ABEAD GRT 5 – Recomendações para a Prevenção de Drogas no Brasil

ABEAD 2014
GRT 5 – Recomendações para a Prevenção de Drogas no Brasil
Ana Cecilia P. R. Marques, Florence Kerr-Corrêa, Priscila Previato, Clarice Madruga, Cesar Pazzinatto
Ao longo da história da Humanidade, as substâncias psicoativas e psicotrópicas ou de abuso (SP) vem sendo utilizadas com finalidades múltiplas, tanto como parte de cerimônias religiosas, sociais, festivas, até como medicamento, em antigos rituais de cura. Ainda hoje, algumas são prescritas para regular o pensamento e o comportamento. Essa sobreposição de contextos para o uso dificulta o entendimento do processo etiopatogênico, que pode levar de um primeiro contato com uma SP (ou “droga”, no sentido popular da palavra), aos limites devastadores da dependência, com lesões de vários órgãos, entre os quais, e mais importante, o cérebro.
Diversos fatores foram identificados como relevantes na determinação do uso problemático e da dependência, entre eles, os transtornos mentais e de comportamento, que para alguns precedem a experimentação, e na maioria dos casos não são diagnosticados (1-10). O transtorno de atenção na infância, o transtorno opositivo desafiador, são exemplos, pois podem desencadear comportamentos impulsivo-agressivos na adolescência, dificuldades no estabelecimento de relações interpessoais, e ainda mais, abuso e dependência de SP (11-15). Assim, é muito importante definir os pressupostos filosóficos, éticos e científicos para o desenvolvimento de intervenções preventivas. Os mais importantes são:
·         O fenômeno do uso, abuso e dependência de SP é composto por dimensões biológicas e psicossociais, que lhe confere extrema complexidade, e implica em adotar modelos de abordagem com multicomponentes (16-24).
·         Prevenir o uso precoce de SP, isto é, de início na adolescência, é um procedimento que apresenta benefícios para a saúde,comprovadamente (25-38).
·         A dependência de SP é uma grave doença do cérebro, crônica, recidivante e fatal, se não for tratada (39-43).

ABEAD em 1990 elaborou um programa de prevenção para o não uso de álcool, o PRONAL, e recomendou ao governo brasileiro a adoção dos seguintes princípios gerais (44):
·         O impacto do consumo de bebidas alcoólicas atinge o indivíduo e seu entorno e portanto, a prevenção deve ser universal;
·         As ações de enfrentamento do problema devem respeitar particularidades históricas, sociais e culturais, e envolver toda a comunidade;
·         As políticas devem ser integradas às demais, fundamentadas no conhecimento científico já existente sobre o tema.

Na atualidade, a partir dos resultados de estudos recentes sobre prevenção, “novos princípios” são recomendados:
·         A prevenção deve acontecer em níveis hierárquicos de acordo com o diagnóstico situacional (45-53).
·         O modelo preventivo moderno é aquele que otimiza e amplia o foco da intervenção nos fatores de proteção, e age para a diminuição dos de risco, quer seja no indivíduo, na família, na comunidade ou na escola (54-67).
·         Para o desenvolvimento efetivo de medidas preventivas, os pais devem ser envolvidos, pois representam a influência mais importante no comportamento de crianças e adolescentes (68-80).
·         influência do grupo é muito importante: a maioria dos adolescentes estava com amigos quando experimentou pela primeira vez alguma SP (81-97).
·         As políticas sobre drogas devem ser definidas levando em conta as diferenças existentes entre os gêneros, fases do desenvolvimento humano, entre outros aspectos (98-103).
·         Sustentabilidade é um aspecto fundamental para o sucesso de qualquer programa preventivo, pois permite supervisionar, avaliar e redirecionar as ações aplicadas (104-112).

Para desenvolver a prevenção hoje, as seguintes estratégias são preconizadas:
·         Educar ou persuadir as pessoas a não usar, ou fazê-lo, quando permitido, de modo a produzir o menor risco possível (113-117).
·         Dissuadir os comportamentos relacionados ao uso com a ameaça de sanções (persuasão negativa) (118-120).
·         Regulamentar e controlar a disponibilidade das SP ou as condições de sua utilização (121-127).
·         Agregar aos programas preventivos os movimentos sociais ou religiosos empenhados em evitar e reduzir o uso (128-129).
·         Tratar ou aconselhar as pessoas que já apresentam problemas relacionados ao uso (130-140).
·         Acompanhar os resultados dos estudos sobre a estratégia de Redução de Danos, entre outras estratégias aplicadas nos países desenvolvidos, antes de replicá-las no Brasil, e se adotadas, utilizá-las na forma de pesquisa, aplicando os princípios éticos e metodológicos exigidos (141-147).
·         Integrar as políticas preventivas às assistenciais e aquelas para controle da oferta, o modelo de uma política integral, preconizado pela Ciência(148-150).

A ABEAD endossa as recomendações advindas dos estudos científicos, e ressalta que em função da diversidade regional do Brasil, assim como de suas dimensões, é preciso descentralizar as políticas, principalmente as preventivas, aculturando as ações, estruturando-as de acordo com os recursos locais, e acima de tudo, garantindo programas permanentes e sustentáveis.



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