When you think of Portugal, you might think of their dominant national football team (or the dominant personality of their star player, one Cristiano Ronaldo), charcoal chicken, or, for people with a historical bent, the foundation of the first global empire. However, for us, Portugal provides a guiding example of forward-thinking, person-centred drug policy.
In the eighties, when European appetites for addictive drugs were sweeping through other European countries, southern Portugal became one of Europe’s largest drug ports. As in many other countries, addiction, particularly to heroin, skyrocketed, and overdose deaths began to plague the streets. Once the HIV epidemic hit Portugal, injecting drug users – who, by that point, comprised around one per cent of the population – were affected by Portugal’s infection rate, at the time the highest in the European Union.
The rapid, devastating toll of the arrival of the drug market in Portugal was partially to do with the country’s forty-year authoritarian regime. Antonio Salazar, the dictator who ruled Portugal with an iron fist from 1933, had crippled education and kept Portugal closed to the outside world. As a result, the Portuguese were not exposed to the early waves of hippie drug culture that saturated other Western countries in through the sixties and seventies. This lack of education – both on the matter of drugs, and education more generally – meant that the population was poorly informed about the drugs arriving on their shores, and those in the legal and medical professions were unable to respond adequately to the growing tide of deaths due to overdose.
Early efforts at battling addiction were impromptu, driven more by guesswork and desperation than the evidence-based approach adopted by modern SMART Recovery groups. Some doctors smuggled in methadone for addicted patients, while other faith-based clinics offered spiritual, rather than physical healing.
Surprisingly for a country as notoriously conservative as Portugal, it was as early as 1996 when the government, under advice from Rui Pereira, a former constitutional court judge, declared that the practice of jailing drug users was “counterproductive and unethical“. This position – that to combat an epidemic, you need to discourage people with education rather than punitive measures – was as radical then as it might seem now. Although it sounds like common sense to us, widespread fear and misinformation meant that drug users and those who supported them faced ostracism and isolation.
In 2001, the Portuguese government decriminalised all drugs. The results of this action speak for themselves: overdose rates dropped, drug-related crime dropped, and HIV infection went from an all-time high in 2000 of 104.2 new cases per million to 4.2 cases per million in 2015. The Portuguese strategy is motivated by principles that will seem very familiar to anyone who has dealt with SMART Recovery Australia:
- There is no such thing as a “soft” or “hard” drug, only relationships with drugs that can be healthy or unhealthy.
- An unhealthy relationship with drugs more often than not heralds other damaged relationships with other people.
- It is impossible to eradicate all drugs.
Portugal’s national policy, in a nutshell, is treating every individual patient like an individual. Every single one is a person with hopes, dreams, feelings and a unique experience of the world that led them to seek treatment. Portugal’s person-centred, future-focused strategy has been proven to work wonders, and it’s evidence like this that encourages SMART Recovery to continue valuing people, and our evidence base, over knee-jerk or fearful reactions. Kindness and education always wins.