The National Association of Social Workers policy statement views the issue from both a family systems perspective, as well as a patient-centered approach. They also show concern for treatment of commonly co-occurring disorders, such as mood or anxiety disorders. They suggest that substance abuse should be viewed along a continuum, rather than a dichotomy of substance dependence or substance abuse; this allows a larger number of clients to be eligible for treatment by meeting the criteria of Substance Use Disorder. Additionally, harm reduction has become emphasized as a means of consistency with the social work value of self-determination.
NASW policy on substance use requires “evidence-informed methods” of treatment, as well as a holistic approach that considers “clinical intervention, medication therapy, harm-reduction approaches, and alternatives to incarceration.” There is an emphasis on empathy, suggesting the “elimination of stigmatizing language,” that is not supportive and respectful. Strengths-based language is encouraged. Comprehensive care is also important: addressing other issues in the client’s life that affect the substance use, such as “health, employment, family, housing, legal, and other problems that may impede recovery.” These issues should be collaborated on by other relevant professionals, who will also utilize evidence-based “methods of assessment, intervention, and evaluation.” (National Association of Social Workers, 2018-2020, pp. 316-317)Substance Use Policies in PortugalIn 2001, Portugal decriminalized substance use. This includes the “acquisition, possession, and use of small quantities of psychoactive drugs,” (Lacqueur, 2014, p. 1).
The main goal of the Portuguese CDT referral system is to “dissuade new drug users and to encourage dependent drug users to enter treatment,” (Hughes & Stevens, 2007, p. 2). These CDTs employ social workers, legal experts, and medical advisors. A citizen found in possession of drugs is referred to the CDT, appears before them within 72 hours, and the panel reaches a decision for treatment. They determine whether the person is an occasional drug user or a dependent drug user; they use this to establish a course of action. If they are an occasional drug user, they will most likely be given a fine or community service; if they are a dependent drug user, they will receive no fine, but will be entered into a treatment or education program (Hughes & Stevens, 2007, pp. 1-2).It can be debated whether the results of these policy changes are positive.
From 1999 to 2007, cannabis use has increased in school-age pupils, but heroin and opiate use has decreased (Hughes & Stevens, 2007, p. 3). Drug supply has also decreased; drug trafficking through Portugal into Latin America has been historically significant (Hughes & Stevens, 2007, p. 3). Drug-related diseases, such as HIV and Hepatitis, were significantly decreased between 1999 and 2019, possibly due to the needle exchange program implemented (Portugal Country Drug Report 2019, 2019).United Nations substance use policies. One of the United Nations’ main principles is to “ensure that no one is left behind,” resulting in policies that call for the decriminalization of illicit substances.
The UN describes the criminalization of substance use as “punitive laws that have been proven to have negative health outcomes,” (Joint United Nations statement on ending discrimination in health care settings, 2017). The UN has also launched a task force “to enhance coordination and deliver more comprehensive assistance to countries facing drug-related challenges,” (Guterres, 2019). The UN Secretary-General stated in a video that “Drug addicts need treatment, not punishment,” (Guterres, 2019).
Guterres was the Portuguese Prime Minister, and stated in the UN press release that the 2001 decriminalization of substance use in Portugal was incredibly effective. Personal opinions on substance use policies. My personal opinion is that substance use should be treated as a health issue, including both medical health and psychological health. I feel that a system similar to that of the Portuguese could be effective in the United States, though some changes may be necessary due to culture, population, etc. I also feel that substance use sanctions in the United States are far too harsh and incredibly discriminatory.
To me, there is an obvious discrimination against racial minorities in arrests and punishment for non-violent drug crimes. As stated in the abstract, there are disproportionate amounts of African American and Hispanic American citizens incarcerated, as compared to white citizens. Additionally, I feel that part of the cause for these disparities is political power; racial minorities most often vote liberally, and once they are released from prison, they no longer have the ability to vote for elected officials. Republican elected officials standardly support policies of incarceration for non-violent drug crimes, effectively removing a large population of those who would vote for Democratic candidates and policies.
There are more similarities between the UN, NASW, Portuguese, and my personal stances on drug use than there are differences. Similarly, decriminalization is supported by Portuguese laws, the UN, and my own personal opinions. All three see a need for medical and mental health treatment rather than incarceration. However, the scope of these three are different. Portugal has a specific, already-implemented system with rules, regulations, and standard procedures. The UN, in contrast, has given multiple statements of support for legalization, but has not implemented a requirement for its members, or put specific systems in place.
Personally, I mostly align myself with the Portuguese policies on drug use, though my own opinions are more relevant to the United States. I also agree with the UN’s policies, though again, my opinions are more relevant to the United States’ history, culture, and politics.The NASW policies are more clinical and less broad than the other institutions discussed. NASW speaks more on personal interactions with substance users, and how a social worker should provide treatment for them. The 2018-2020 NASW policy statement does not mention decriminalization as the UN, Portugal, and myself do, but it does reference “alternatives to incarceration,” (p.317). However, the common theme in all four policies is that of empathy, methods of harm-reduction, and treatment rather than incarceration.