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ABEAD: AN ATTEMPT TO TURN

TECHNICAL PRESTIGE INTO

POLITICAL POWER

The Brazilian Association for the Study of Alcohol andother Drugs [Associação Brazileira de Estudos do Álcoole outras Drogas (ABEAD)] is more than a forum bringingtogether practitioners specializing in the treatment of chemical dependency. Over the past 10 years, it hasgrown into a domestic and international benchmark asa centre producing scientific knowledge. Its target now isto extend its participation in the public heath policies of Brazil and Latin America more widely.

ABEAD was established during the 1970s in responseto the need among practitioners to create a greater dedi-

cation in the field to attendance at its congresses andseminars, better understanding of advances in the pre-vention and treatment of drug addition and of research

into the complex relationships between human beingsand drugs. From an initial group of no more than 40people, it has grown to 840 members. It differs from othersuch organizations in its multi-disciplinary composition,with members ranging from psychiatrists, social workers,nurses, psychologists and lawyers to community leaders.The representation of such a wide variety of perspectivesextends understanding of this topic, underpinning adynamic exchange of experiences that are always up todate.

Thanks to this working philosophy and in close co-operation with other organizations, this association has

© 2002 Society for the Study of Addiction to Alcohol and Other Drugs Addiction, 97, 9–13

The Brazi l ian Association for the Study of

Alcohol and Other Drugs

João Carlos Dias da Silva1,2, Sérgio de Paula Ramos1,2, Ernani Luz Jr 1,2, Evaldo Melo de

Oliveira1,2, Dagoberto Hungria Requião1,2 & Angelo Americo Martinez Campana1,2

Brazilian Association for the Study of Alcohol and Other Drugs1 and Brazilian Psychiatric Association, Brazil2

Correspondence to:

João Carlos Dias da Silva

Avenida Taquara 595, Sala 402

CEO: 90 460 210 Porto Alegre

Rio Grande do Sul

Brazil

E-mail: [email protected]

Submitted 16 December 2000;

initial review completed 15 January 2001;

final version accepted 10 March 2001

ABSTRACT

The Brazilian Association for the Study of Alcohol and other Drugs [AssociaçãoBrazileira de Estudos do Álcool e outras Drogas (ABEAD)] is a non-profit entitywith the purpose of encouraging discussions and exchanges on advances in theprevention, treatment and research of addition. It currently brings together

840 professionals from different areas, such as Psychiatry, Social Assistance,Nursing, Psychology, Sociology, Law, in addition to community leaders, thushaving an innovative and dynamic character. It organises annual national con-gresses and regional meetings hosting foreign guests. The society has a stylethat is innovative and dynamic. After more than 20 years of work, ABEADexerts significant national influence and its members have been invited to par-ticipate in the main decisions regarding issues linked to drug abuse in Brazil.Among other achievements, it has contributed to the proposals on preventionand treatment policies and the standardization of the different levels of assis-tance provided by public health-care. In addition, its members have workedclosely with the initiatives made by the government and medical entities in thesearch for a consensus on the treatment of the different types of dependence,

including alcohol dependence and smoking. ABEAD’s goal for the future is tobroaden its participation in the national drug policy arena and to intensify thework with other medical organizations and with the community.

KEYWORDS Alcohol-related problems, association, national drug policy,substance abuse.

NATIONAL SCIENTIFIC SOCIETIES


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been firming up its presence through significant partici-pation in decisions on the prevention of drug and alcoholaddiction and the treatment of substance users in Brazil.The members of ABEAD believe that the main challengefor the future is to turn its technical prestige into politi-cal power. Additionally, they want the association to playa more dynamic role in shaping health-care policies. Oneof its current battles is to achieve a ban on cigaretteadvertising on television through a Draft Bill currentlyunder discussion by the Brazilian Congress. Other longer-term projects include guaranteeing a seat for this orga-nization on the National Anti-Drug Council and boostinginternational exchanges. Until now, this relationship hasrelied on invitations to leading members of ABEAD linkedto universities or hospitals. There is a possibility of ABEAD offering on-the-job training facilities to non-Brazilians at places where its members work.

ABEAD is striving to become even more professional

in its capacity to meet the needs of a third world countrysuch as Brazil. For instance, for the past 10 years it hasorganized the Forum on Chemical Dependence inCompanies, held in Rio de Janeiro. In the opinion of itsmembers, a problem lies in the fact that governmentagencies are unaware of the severity and extent of druguse in Brazil. Calculations (Ramos & Bertollote 1996)indicate that some 20% of Brazilians have problems withalcohol (either abuse or dependence). At least 20–25% of the population smokes cigarettes, mainly young people.Consumption surveys in schools throughout Brazil showthat the most commonly used drugs are legal (alcohol

and tobacco). Regarding illicit drugs, among girlsamphetamines and tranquillizers predominate, whilemarijuana and cocaine are more common among boys(Galduroz et al. 1997).

The members of ABEAD work on the basis of thesedata in their daily tasks. They acknowledge that thereis a government policy focused on treating patients suf-fering the consequences of cirrhosis, or undergoingpsychotic episodes, but there are no investments in pre-vention. This is why one of the proposals urged by theassociation is to include chemical dependency treatmentin family programs, as well as community agencies. In a

society where a mother fails to vaccinate her childrenbecause of alcohol abuse, it is necessary to bring health-care policies closer to reality.

There is a long and difficult path ahead. At the sametime as it is struggling to make its voice heard in decisionsover medication control and other measures that willhelp to re-shape precarious health-care services in Brazil,ABEAD is striving to build up closer links with the com-munity through sponsoring events, and is also develop-ing relationships with other medical specialities such ascardiologists and chest physicians, in order to treatsmoking, with a similar approach in other areas.

This non-profit organization survives on the annualfees of its members. In practice, this means coping withall the difficulties inherent to a developing countrylacking economic stability. However, this does not preventthe association from investing in upgrading its proposals.In 2000 it launched its homepage, as well as a specialized

journal ( Jornal Brazileiro de Dependências Químicas), andwe will deal more fully with both developments later inthis paper. The next stage will be rewriting its bylawsin order to provide its management with a more pro-fessional approach.

BACKGROUND

This association began to put down roots in 1978 at aCongress on Alcoholism held in Argentina. PsychiatristsSérgio de Paula Ramos (Rio Grande do Sul) and Vicente

Antônio de Araújo (São Paulo) attended this event andnoted rising interest in this matter. They saw the possi-bility of setting up a group in Brazil to bring togetherother practitioners who generally met to exchange in-formation only at non-specialized congresses and semi-nars. It did not take long for new supporters to line upbehind this proposal. At the Congress organized by theBrazilian Psychiatry Association (Associação Brazileirade Psiquiatria) held in October that year, they managedto bring together 20 people interested in these issues.In May of the following year, during the first Inter-national Seminar on Alcoholism held at the São Paulo

Medical School and organized by Jandira Masur, theembryo of this organization finally emerged, calledthe Interdisciplinary Group for Studies of Alcoholand Alcoholism (GRINEAA (Grupo Interdisciplinar deEstudos de Álcool e do Alcoolismo)).

Co-ordinated by three practitioners (Sérgio de PaulaRamos, Vicente Antônio de Araújo and Jandira Masur, inaddition to José Manoel Bertolote in São Paulo), this groupbegan to disseminate the idea of setting up an entity thatwould draw together other practitioners interested inthese topics, and which could co-ordinate national meet-ings that drew large audiences. Of the four members of its

first board, Bertolote was selected as its Chairman (seeTable 1). In April 1980, the co-ordinators of GRINEAAorganized the first National Meeting on Alcoholism,attracting 40 specialists from southern Brazil. The de-dication and commitment of the participants at this eventprovided ample leverage for the appearance of the Brazil-ian Association for Studies of Alcohol and Alcoholism(ABAA (Associação Brazileira de Estudos do Álcool e doAlcoolismo)) in Porto Alegre in 1981.

Structured into an entity, is members began to mountcongresses at 2-year intervals, interspersed with regionalevents. During this period, it became clear that it was no


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Brazilian Association for the Study of Alcohol and Other Drugs 11

© 2002 Society for the Study of Addiction to Alcohol and Other Drugs Addiction, 97, 9 –13

longer possible to restrict the discussions only to alcohol,because many practitioners were being called upon totreat dependence on other drugs as well. In 1989, duringthe Brazilian Congress on Alcoholism held in São Paulo,ABEAA became ABEAD, meeting a demand from its

members. Some of its members were already represent-ing it at a national level, and had been appointed by theBrazilian Medical Association to a seat on the NationalNarcotics Council, former CONFEN, today replaced by theNational Anti-drug Bureau.

Since then, ABEAD activities stand out not onlythrough domestic and international congresses, but alsothrough an effective participation in the preparation andimplementation of drug use prevention policies andtreatment for drug use in Brazil. It ensures that itsmembers are data empowered.

This organization has represented Brazil at specific

events in this field. Backed by its track record, ABEAD hashelped reduce the stigma relating to chemical depen-dence. However, this is not enough. If the difficulties in1978 focused mainly on treating alcoholism, the targetnow is to get reach the users of other drugs such ascocaine, where use has risen to astronomic levels duringthe past 30 years. There is also concern over syntheticdrugs (United Nations 2000).

ABEAD AS A PART OF N ATIONAL

POLICY

At the invitation of the Brazilian Ministry of Health, in1981 the members of ABEAD took part in the preparationof Brazil’s national alcoholism program (Pronal), which isone of the most complete projects providing assistance forthe problem alcoholism of Brazil. This program sets upprevention units offering diagnosis, treatment and reha-bilitation facilities. Pigeon-holed since then by the govern-ment, it was presented again in 1996 by ABEAD at theLatin American Congress on Public Health in São Paulo,and was widely accepted by the public—indicating thatthe ideas on the document are still highly up to date.

In 1998, ABEAD worked closely with the Ministry of Health to draw up the draft document for the ‘Standard-ization in the treatment services for disorders caused bythe use of psychoactive substances’. This project is ready,and awaits only the government’s decision to put it intopractice. Basically, it suggests a detailed evaluation of

patients in order to avoid unnecessary hospitalization(Ministry of Health 1999). The idea is to establish homecare detoxification services, making good use of the staff at the medical aid posts run by the single health-caresystem [Sistema Único de Saúde (SUS)] and communityhealth-care agents. This measure would have immediateeffects on the population using the government health-care services, by removing patients from psychiatric hos-pitals and placing them into the public outpatient clinicnetwork. This would reduce the problem of hospital bedshortages in some parts of Brazil, as well as overcomingeconomic discrimination—in some places, hospitals are

open only to those able to underwrite treatment costs.The implementation of these services depends ontraining staff and computer back-up. Before being putinto practice, the intention is to hold regional forums inorder to hear all segments involved (governmental, non-governmental). The Ministry of Health will organize asurvey in order to map out the resources available, andregister treatment facilities.

A supplementary project was set up in 1999 byABEAD, jointly with the National Anti-drug Bureau(SENAD) and the Ministry of Health. Called theStandardization of the Psychosocial Treatment Centres

(Normatização dos Centros de Atenção Psicossocial) itstarget is the lay, religious and philanthropic treatmentcommunities. It also stipulates how many beds each insti-tution may have, the distance between them, and othertechnical standards.

SENAD suggested that the social cost of drug use inBrazil should, for the first time, be calculated and ABEADbecame involved in this initiative, helping to implementthe pilot project for the Drug Use Household Survey in1999, in Florianópolis, Santa Catarina (Campana & Neto1998). This project is an important tool for establishingepidemiological surveillance programs on drug use and

determining prevention program targets, while respect-ing the cultural differences found in the various states of Brazil. This survey requires the collection of data invarious settings, ranging from schools through to work-places and the community. Consequently, if a drunkdriver has an automobile crash, this accident may berecorded not only as another case of multiple fractures,but also as alcohol abuse or chemical dependence, thushelping to understand the complex universe involvingthis patient and referring him for treatment.

SENAD published the pilot project run inFlorianópolis, but the survey has been interrupted since

Table 1 Chairpersons of ABEAD, 1981–2001.

1981–83 José Manoel Bertolote

1983–85 Vicente Antonio de Araújo

1985–87 Ernani Luz Junior

1987–89 Jandira Masur

1989–91 Sérgio de Paula Ramos

1991–93 Dagoberto Hungria Requião

1993–95 Arthur Guerra de Andrade

1995–97 Angelo Américo Martinez Campana

1997–99 Evaldo Melo de Oliveira

1999–2001 João Carlos Dias da Silva


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the new President was appointed to this governmentagency, meaning that it has not been extended nation-wide. Political uncertainty is being caused by shifts inpositions and offices and the centralization of decision-making powers.

Nevertheless, ABEAD has achieved some importantprogress. In June 2000, ABEAD representatives helped todraw up Brazil’s National Anti-drug Policy, workingclosely with leading specialists in this field who wereinvited by SENAD. From the standpoint of prevention andtreatment, the concepts suggested apply to the LatinAmerican countries in general, and indicate the bestways to work jointly with schools, the church and otherinstitutions.

OTHER TASKS

Working closely with the Chemical DependenceDepartment of the Brazilian Psychiatry Association,basic standards are being defined that will guide decisionson drug treatment in Brazil. Discussions among themembers of these two organizations have resulted inthree consensual agreements. The first, reached in 1999,is on the treatment of withdrawal symptoms for alcohol.In 2000, during the Brazilian Psychiatry Congress, aconsensus was established on treatment for smoking.Discussions are currently under way on reaching a con-sensus on the treatment of alcoholism.

The actual situations faced by members of ABEAD

during their daily task with their patients were used asfoundations for the guidelines stipulated in these docu-ments. During the withdrawal period from alcohol,patients’ lives are at risk. In Brazilian hospitals there is acertain prejudice against this type of patient, who is oftensent afterwards to a psychiatric hospital. However, surveysprove that in Brazil, 51% of traffic accidents involve theuse of alcohol; but when these patients arrive at the emer-gency room they receive emergency treatment and aresent back home, and there are no intervention plans todeal with this dependence. At the very minimum, suchpeople should be advised to attend the Alcoholics Anony-

mous self-help groups (Oliviera & Melcop 1997).The consensus suggested that the emergency depart-

ments should create a designated health-care postfor injured accident victims, ensuring that treatmentextends not only to the consequences of alcoholism, butalso deals with the chemical dependence itself. Thepurpose is to deal with the problem as a whole (medica-tion, type of therapeutic intervention and whether or nothospitalization is indicated).

In September 2000, members of ABEAD attended ameeting to organize the Consensus on the Treatment for

Smoking proposed by the National Cancer Institute,which is an organization under the aegis of the BrazilianMinistry of Health. Its target is to train health-care prac-titioners in general, setting up a broad-ranging treatmentnetwork. The structure ranges from quick interventionsto warning about the risk for smoking in any medical

consultation, and avoiding contradictory models, such asphysicians who smoke. The aim will also be to refer thepatients to government treatment centers, as the recom-mended medication is too expensive and not available tomost of the Brazilian population.

PARTNERSHIPS

The work undertaken by ABEAD influenced the estab-lishment of the Chemical Dependence Department onthe Brazilian Psychiatry Association during the 1990s.

Working with the former Narcotics Department of theFederal Narcotics Council (CONFEN), the first NationalSurvey on Psychoactive Substances Consumption wascarried out for the population in general. Agreementshave been signed with the United Nations Program forInternational Drug Control (PNUCID), resulting in thelaunching of two editions of the ABEAD Magazine onAlcohol and Drugs (Revista da ABEAD Álcool e Drogas) andthe publication of bulletins brought out by ABEAD,which are also backed by the Brazilian Ministry of Health.

This pioneer program, ‘Handle your Life with Care’

(Valorização da Vida) prepared by ABEAD, was run in RioGrande do Sul for 1992–1994, in a partnership with theMinistry of Education, the Maurício Sirotsaky Sobrinhofoundation and the State’s Education Bureau. Initially,36 primary and secondary schools were selected in PortoAlegre, the state capital. The previous survey undertakenwhen the project began indicated that drug consumptionin these establishments reached 27.4%. The schools werethen divided into two groups, each containing 18 educa-tional institutions, with a total of 40 443 students. Thedrug use prevention program was implemented in onlyone of the groups. Without necessarily mentioning

the topic of drugs, the students in the selected groupwere provided with information on the advantages of ahealthy life-style, and were offered examples of changinghabits.

Thanks to this program, after 2 hours’ teachingthe experimental schools achieved a drug consumptionlevel 10% below that recorded for the other schoolswhere this campaign was not run, as shown in a fol-low-up survey carried out in 1994. This project wasinterrupted for political reasons, due to the change of government.


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STANDING ACTIVITIES

Seven to eight meetings are organized each year by thisentity, with ABEAD congresses held in the alternateyears.

In 2000, the ABEAD advisory board authorized spon-sorship of a congress by a pharmaceutical laboratory forthe first time. Until then, members believed that it wouldbe contradictory to agree to sponsorship of professionalevents by the same pharmaceutical industry that turnsout the products that create chemical dependency. Thisshift in thinking was prompted by the launch of medica-tions used to combat smoking and alcoholism. The boardagreed to this sponsorship only for these specific medica-tions. The last national conference, which took place inSeptember 2001 in the city of Gramado in the state of Rio Grande do Sul, had about 700 participants fromvarious countries and the following guest speakers: Dr

Jonathan Chick (UK), Dr Brian Rush (Canada), Dr DanielSeijas (Chile) and Dr Raul Caetano (USA).

PUBLICATIONS

In order to publicize the work of ABEAD, the Brazilian Journal on Chemical Dependence ( Jornal Brazileiro deDependências Químicas) was launched in October 2000. Inmagazine format, its 48 pages feature refereed articlesthat meet international scientific requirements. As a 6-monthly periodical, its first edition had a print run of

2000 copies. It is edited by psychiatrist Sérgio Nicastri,from the Institute of Psychiatry, at the São Paulo FederalUniversity and Izabel Martins.

Members receive the ABEAD bulletin (Boletim daABEAD) on a quarterly basis. The eight-page bulletincontains brief papers, a calendar of events and otherinformation.

On its homepage (http://www.abead.com.br), ABEADruns a discussion forum. The intention is to make an on-line version of the bulletin available shortly, togetherwith articles published by the magazine. Its members willbe able to access these texts through a password. This

homepage will also offer links to other drug-related sites.The homepage also contains a list of names, professionsand addresses of the members, making it easier to ex-change experiences and refer patients, when necessary.

CONTACT INFORMATION

In 2000, ABEAD had 840 registered members. It is opento anyone wishing to join, with an annual fee of R$110(around US$55.00). All members have a vote to elect thechairman, but there is a trial period of 2 years after reg-istration before this vote is valid.

The national secretariat of ABEAD operates in PortoAlegre, at the following address:

Avenida Taquara, 595, sala 402CEO: 90.460–210, Porto AlegreRio Grande do Sul, Brazil.

The travelling secretariat is located at the followingaddress:

Rua Dinis Cordeiro, 19Botafogo, Rio de JaneiroRJ, CEP: 22.281–100, Brazil.Contact by Tel/Fax: (55 21) 539 7941

E-mail:[email protected]

REFERENCES

Campana, A. M. & Neto, F. B. (1998) I LevantamentoNacional Sobre o Consumo de Substâncias Psicoativas naPopulação Geral [1st National Survey on PsychoactiveDrugs Consumption in the General Population]. Brazil:Florianopolis.

Galduróz, J. C., Noto, A. R. & Carlini, E. A. (1997) IV Levantamento Sobre o Uso de Drogas entre Estudantes de 1st e2nd Graus em 10 Capitais Brasilieras [IVth Survey on

Drug Use Among Elementary and High School Students in10 Brazilian Cities]. São Paulo: Centro Brasiliero de Infor-mações Sobre Drogas Psicotrópicas [Brazilian InformationCenter on Psychotropic Drugs (CEBRID)], Federal Universityof São Paulo, School of Medicine.

Ministry of Health (1999) Proposta de Normalização dos Serviçosde Atenção à Transtornos por Uso de Substâncias Psicoativas[Proposal of Normalization of the Care Services for Disorderscaused by Psychoactive Drug Use]. Brasilia: Ministry of Health.

Oliviera, E. M. & 7 Melcop, A. G. (1997) Impacto do uso de Álcoole Outras Drogas em Vítimas de Acidente de Trânsito [The Impactof the Use of Alcohol and Other Drugs on the Victims of Traffic Accidents]. Brasilia: ABDETRAN.

Ramos, S. P. & Bertollote, J. M. (1996) Alcoolismo Hoje[Alcoholism Today]. Porto Alegre: Artes Medicas.United Nations (2000) Report from the United Nations Programme

for the International Control of Drugs. Geneva: World HealthOrganization.

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