be as horizontal as possible.

After the media scandal, the two priests remained in prison until responsible newspapers such as La Repubblica in Rome, which is the newspaper of Christian Democracy, and the New York Times in the United States, took up the matter and demonstrated that it was a total lie, that the two clergymen were helping addicts and that there was no public policy for addicts, which demonstrated a flaw in the health system. The same thing we would discover shortly afterwards in Argentina. The clergymen then went from denigration to the leading role: when Monsignor O’Brien regained his freedom, one of those things that happen in the United States occurred. A gentleman said to him: “I think what you are doing is very good. I have a hotel, here, on 40th Street, a block and a half from Fifth Avenue, would that suit you?” “That would be wonderful.” “Well, I’ll leave it to you, I have five or six hotels, I don’t need this one.” The hotel still exists and it is the headquarters of the World Federation of Therapeutic Communities.

The CeIS in Rome is more like what we do: it has to do with the family, with family interventions, and it is precisely an Argentine, Francisco Mele, who has been there for quite a few years, who coordinates the family therapy work. They included family therapy in treatments well before the North Americans, but the populations they work with are also different. In a therapy group in New York, one possible participant could be someone who cut his mother’s throat because she wouldn’t give him the piggy bank, and who has been injecting heroin for ten years; another would be someone who prostitutes herself because the need for crack is so intense that she cannot do otherwise than go and perform fellatio to get it. There, crack is packaged in the form of ampoules that are broken and inhaled.

But these programs are not governmental.

What happened is that these programs began to experience great development, great influence in the world, because world public health left aside the problem of addictions, as it had previously left aside alcoholism, because no one knows what to do.

The alcoholic arrives at the hospital and is treated if he is drunk, he is hydrated, he recovers and is sent home; it doesn’t occur to anyone to say: well, maybe this time, when you got drunk, you had a particular worry, or you lost your job, or one of your children died, or whatever, that is, to inquire into the cause of that state of drunkenness. If this is worked through at the level of thought, it can be worked through therapeutically. Both the one who takes drugs and the one who responds to it from the side of care obey a system of interruption of thought: the addict interrupts thought through the psychoactive action of what he ingests, because something makes him so desperate that he cannot tolerate what he is thinking; and in order not to convert it into thought, he transforms it into sensation, euphoria, excitement, hallucination or whatever else, and he thus establishes a kind of recreation of the imagination, so that thought cannot function.

Guidelines for an effective therapeutic system

What should an effective therapeutic system do?

What it should set out to do is to create the possibility of generating thought. Whatever we do, what we must create for an addict who wants to stop being one is the possibility of converting his despair into thought. If we managed to do that, the program doesn’t matter, as long as it is respectful and effective. Effectiveness would be being able to convert the desire to remain saturated with images, sensoriality, excitement, loss of control, into a process that allows him to think, to reflect. If we can work through sensation by means of thought, the person begins to get depressed and, from the depression, begins to realize that there is a distance from the drug, that the incorporated drug is a drug he can also move away from, and that this moving away, in the best case, can allow him (it is not always the case) to recover experiences of his own, personal ones, which are his individual wealth and which must be saved. This is the process of individuation that the person who has been an addict for a long time has the right to go through, and what we must have is a therapeutic space so that this can happen.

In Italy, this is done through youth aggregation centers, which are the centers for street youth. I have seen the famous piazzas, which are concrete squares; we think of them in vegetal terms and they in mineral terms. The piazza is the meeting place of Italian adolescents, differentiated by age group: there is the one for twelve-to-fourteen-year-olds, the one for fourteen-to-sixteen-year-olds, the one for seventeen-to-nineteen-year-olds, and they do not mix on the same piazza. The practitioner we train, the street worker, must know what the values are, what the culture is, what the expectations, needs and problems of the different age groups are; adolescence at twelve is one thing, at sixteen or seventeen another…

On the transformation of drugs, their growing availability and the changing meaning of their use over time

Do drugs change, do they become more powerful?

Today, marijuana crops are genetically manipulated to produce a marijuana twenty times more potent than the one we knew in the 1960s, that is, it contains twenty times more THC, tetrahydrocannabinol. The drug contained in what is smoked is like going from Coca-Cola to whisky without realizing it. What do we notice? That the effect is different; but not only is the effect different, the stimulus that produces this effect in the brain is twenty times more powerful.

The cocaine that arrives here is of a good level of purity, but as in everything social classes weigh in; so, for example, in the shantytowns cocaine is sold mixed with crushed neon tube. They grind it and mix it with the cocaine powder. Amphetamine is added, and whoever buys that for 5 pesos thinks he is buying cocaine. He may notice that his nose bleeds more than usual, or that he then has a toxic effect, or that there is amphetamine in it. But whoever doesn’t know much about it thinks that the euphoric effect of the amphetamine comes from the cocaine, and he is wrong, of course. They are sold a cheaper product as if it were more expensive, because up to 5 pesos, it’s profit.

On another note, I went to Gualeguaychú and, during a meeting with second-year students of a secondary school, they asked me to run a workshop with them. So, being a bit of a philosopher, I think: “Gualeguaychú, deep in the provinces, here there must be… Jewish gauchos, it must be an ancestral culture, they do the carnival, but everything else must be very traditional, these must be people who drink mate on their doorstep, who watch the neighbors go by…” So, just in case, I naively ask them: “Do you feel close to the drug issue?” And one of them, very small, twelve years old, answers me: “Well, quite close: here, twenty meters away, at the kiosk, they sell marijuana for 5 pesos, cocaine for 10 and acid for 15, but you have to order it from Paraná because they don’t have it here.” It wasn’t that he felt close: the drug was totally available and was part of his context.

In the first stage, let’s say from 1960 to 1975, drugs were out there, they had a rather recreational, experimental use, and it was precisely the experimental era, the era of the Buenos Aires bohemia. It was a counter-cultural, rebellious stance. Rebellion was confused with who knows what. Surely, the one who consumes has a need that we fail to perceive; if we could name it, we would be closer; what happens is that we do not perceive the need until we see the consequences of what he does to satisfy it. Moreover, that era was flooded with alcohol and marijuana; there were a few amphetamines, but that was not the main thing; what there was, on the other hand, were psychotropic drugs.

Amphetamine, for example, was used to study, to keep going, at the medical school, in front of the long volumes of human anatomy, but it was not an addictive use. I knew very few people at the school who had problems with amphetamine. Later, I saw many more people who had problems with amphetamine because of its anorexigenic effect, when eating pathology began to grow, but it was not a widespread thing.

Argentines have always been polyvalent in everything, we do everything together, in matters of drugs too: the guy who came for a consultation at the Cenareso, inaugurated in 1972, was a polyvalent addict; he had consumed in the last week an acid, marijuana almost every day, psychotropics, amphetamines and a bit of cocaine, but less, because there wasn’t much of it and besides it had no prestige; then that changed.

In the second stage, from 1975 to 1990, we have a predominance of cocaine, almost a monopoly of cocaine, always accompanied by alcohol, but alcohol comes to be used rather as a “digestive” for cocaine, as a moderator of excitement: when the guy feels stiff, when he says “I’m made of wood,” that’s when he took alcohol to come down, and that is where the famous cocaine-alcohol mix comes from, where one could say the aim was not to get drunk but to self-medicate the excitement of cocaine: so cocaine was taken to go up and alcohol to come down.

The third stage, from the 1990s onwards, became an era still dominated by cocaine, but with a leading role for ecstasy. At the moment, the most worrying thing is synthetic drugs, and not only for their effect: you saw the young people who died in Spain three weeks ago, El País devoted a special issue to it; here, it was commented on in a few newspapers, they ran articles, but it wasn’t given the importance it should have been. Any drug user or abuser knows that mixing ecstasy, which is an amphetamine, with alcohol is deadly, so much so that in the jargon it is called the “bomb”; well, it kills, and it killed three adolescents aged seventeen to nineteen in one weekend in Spain.

Drugs today

The current dysregulation of drug use is determined by a limitless supply, by the prestige acquired by drugs: they have ceased to be what they were before, when they were distant, when they were not so accessible and consumption was associated with an act of rebellion, or signified one. If I smoked a joint, I was outside the system; “you drink whisky,” people said to their parents, “we smoke marijuana,” and along came Bob Marley, marijuana leaves and all the rest. Then, it became something the system needed, it became socialized. So, instead of marginal sectors, it was sectors that wanted to end up, without knowing it, as marginals. There is no drug whose exaggerated, abusive consumption is harmless. In the long run, the marijuana smoker at three or four joints a day is a guy who ends up in a corner, in social demotivation, with no interest in any project or in doing anything, and in a state of near-hallucination. One would say: I don’t know whether he is catatonic or stupid. Today, it is very hard to know what stupidity is; you saw that a political group at a faculty of the University of Buenos Aires is called “Dumb, but not that dumb,” and that it won the elections. We are really making stupidity a kind of banner.

There is a first stage, from 1960 to 1975, where the intention was rather experimentation or recreation; in the following period, from 1975 to 1990, dependencies appear: it is no longer an intention, but the resolution of a blinder problem. The situation of dependence has to be resolved, which demands a persistent and continuous supply of the drug; and from 1990 to 1995, we have the appearance of dependence and of prestigious drugs. That is how ecstasy emerged, with that business of raves and endless dancing, what in Spain is called the “ruta del bacalao,” which consists in going to one nightclub, then another, then another…

This becomes a cultural obligation: the subject has ceased to be a subject endowed with intention. We used to say: what is consciousness? It is the search for an external object; and now the object has been internalized and determines behavior, and we believe we are choosing when in reality we are determined by a need to which we cannot give a name. The type of drugs goes back to being alcohol, marijuana and psychotropics, with a marginal presence of amphetamines. For example, the patient used amphetamines from time to time, he used a lot of psychotropics to calm down, to go up, to come down; it was the era of pills in the United States: executives, who were ahead of ours, took five or six pills a day, one for anxiety, one to get up in the morning, another to sleep at night, and this turned into a chemical culture.

Chemical culture prepares the way for our children to understand that we must take advantage of this culture for whatever we want. The kid who uses drugs has, most of the time, a father who has problems with alcohol, nothing more: not a drunkard, a father who has problems with alcohol and who, whisky in hand, tells him: “You shouldn’t have such long hair, because with such long hair you won’t be able to get into any university”; and the son answers him: “Who wants to go to university?” With his wife, he has infrequent sexual relations, and the wife calms herself with Lexotanil, which is something we have already incorporated.

There is a guy who designs drugs in Chile and who can make acids lasting fifteen minutes, which some think are a good thing because they can be used in session; this type of drug will not be used for good, some will get the idea of marketing them. Ecstasy is an amphetamine that was discarded from production and to which an X was assigned, meaning danger, because it has a toxicity higher than that of ordinary amphetamines; it is a highly toxic amphetamine, with irreversible brain damage, and it is advertised and sold on the internet as the love drug.

Families of today and of yesterday facing drugs

Do families play a containing role?

The family of the 1960s and up to 1975, to begin with, had no idea what it was being told about. When it was told: your son is taking drugs, it answered: what do you mean, he’s taking drugs? The doctor must have given him something. They were ignorant of the subject; it was something remote from the knowledge of the culture of the time.

Today, young people enter adolescence in a state of vulnerability, with overstimulation and an inability, or at least a difficulty, in socializing thought. I think the responsibility of our culture is to create, as pathogenesis, a sensory overstimulation, when one cannot work out what one wants to have: what is it like, what one wants to have? what does one want to do? And there is, in addition, a loss of the relationship between the head, the hand and the object. We are producing a hypertrophy of the thumb, because the thumb is becoming the most important muscle in the body: it governs the television remote control and, moreover, with it we can handle almost all stimuli. Kids can be chatting on the screen, watching television and listening to a record playing different music. We are producing a kind of experimental schizophrenia, or teaching them that dissociation is excellent. I think it is hard to form a reflective culture on the fate of humanity, a question that will have to be thought about one day.

The family changes from 1975 to 1990. Instead of being bewildered, it appears worried, because it begins to register cultural signals from the media indicating that this is a problem, and it begins to recognize the problem, but it recognizes it first outside before recognizing it inside, in others and not in its own children.

Between bewilderment and ignorance unfolds a situation where the son has to do the impossible for the family to realize what is going on, for example leaving bloodied syringes on the cupboards. A mother told me: “I saw that he had a syringe, I thought he had an illness; so what I did, every morning, while he was still asleep, I boiled the syringe for him so he wouldn’t get an infection.” “But what did you think he was injecting?” “Well, a medicine, vitamins.” The mother, surely well-intentioned, was preserving an ignorance that turned out to be complicit. The complicity of the family is one of the givens and one of the obstacles we encounter in treatments.

The current situation has already moved from bewilderment to worry, and from worry to being overwhelmed. Today’s family is overwhelmed because, within the same family, four children can be consuming simultaneously. These families tell us: “One of them, I had him hospitalized, he is in a therapeutic community, but his brother is now worse than he was when I had him hospitalized, and I have no more money to hospitalize him; besides, the health insurance fund does not reimburse me for the hospitalization, the fund says that addictions no, that if at a pinch it were psychiatric problems…” It seems it is better to have a psychosis than an addictive problem; the laws exist, they make treatment compulsory, but no one has the will to apply them.

Can you, then, give a synthesis of this trajectory?

The first stage, 1960-1975, is that of a distant and optional object, which fits a need for recreation or experimentation; the drug is still external, if one doesn’t want to touch it one doesn’t touch it. After all, in the 1940s, cocaine was sold in pharmacies because it was used to make remedies, for peripheral anesthesia; Freud was one of the first to recommend it for peripheral anesthesia, then he didn’t follow his own instructions and used it for other things. Morphine was indicated in the manuals, in other eras, as the best remedy for diabetes. The diabetic received morphine and the guy was “happy as anything,” because he spent his time hallucinating, and the diabetes continued its course. Heroin appears to cure opiate dependencies, it is called the “heroic remedy” against opiate dependence, and it becomes the chemical opiate par excellence in the service of addiction, and so on. At the moment, one of the problems of the whole world, with the famous harm reduction policies, is those dependent on methadone, introduced to avoid heroin dependence. So we have a medicine introduced just like the psychotropic, without taking its dangerousness into account, but there is no rational and objective study of what is happening; at the moment, the laboratories of the United States have managed to impose on the drug regulatory agency the acceptance, in several states, of the administration of Prozac to minors. Not only are we going to find ourselves out of work, but we are going to have excited kids who don’t know why they are excited, overstimulated kids once again: the same story of stimulation that is not converted into thought.

The kid who killed in England was on antidepressants, wasn’t he?

Of course, and the two kids from Central Park who killed a person, too. On that subject, the New York Times published a series of articles for a whole week. I was there and I followed it, appalled: they killed a homeless man at three in the afternoon, kids with cell phones, with a chauffeur, with every luxury. The cell phone was to call the chauffeur when they had finished playing in the park. They killed a homeless man because they had nothing to do, they were on drugs. That does not mean that drugs make people bad, that’s another story. The trajectory over time goes from the distant and optional object, in the first stage, to the close and necessary object, in the second. If the object stays on the shelf, it doesn’t chase me for all that. Cocaine is not a panther that pounces on adolescents. If I want to use it, I use it. It becomes a close and necessary object, and the intrafamilial criminal conspiracy begins, where petty delinquency begins: selling grandmother’s keepsakes, selling the brother’s tape recorder… That is why one of the first useful questions is: have things disappeared at home?

In the third stage, this growth of the object, which is the growth of the drug, is converted into the annulment of the subject: the subject is then replaced, in his role as protagonist, by the protagonism assumed by the drug, as if it were the initiator of everything.

The legalization of consumption

What do you think of the legalization of drugs?

I am opposed to it, because I think it produces no benefit. The only benefit I was able to note, reading Milton Friedman saying that taxes could be collected, is that it would reduce the price of the drug and therefore make it more accessible. As Amadeo said: Samuelson’s second law establishes that any product whose price decreases sees its consumption increase. So, what are we doing by allowing free access? Because the human rights of children are going to come up: buying drugs. I ask the question: could children legally buy drugs? It’s like asking whether people can have weapons at their disposal if they want to. I think that if we start from the principle that the drug is not harmless, or at least that drug abuse does not turn out to be harmless in the long run, we must regulate its availability in one way or another.

The era of Prohibition in the United States is often taken as a model to show that prohibition also increases consumption…

Yes, that is debatable. There were no higher rates of alcohol consumption. People drank illegally, but not every day, because you had to go to certain places that pretended to serve tea when in reality they served gin; but in reality the rates are not very conclusive, it remains a subject under discussion. In any case, I am not saying that the objective is to make the thing clandestine, because it already is, and that works rather well. Even the drug traffickers must not want legalization: they would first have to legalize themselves, which is the last thing they wish to do, because their power comes from there. The idea is not that they seek to have people consume drugs, but that they seek unlimited sources of goods. Even if certain contradictory figures like Pablo Escobar were adored in Colombia, as certain public figures of our recent history have also been on their home ground. If one goes to their region and asks what people think of a great figure, controversial at the national level, the locals will surely answer: Don So-and-so, of course, he’s the one who built the school, the road, the airport. Obviously, he did it all with what he had left over, but behind it there is very often a story of organized crime.

I don’t think legalization would be of any use and, moreover, one cannot legalize in one country without turning it into an island of desire for the region. The president of Uruguay announced his idea of legalizing drugs without measuring the consequences. Let’s all go on vacation to Uruguay to consume drugs because it’s legal, then come back after having consumed drugs, and a few of us having become addicts.

The subjects related to availability, which I did not want to go into today, are the control of precursors, which is a matter of tracking the production of cocaine and heroin. What matters most to us is what comes in; there are international studies on products such as potassium permanganate. If one follows the path of imported and exported potassium permanganate, when its volume increases beyond what is necessary for the chemical or perfume industry, it means it is being used to produce cocaine.

The laundering of drug money results from the proceeds of sales, which are not easy to introduce directly into the financial circuit. The problem of drug traffickers is that they have too many banknotes and don’t know where to put them; hence all that importing of banknotes that was done here with the complicity of prominent figures of local politics and customs officials who couldn’t even speak Spanish. It is essential to control all this if one wants to detect the actions of drug traffickers, who for this reason want to build all those useless hotels we have. That is why they have to invest in this type of construction, which is the way to legitimize the money.

The legal aspect and the importance of integrating the family into treatment

What do you think of law 23.737?

It is a good instrument, which one must know how to apply. I have seen successful cases, but based first on better work with the federal jurisdiction. From 1985 to 1995, we worked on training courts I and II, those of Marquevich and Bengesio, in the judicial district of San Isidro, in San Martín, in Lomas de Zamora, in Quilmes and in a few others, and Juan Yaría, the former Secretary for Addictions of the province of Buenos Aires, did the same in many other jurisdictions. The work with the courts stems from the need to overcome the courts’ lack of knowledge of 23.737, which is the law on addictions, a much-discussed law, with interesting debates; the position of Fapiano, who was then at the Ministry of the Interior, was truly brilliant and remains available for comment.

This law establishes an educational security measure for people whom the police have found, for example, with a marijuana cigarette in their pocket: an educational security measure is applied to them, which falls under the Ministry of Education; and, for other cases, a curative security measure, which is the replacement or interruption of the sentence by the option of treatment. The person is in judicial proceedings; anyone in judicial proceedings who is asked “prison or treatment?” would have to be pretty foolish to opt for the sentence. Besides, if he opted for the sentence, he would do the third cycle of drugs, because what are prisons? Third cycles of drugs. That person, already under judicial sanction, properly advised and with services available, can follow a preventive intervention of three weekly sessions for eight weeks, which can serve as a kind of introduction to the question. It may or may not have to be followed by treatment, but this is not a person suffering from physical dependence or an inability to abstain from consuming. For those others the curative security measure is reserved. In that case, the judge orders: go to an establishment, which may be of the person’s choosing; many then ask for therapeutic communities. Many judges refer to therapeutic communities, the San Martín Court too, but this requires prior work, in which prevention and care centers, public and/or private, offer themselves to the courts as advisors for assessment, and it is complicated. We have to work with all the federal judges of the capital, who number twelve.

On the other side, there are also the family court judges. In these cases, there is an experience of transformation of the judiciary in recent years, where, unfortunately, Dr. Eduardo Cárdenas resigned, he who is a clear example of the accessibility of judges to psychological, psychiatric and therapeutic intervention.

In my opinion, no general recommendation can be made; I would not recommend to a family that it go to see the judge, because from the outset, if other obstacles or other instances have not been overcome, this implies a delegation of function, that is: you go, and I place you under the authority of the judge. What does that mean? If one has failed before, if one has tried other paths and one reaches this instance… This happens with people who are already involved in criminal activity. There is no single answer: I have seen cases that evolve very well, I have seen others that, before the judicial instance, disappear; but the work with the services for the defense of minors interests me a great deal. We started with Atilio Alvarez, many, many years ago, at the minors’ prosecutor’s office. The prosecutor’s offices for minors and incapacitated persons that intervene in hospitals in application of law 22.914 on psychiatric hospitalizations: psychotics, and also drug addicts, as the law calls them, depend on the prosecutor’s office for minors and incapacitated persons, and consequently hospitalizations must be communicated to it, they must be audited; but none of that exists, nothing is communicated, nothing is audited, nothing is supervised.

We have just replaced the entire audit team of the Secretariat, because we do not agree with the way audits are done. They ask: do you have damp? do you have coffee? Those are the two stages of the audit; if you have no damp, it is praise for the institution. The audit must go and audit the therapeutic program and ask: are there group coordinators, is there family therapy, from what point on? Is there training? In the history of addictions, one used to work with the family at the moment of discharging the patient: the patient remained hospitalized for a year and a half, did not see his family, and on the last day it was said: we must call in the family because Juanito is leaving. How can one call in the family at the moment he is leaving?! We must call in the family from the moment of hospitalization, from the very beginning.

What do you propose, then?

We are of the opinion that the family must always participate when we run psychiatric inpatient facilities. From the outset, we integrate the family, and when we don’t, we call into question the possibility of carrying out an effective hospitalization. One cannot treat a hospitalized patient without working with his family. The work must even come beforehand. We have worked much more with parents’ groups before hospitalization, and less with the family which, at that moment, is stricken, wounded and disoriented. We must bring help to these people, because the possibilities of help usually come from lay people, or from the Church or other religious systems; or else, from people who have lucrative interests or appetites; lucrative appetites are dangerous on their lucrative side and on their appetite side, because they end up making profit and not helping. There are families that are convinced, including from within the psychiatric profession, that if they have an apartment, they can sell it to pay for the hospitalization. If the criterion is that treatments should be accessible to everyone, we must change policies.

Closing remarks

How does the question of private insurance for drug addiction work in first-world countries?

In general, treatment is covered; for example, the CeIS in Italy has a budget of 18 million dollars a year. Of these 18 million, 12 come from social security, that is, from patients in treatment, and 6 from donations, grants, foundations, etc. If twelve million dollars come from social security, that means the agreement is very clear. Italy has an enormous lead in this field; for that country, drug addiction is a phenomenon situated within social marginalization: not that it produces social marginalization, but it is social marginalization that produces addiction. The social conscience of the Italian Parliament is evident. When I was there, shortly before the 1990 Football World Cup, this question was being discussed in Parliament, and I read with passion the speeches of lucid, intelligent politicians, who discussed public policies as they are not usually discussed here. The other day, I went to the Chamber of Deputies, to the drug addiction committee, and I was asked to please not be so punctual. If I am summoned at 8:30, I arrive at 8:30. I was told that with my rank, I could arrive at 9 o’clock. There were twelve deputies and ten advisors, a real crowd. Never, in the drug addiction committee, had there been so many deputies present; they were very enthusiastic, but the level of the questions was a bit pathetic.

Is there a scholarship program at the Secretariat?

We are trying to move the question forward and to survive like everyone else. I have the rare privilege of working fourteen hours a day, and I see my patients in a limited slot at the end of the afternoon, because the Secretariat calls on me from 8 in the morning. At the moment, we are inaugurating the Quilmes course: two hundred practitioners are enrolled in a training for socio-therapeutic practitioners, where some of you have taught, and there we are, trying to keep moving forward, thinking that the country must find a better balance than this one, that it must respect the principles of social justice and that it must do for the less favored what it did for so many years for the more favored.