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By: Silvio Saidemberg , M.D.*

From my standpoint, the reply to this inquiry is No! A true approach against recreational drugs still has to be developed. It does not make sense to legalize drugs as an act of spiritual benevolence or national surrender. The general community and also the chemical dependants are entitled to have facts, not fiery opinions.

The direct connection between consumption of drugs and the increase of crime is well established. We must keep in mind that generally crimes in Brazil tend to be committed under alcoholic beverage influence, a legalized recreational drug. Also, that in the community, the group most inclined to violent behavior is the chemical dependants one. On the roads, accidents with victims including fatally wounded ones are caused mainly by driving under influence of alcohol, but, in second place staying the use of other psychoactive substances. The drug recovery programs therapeutic success reaches up to 70% for chemical dependants in 2 or 3 years treatment follow up. However, the treatment dropping out rate from the start of the abstinence period tends to raise, due to antagonism and problem denial of many chemical dependants and their impatient and many times extenuated relatives. Generally, the follow up program is abruptly terminated whenever there is any habit relapse.

The reduction of the demand for drugs through primary prevention is a well established fact, but, really, the government and the society need to support the establishment of programs that are scientifically evaluated as they go on. Those programs must have a proper table of contents and remain part of the educational system program and not as an eventual non methodical activity. Nevertheless, there should be a deep respect for all initiatives to argue with responsibility and knowledge the question of the recreational substance use.

In Brazil, June of 1998, the federal government created the Secretaria Nacional Antidrogas (SENAD) and signed a pledge with the United Nations to eliminate "the affliction caused by the drugs", in a 10 years period. However, this Secretariat relies on insufficient financial and material resources to carry forward its task. Moreover, the method was not defined as how to diagnose the drug consumption rate in Brazil and other essential researches, starting point for the foundation of the national anti-drug policy.

Demand Reduction, the national program of prevention of drug use and abuse must be treated as a different program, not subordinated to the politics of traffic repression, as it already occurs in U.S.A., Great Britain and Canada. A National Agency for drug addiction prevention should have its proper agenda and life.

We need to have in mind that the lawful consent must remain for legitimate medicines under medical supervision and with increasing restrictions for alcohol and tobacco, both enjoying an enormous and undeserved social acceptance. The defenders of recreational drugs legalization indicate that despite the continuous repressive efforts, the use persists to grow. Thus, why not to wave the white flag in the fight against drugs? Why not to offer the unconditional surrender to the drug trafficking? The drugs are cheaper and more abundant in the streets of the Brazilian communities, would not be this the very moment to quit all the efforts in the repressive control of drug trafficking? The truth is that Brazil has not undertook a really efficient fight against drugs. The lack of a broader and mobilizing strategy from this society has been one of the causes for the defeat imposed by the drug traffic. Instead of a concentrated effort in the preventive educational measures to thwart the use in our schools, homes and workstations, we identify attitudes that vary from indifference to the most contradictory feelings and ideas. The pro-legalization movement takes hold due to scant social opposition. This confirms that the message on the destructive and mistaken use of drugs has been undermined. Progressively, the youth has learnt to ignore problems in the use of drugs.

The favorite myth associated to the movement pro legalization is that the revenues from the official "recreational drugstores" and the taxes will help to stimulate the economy. This claim is at the very least nave and certainly, not supported by the facts. The envisioned economic benefit would be overcome by the billions of "Reais" or dollars expenses to repair the social losses, added of course to the severe harm to the health, the precocious handicapping of new generations and finally millions of lives curtailed by drug use. We cannot deny evidences, we should not be lax towards politicians that are compromised with the organized crime or when they choose not to recognize reality due to their own idiosyncrasies.

There is the widely spread idea that genetics have something to do with the drug-addiction fatality, compounded with the psychological traumas and other psychiatric conditions concurring for a deterministic result. These are concepts that tend to conceal the fact that the availability of a substance plays a much more preponderant role favorable to the drug culture. To a certain extent, the allure for what in science is more measurable makes this elementary truth to remain dimmed.

To prevent the occurrence of new cases, to treat and to recoup chemical dependants are necessary measures to push away the misery caused by drugs. However, always there are some backtracking at different points of the best approaches, and that goes for all attempts to deal with any illness. The criminal groups have become stronger and already they are very well armed. They openly defy the police and the justice system.

Ironically, the most efficient war against drugs has taken the crime to a gradually improved performance. As a more notable example of this backtracking, we have the increasing traffic repression, that has stimulated the commerce of more concentrated drugs. The reduction of the volume of the product decreases the possibility for detection. The same has happened when the treatment of infectious diseases stimulates the development of more pharmacologically resistant micro-organisms. In spite of that, the fight to save lives must continue.

We are remembered that during the "Prohibition - from 1920 up to1933" the alcohol consumption was more abated in the case of lesser alcoholic concentrated beverages, such as beer, while predominated the market of smuggled or illegally distilled beverages ("bootlegging "or" moonshine"); the latter consumption still to a much lesser degree when compared to levels prior to 1920. Soon after the repeal of the "Prohibition" (enacted in 1933), low alcoholic concentration returned to be the standard for the larger consumption of drinks, next to the previous levels to the year 1920.

However, the general alcoholic beverage consumption only regained its intensity ten years after the Prohibition Repeal. (The law known in U.S.A. as "Prohibition" was the result of the ratification of 18th amendment to the USA Constitution That change forbade the manufacture and sale of alcoholic beverages. From a practical standpoint towards alcoholic beverage consumption reduction, Prohibition functioned quite well. However, it was repelled by having fallen in unpleasantness with the population, probably, due to the US government lack of efficient educational programs to keep the community approval).

From this experience, it is inferred until a certain point that the current trend for more powerful drugs would be directly related to the restrictive barriers imposed upon the drug. Certainly, other historical factors largely neglected by the world need to be taken in consideration. For instance, when a prohibitionist law is about to be approved or enforced, most probably the consumption of one particular drug has already become more generalized, being a well known danger to the health, displaying an epidemic character and when other personal and social damages are clearly the main issue.

The unlawfulness thus is considered in consequence of the more or less obvious associated harm to a substance use, only after such a consensus is reached, there is a firm attempt to interdict its access. It was for this perception that the Chinese government in 1839 proclaimed the prohibition for the opium trade. Such measure provoked a British military intervention towards liberating such a commerce again; besides, being demanded from the Chinese government several concessions, even territorial ones, as a way to repair for the economic losses caused to the British Crown. In the case of the legalization of recreational drug trade in Brazil, ironically, also the national community will see itself in the contingency to make suitable amends for the resulting material and moral losses suffered by the drug traffickers during all those years of repression. On the other hand, the drug traffickers do not assume responsibility for their victims.

Additionally, in favor of repression, there is the strong and responsible desire to protect the infancy and the youth from drugs. Finally, always when a drug is wide and eagerly accepted, as it occurs in the case of alcohol, there should be a strategy to unchain social co-operation in order to remove it from the shelves, otherwise revolt will easily prevail. The rebellion can defeat the attempts of control. Is it possible to deprive people of a product that takes 10% of its users to a serious physical dependence? Suppose there is a great acceptance for a much larger number of users? Tobacco will be even more difficult to be curbed in its use, as it causes strong physical dependence in the majority of the smokers; and usually its awful effects to health are less conspicuous. Would its interdiction bring still more revolt and a blatant lack of social compliance?

Instead of inspiring defeatism, this historical occurrence of the revocation of "Prohibition" in U.S.A. may generate more efficient measures to restrain other dangerous drugs that should not persist in greater availability and acceptance. Certainly, we do not need more drugs that kill and maim on the roads or make easier for violence and other crimes. A lesson that should derive from "Prohibition" deals with the need for the community to be set in motion as an essential part of the drug control program. In the first few decades of last century, there was not yet the idea of effectively instructed community action in the fight against recreational drugs.

The politicians, judges and in all levels, the law enforcement agents need recognition and to be esteemed in their role They should be helped in problem solving for the sake of social safety. They should not be left ignored and unsupported, as they usually are to the point of being forced by circumstances to make special agreements with criminals in order to guarantee their own safety and survival. In consequence, a policeman will sell and supply protection against drug apprehension. A defendant with good financial resources will buy false witnesses or will try to bribe a district attorney or a judge.

In the beginning of the twentieth century, Brazil National Secretary of Health, Dr. Oswaldo Cruz tried to fight the epidemics spread by rats. For that initiative, he had to face political opposition and also his program had to deal with producers of rats. Then, due to a financial incentive to get people's compliance in mice catching, there came the figure of the mice producers, they raised mice and afterwards would exchange "captured rats" for money.

Thus, it is not fully truthful that only with drugs, "the corruption is the cancer and the money the carcinogen". Yes, there is corruption among public officers: judges, policemen, employees of the penitentiaries, law enforcement agents and others in public office. We can even consider that money is an efficient tool for corruption. This is not solely the inevitable and destructive consequence of the politics in favor of drug prohibition.

Whenever the community remains aloof and non participant in decisions that will matter to its own fate, the institutions will be dominated by the organized crime. In consequence, a policeman will sell and supply protection to criminals.

To only trust a law to be implemented by the government and its official agencies is to choose a fragile move. Without a powerful alliance with the community, the fight against crime will not have a real impact. The "Prohibition" was defeated by the moralist thirst for scandals of its time, when alcoholism was seen more as a character weakness and not as an illness with a fatal chronic course.

Inside our safer penitentiaries, the ample availability of drugs is a powerful example of the economic swaps and the corruption that the money can buy. Unfortunately, Brazil is exporting this corruption. The Brazilian dollars of the drug trafficking pay for murders, for kidnappings and bribes related to the drugs in other countries too. Instead of taking responsibility and recognizing that the proper demand and production are the real cause of the problem, it has been attempted to export guilt. To deal with the real issue, we must focus in the national problem and its causes. Without our own demand there would not be any external production directed towards the domestic market. Without the national production there would not be any demand to be met, either internal or external. Nevertheless, it is much more comfortable to severely incriminate other nations that are not fulfilling their role in fighting against demand and traffic of drugs. It has a main persecutory conclusion: "the developed nations are not reducing the demand and our neighboring nations are not diminishing the production and the traffic".

Of course, with prohibition the illicit drugs only would be obtained through the black market. Then, the prices will continue to be established by this market, having as a result high values and profits. Since the drugs are thus expensive, many users will have another motivation beyond the simple friendly desire of sharing: there prevails the wish to transform friends into drug consumers, and by doing so drugs will be sold to the newcomers, what will help to defray the former users' own drug addiction. There will be no control upon adverse effects, and the most active enticement towards initiation of new users is another of the consequences of the prohibition. Generally, the consumers are the same ones that will be dealing with drugs for a profit.

Nevertheless, if drugs were liberated, friends more effectively would be enlisted to share a ceremonial use. In such a case, the party will be fully subsidized by the government. Naturally, the excluded ones, children and adolescents will continue available for a newly defined black-market. We will have a similar tragedy as the opium in China, which eradication was at the highest human and economic cost.

The high prices of the black-market withhold the choice concerning determined drugs. Notwithstanding, the chaos will prevail as more drugs become freely available for recreational use. Already we have the examples of tobacco and alcohol, children of all ages are fully under the incantation of these two substances, in spite of laws that supposedly should prevent individuals below 18 years to use them. Even in the maternal womb, the child from conception until birth is frequently subjected to the extremely harmful impact of those two socially well accepted substances.

The Legalisers defend that there will be a great loss of motivation for any illegal drug business, once the "Drug Prohibition ceases". In reality, one of the more harmful aspects of the drug black market is the allurement for easy money, attracting the young of the inner cities. Supposedly, with the Legalization, this money source will dry. The proponents of the Legalization emphasize that the drug is not necessarily bad, some measures could mitigate current risks for its use, "the reform of the laws on drugs" would bring a greater acceptance for the chemical dependent and for one's freedom of choice. Also, they emphasize the resulting benefits from the mental health workers' team and from the programs of "harm reduction" directed toward those that choose to remain chemically dependant. Many of the proponents of the Legalization are professionals of the health area wishing to guarantee a legitimate professional support for the chemical dependants, acknowledging that they are in a serious mental turmoil, therefore, their personal drama should not be aggravated by the severity of the law. They seem not to have any doubt about the fantastic results of their proposition, even though the already legalized substances represent a definite enormous health hazard.

The Legalisers want to convert everyone to the belief in the great reduction of motivation for the ones that are in business with illegal drugs, a commerce that supposedly immediately would be substituted by the supply of those same substances with extremely low prices or by their free distribution, totally sponsored by official agencies, with proper guidelines to drug users for a safe experience. Quite efficient governmental action completely free of bureaucracy; warehouses amply supplied with all recreational substances, including the most lethal ones, furthermore, functioning 24 hours per day, no space would remain for the drug trafficking. Regarding such a proposal, is there any place left for doubt or skepticism?

Anyway, the drug law in Brazil has become gradually less efficient. There have been judicial initiatives to legalize marijuana for "medicinal use", unfortunately, a cover-up for liberating its recreational use. This trend reversal might compromise the future of this generation. Of course, we need to realize the legitimate support that the drug users should receive, even when there is no desire to overcome their drug consumption. Nevertheless, nobody should ignore one's moral and legal responsibility for disseminating drug use. All these individuals need to be confidant that they are getting all the help through programs meant to control the dissemination of HIV and other transmissible illnesses. However, we cannot use the legitimate support due to the chemical dependent as a maneuver to liberate the access towards recreational substances.

The new generations deserve efficient and energetic measures taken to retain the prohibition to substance use and to its traffic. We need to eliminate the confusion on the essential drug prevention programs, that for certain will continue to keep the ideal of total abstinence and the necessary medical attention in order that each chemical dependant is humanly taken care of. In fact, for the mental health professionals there is no alternative besides to respect the individual free decision on compliance with a drug abstinence program. However, even if a person does not want to cease this use, the overture for medical help should never be dismissed by the caretakers.

The traffic of drugs is a fantastic business, probably the greatest of all. The enormous profit depends on customers' faithful adherence to the substance. If there is little repression, the availability of the substance raises, the price will be affordable and many children and adolescents will choose to engage in its use. The lesser is the cost to cultivate and to transport drugs in this country, the lower will be their final price in the street. Conclusively, to reduce the drugs influx and their national production in Brazil must be a maximum priority. Until the availability of drugs is dramatically reduced, with its price staying high, preventive instruction and the efforts for law enforcement will not be able to meet success.

It is basic to consider a continuous investment in strategies that lead to abstinence. We need to find ways to persuade each citizen that the use of drugs is wrong; it destroys lives, families, schools and communities. To label a dangerous drug as "soft" and to defend its use as "medicine" is a manner to convey a misguiding message to our young.

Someone might wonder how much would it be necessary for children, adolescents and adults to fall into the trap of "more soft" recreational mind altering substances. I would ask from everyone: have you examined yourself to detect any curiosity to make personal changes through those substances? Perhaps you have either the feeling of not belonging or are attempting to deal with loneliness; even, there might be a strong desire to receive compensation for something unacceptable in yourself or in the world.

In "Agony From Ecstasy", by Lynn Smith, we can read the personal drama of a young woman that until her meeting with "Ecstasy" had a normal life; as a result she became ill, fortunately, again she was able to enjoy a good level of recovery. Some excerpts: "I hear people saying that 'Ecstasy' is a harmless, happy drug. There's nothing happy about that 'harmless' drug chipped away at my life. Ecstasy took my strength, my motivation, my dreams, my friends, my apartment, my money and most of all, my sanity. I worry about my future and my health every day." Let us move now to another example, one I take from my own office: a 19 year-old lad, that developed a psychotic break after several years of marijuana use. Once more, under marijuana influence in a time when already there was a reasonable recovery from psychosis, he makes a quite serious impulsive attempt to commit suicide. Afterwards, he affirmed that at the suicidal moment, he had a strong idea that he was an angel returning to heaven, where he would be able to smoke marijuana with other heavenly creatures. Several months have elapsed since then, however, he still maintains the strong belief that marijuana can do no harm. In favor of that conclusion, he would quote statements from the media, of course only those friendly to marijuana.

One unavoidable question needs to be made over and over again: every citizen of this country is making enough effort to prevent new cases of drug use? If the reply is no, instead of keeping the complaint that the other one is at fault, we need to make more and to give full support to the fight against the traffic of illicit drugs and in a general way, against the culture favorable to recreational drugs.

NB: (the abuse of drugs is the use of a psychoactive substance - legal or illegal - such use being sufficient to cause to the abuser physical, mental, emotional or social damages. Addiction or dependence is the compulsory and continuous use of a drug.)

* The Dr. Silvio Saidemberg, psychiatrist and psychotherapist, professor of psychiatry at the College of Medical Sciences; PUC - Campinas.



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