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Since it decriminalised all drugs in , Portugal has seen dramatic drops in overdoses, HIV infection and drug-related crime. W hen the drugs came, they hit all at once. It was the 80s, and by the time one in 10 people had slipped into the depths of heroin use — bankers, university students, carpenters, socialites, miners — Portugal was in a state of panic. The crisis began in the south. Headlines in the local press raised the alarm about overdose deaths and rising crime. Pereira recalled desperate patients and families beating a path to his door, terrified, bewildered, begging for help. In truth, there was a lot of ignorance back then. The country was closed to the outside world; people missed out on the experimentation and mind-expanding culture of the s. When the regime ended abruptly in a military coup in , Portugal was suddenly opened to new markets and influences. Under the old regime, Coca-Cola was banned and owning a cigarette lighter required a licence. When marijuana and then heroin began flooding in, the country was utterly unprepared. Pereira tackled the growing wave of addiction the only way he knew how: one patient at a time. A student in her 20s who still lived with her parents might have her family involved in her recovery; a middle-aged man, estranged from his wife and living on the street, faced different risks and needed a different kind of support. Pereira improvised, calling on institutions and individuals in the community to lend a hand. Rather than being arrested, those caught with a personal supply might be given a warning, a small fine, or told to appear before a local commission — a doctor, a lawyer and a social worker — about treatment, harm reduction, and the support services that were available to them. The opioid crisis soon stabilised, and the ensuing years saw dramatic drops in problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime and incarceration rates. HIV infection plummeted from an all-time high in of The data behind these changes has been studied and cited as evidence by harm-reduction movements around the globe. In many ways, the law was merely a reflection of transformations that were already happening in clinics, in pharmacies and around kitchen tables across the country. The official policy of decriminalisation made it far easier for a broad range of services health, psychiatry, employment, housing etc that had been struggling to pool their resources and expertise, to work together more effectively to serve their communities. The language began to shift, too. This, too, was crucial. While drug-related death, incarceration and infection rates plummeted, the country still had to deal with the health complications of long-term problematic drug use. Diseases including hepatitis C, cirrhosis and liver cancer are a burden on a health system that is still struggling to recover from recession and cutbacks. They criticise the state for dragging its feet on establishing supervised injection sites and drug consumption facilities; for failing to make the anti-overdose medication naloxone more readily available; for not implementing needle-exchange programmes in prisons. Where, they ask, is the courageous spirit and bold leadership that pushed the country to decriminalise drugs in the first place? Drugs were denounced as evil, drug users were demonised, and proximity to either was criminally and spiritually punishable. Informal treatment approaches and experiments were rushed into use throughout the country, as doctors, psychiatrists, and pharmacists worked independently to deal with the flood of drug-dependency disorders at their doors, sometimes risking ostracism or arrest to do what they believed was best for their patients. Lopes was the first doctor in continental Europe to experiment with substitution therapy, flying in methadone powder from Boston, under the auspices of the Ministry of Justice, rather than the Ministry of Health. His efforts met with a vicious public backlash and the disapproval of his peers, who considered methadone therapy nothing more than state-sponsored drug addiction. In Lisbon, Odette Ferreira, an experienced pharmacist and pioneering HIV researcher, started an unofficial needle-exchange programme to address the growing Aids crisis. She received death threats from drug dealers, and legal threats from politicians. She collected donations of clothing, soap, razors, condoms, fruit and sandwiches, and distributed them to users. A flurry of expensive private clinics and free, faith-based facilities emerged, promising detoxes and miracle cures, but the first public drug-treatment centre run by the Ministry of Health — the Centro das Taipas in Lisbon — did not begin operating until But Porto was at the other end of the country. To get around that, Pereira sometimes asked a nurse to sneak methadone to him in the boot of his car. Now 68, he is sprightly and charming, with an athletic build, thick and wavy white hair that bounces when he walks, a gravelly drawl and a bottomless reserve of warmth. By the time he finished school, got his licence and began practising medicine at a health centre in the southern city of Faro, it was everywhere. Like Pereira, he accidentally ended up specialising in treating drug addiction. These kinds of centres have used different names and acronyms over the years, but are still commonly referred to as Centros de Atendimento a Toxicodependentes , or CATs. Local residents were vehemently opposed, and the doctors were improvising treatments as they went along. It had become clear to a growing number of practitioners that the most effective response to addiction had to be personal, and rooted in communities. Treatment was still small-scale, local and largely ad hoc. He found the practice of jailing people for taking drugs to be counterproductive and unethical. He recommended that drug use be discouraged without imposing penalties, or further alienating users. The resulting recommendations, including the full decriminalisation of drug use, were presented in , approved by the council of ministers in , and a new national plan of action came into effect in He has been the lodestar throughout eight alternating conservative and progressive administrations; through heated standoffs with lawmakers and lobbyists; through shifts in scientific understanding of addiction and in cultural tolerance for drug use; through austerity cuts, and through a global policy climate that only very recently became slightly less hostile. Every family had their addict, or addicts. A drop-in centre called IN-Mouraria sits unobtrusively in a lively, rapidly gentrifying neighbourhood of Lisbon, a longtime enclave of marginalised communities. From 2pm to 4pm, the centre provides services to undocumented migrants and refugees; from 5pm to 8pm, they open their doors to drug users. A staff of psychologists, doctors and peer support workers themselves former drug users offer clean needles, pre-cut squares of foil, crack kits, sandwiches, coffee, clean clothing, toiletries, rapid HIV testing, and consultations — all free and anonymous. On the day I visited, young people stood around waiting for HIV test results while others played cards, complained about police harassment, tried on outfits, traded advice on living situations, watched movies and gave pep talks to one another. They varied in age, religion, ethnicity and gender identity, and came from all over the country and all over the world. When a slender, older man emerged from the bathroom, unrecognisable after having shaved his beard off, an energetic young man who had been flipping through magazines threw up his arms and cheered. And he would know. He had stopped doing speedballs mixtures of cocaine and opiates after several painful, failed treatment attempts, each more destructive than the last. He long used cannabis as a form of therapy — methadone did not work for him, nor did any of the inpatient treatment programmes he tried — but the cruel hypocrisy of decriminalisation meant that although smoking weed was not a criminal offence, purchasing it was. After this relapse, he embarked on a new relationship, and started his own business. At one point he had more than 30 employees. Then the financial crisis hit. I met Raquel and Sareia — their slim forms swimming in the large hi-vis vests they wear on their shifts — who worked with Crescer na Maior , a harm-reduction NGO. Six times a week, they loaded up a large white van with drinking water, wet wipes, gloves, boxes of tinfoil and piles of state-issued drug kits: green plastic pouches with single-use servings of filtered water, citric acid, a small metal tray for cooking, gauze, filter and a clean syringe. Portugal does not yet have any supervised injection sites although there is legislation to allow them, several attempts to open one have come to nothing , so, Raquel and Sareia told me, they go out to the open-air sites where they know people go to buy and use. The man looked sheepish. He was accompanied by his beaming girlfriend, and waved a warm goodbye to the girls as they handed him a square of foil. In the foggy northern city of Porto, peer support workers from Caso — an association run by and for drug users and former users, the only one of its kind in Portugal — meet every week at a noisy cafe. They come here every Tuesday morning to down espressos, fresh pastries and toasted sandwiches, and to talk out the challenges, debate drug policy which, a decade and a half after the law came into effect, was still confusing for many and argue, with the warm rowdiness that is characteristic of people in the northern region. I was told this again and again in the north: thinking of drug addiction simply in terms of health and disease was too reductive. Some people are able to use drugs for years without any major disruption to their personal or professional relationships. It only became a problem, they told me, when it became a problem. Caso was supported by Apdes , a development NGO with a focus on harm reduction and empowerment, including programmes geared toward recreational users. Their award-winning Check! I was told more than once that if drugs were legalised, not just decriminalised, then these substances would be held to the same rigorous quality and safety standards as food, drink and medication. High-level UNgass meetings are convened every 10 years to set drug policy for all member states, addressing trends in addiction, infection, money laundering, trafficking and cartel violence. By the time of the next session, in , worldwide drug use and violence related to the drug trade had vastly increased. The biggest change in global attitudes and policy has been the momentum behind cannabis legalisation. Massive international cultural shifts in thinking about drugs and addiction are needed to make way for decriminalisation and legalisation globally. But if conservative, isolationist, Catholic Portugal could transform into a country where same-sex marriage and abortion are legal, and where drug use is decriminalised, a broader shift in attitudes seems possible elsewhere. But, as the harm-reduction adage goes: one has to want the change in order to make it. But the opposite happened. The CAT building itself is a drab, brown two-storey block, with offices upstairs and an open waiting area, bathrooms, storage and clinics down below. The doors open at 8. Patients wander in throughout the day for appointments, to chat, to kill time, to wash, or to pick up their weekly supply of methadone doses. Anyone receiving treatment elsewhere in the country, or even outside Portugal, can have their prescription sent over to the CAT, making the Algarve an ideal harm-reduction holiday destination. After lunch at a restaurant owned by a former CAT employee, the doctor took me to visit another of his projects — a particular favourite. Several such UDs, as they are known, have opened in other regions of the country, but this centre was developed to cater to the particular circumstances and needs of the south. Pereira stepped down as director some years ago, but his replacement asked him to stay on to help with day-to-day operations. Pereira should be retired by now — indeed, he tried to — but Portugal is suffering from an overall shortage of health professionals in the public system, and not enough young doctors are stepping into this specialisation. They treat themselves. My function is to help them to make the changes they need to make. The glass doors at the entrance slid open to a facility that was bright and clean without feeling overwhelmingly institutional. This facility, like the others, is connected to a web of health and social rehabilitation services. It can house up to 14 people at once: treatments are free, available on referral from a doctor or therapist, and normally last between eight and 14 days. When people first arrive, they put all of their personal belongings — photos, mobile phones, everything — into storage, retrievable on departure. To the left there were intake rooms and a padded isolation room, with clunky security cameras propped up in every corner. Patients each had their own suites — simple, comfortable and private. In another room, coloured pencils and easels for drawing. A kiln, and next to it a collection of excellent handmade ashtrays. Many patients remained heavy smokers. Patients were always occupied, always using their hands or their bodies or their senses, doing exercise or making art, always filling their time with something. To help bring the body back, there was a small gym, exercise classes, physiotherapy and a jacuzzi. And after so much destructive behaviour — messing up their bodies, their relationships, their lives and communities — learning that they could create good and beautiful things was sometimes transformational. He believed that everyone — however imperfect — was capable of finding their own way, given the right support. He was firm, he said, but never punished or judged his patients for their relapses or failures. Patients were free to leave at any time, and they were welcome to return if they needed, even if it was more than a dozen times. He offered no magic wand or one-size-fits-all solution, just this daily search for balance: getting up, having breakfast, making art, taking meds, doing exercise, going to work, going to school, going into the world, going forward. Being alive, he said to me more than once, can be very complicated. A longer version of this piece appears on thecommononline. By Susana Ferreira. View image in fullscreen. What Britain could learn from Portugal's drugs policy. Read more. Reuse this content. Most viewed.

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Bog Walk where can I buy cocaine

This section explains how using drugs and alcohol can affect your mental health. It also explains how you can get help to stop using drugs and alcohol. This information is for people affected by mental illness in England who are 18 or over. See this 46 second video for why this is important. People use drugs and drink alcohol for lots of different reasons. Whatever your reason, using drugs or alcohol may have a long-term negative effect on you. The possible long-term effects include the following. If you use alcohol or drugs for a long time it can cause serious issues for your mental well-being. Drugs can make you more unwell and more likely to try and harm yourself or take your own life. There is also some evidence that using some drugs may cause mental illness for the first time. For example, research has shown that cannabis can increase your chances of developing psychosis or a psychotic disorder. Psychosis is a medical term. If you have psychosis you will process the world around you differently to other people. This can include how you experience, believe or view things. You might see or hear things that others do not. Or believe things other people do not. Some people describe it as a 'break from reality'. There are different terms use to describe psychosis. You can find more information about 'Psychosis' by clicking here. In this section we have listed some of the different types of substances that could have an impact on your mental health. Please be aware that this list is not a list of all substances. Taking any substances can be dangerous. They can also have bad interactions with any medications or other substances you might use. They are a specialist charity that provides information on drugs. You can find their website here: www. Cannabis is one of the most commonly used drugs in England. According to one study, 1 in 13 people aged had used it in the last year. Young people aged are more likely to use cannabis. The same study shows that just under 1 in 5 young people had used cannabis between and Some people take cannabis because it makes them feel relaxed or happy, but It can also make you feel anxious or feel paranoid. Some people may experience things that aren't real. This is a sign of drug-induced psychosis. Some studies have shown that the risk of psychosis may be higher if you:. If you have been using cannabis and you feel that it is affecting your health, make an appointment to see your GP as soon as you can. Your doctor should not judge you and should not tell other people you use drugs. Some people with a mental illness have problems using alcohol. Alcohol is legal, which means it is easier to get. It can make the feelings of some mental health issues feel worse. The long-term effects of alcohol also depend on how much you drink, and how regularly you drink it. If you drink too much on a regular basis then you could cause yourself serious physical and mental harm. Drinking can make you do something you would not normally do. This can include self-harm and suicide. Very high levels of alcohol can cause psychosis. These are drugs that contain one or more chemical substance. They produce effects that are similar to cocaine, cannabis and ecstasy. This is a common term that people use. It is used because some NPS were legal before However, the name is now wrong, because since they have been made illegal. Some new psychoactive drugs can cause confusion and a feeling of panic. You can also have hallucinations. Hallucinations can affect the way you behave. Your behaviour can become erratic and can put your own safety at serious risk. Some NPS can be very dangerous. They can kill you or hurt you very badly. There is a higher risk of this if taken with alcohol or other psychoactive drugs. In the short-term, these drugs can make you feel wide awake and alert. This can make it difficult for you to relax or get to sleep. They might cause you to have a drug-induced psychosis. In the long-term, amphetamines might make you anxious and depressed. They can also be addictive. Benzodiazepines are a type of tranquilisers. They are used to treat anxiety. They are also used as a muscle relaxant. Sometimes a doctor will tell you to take benzodiazepines to help you with anxiety. But people also buy them illegally because of their relaxing effects. They can be addictive, and so doctors only give them for a short time. In the short-term, these drugs can make you feel calmer. Depending on the type you take, they could make you feel confused or overly sleepy. Taking benzodiazepines with other drugs or alcohol can be dangerous. It can affect your breathing. It can also increase the risk of overdose and death. In the long-term, some people become addicted. This can have a big effect on their day-to-day life. In the short-term, cocaine can make you feel awake, talkative and confident. After this wears off, you can feel tired and depressed after taking it. In the long-term, cocaine use can affect how you feel. It can affect your relationships with friends and family. Cocaine is also addictive and over time you are more likely to have ongoing problems with depression, paranoia or anxiety. Cocaine can cause fits, heart attacks and strokes. If you mix it with some other drugs you are more likely to overdose or die. In the short-term, ecstasy may make you feel energetic, very happy, chatty and confident. It can also sometimes make you feel anxious, confused or trigger drug-induced psychosis. In the long-term, ecstasy use can lead to memory problems. You may also develop depression and anxiety. In the short-term, heroin can make you feel relaxed and happy. It takes away pain and can make you feel sleepy. But there is a higher risk that you could take too much or overdose with heroin than some other drugs. Heroin can be taken in lots of different ways, including by injection. However, there is a high risk of getting an infection if you inject heroin, particularly if you share needles with someone else. Heroin is very addictive. It can have serious long-term effects. You may feel that heroin becomes more important than other things in your life. This might make it harder to keep a job and affect your relationships. In the short-term, LSD may make you experience things that aren't real. Sometimes the experience will be enjoyable, and sometimes it will be frightening. This is known as a bad trip. If you have a history of mental health problems taking LSD can make it worse. If you panic during a trip on LSD it can be scary. Your local NHS trust may have a policy that says how they will help people with dual diagnosis. Check on their website to see if you can find out more about what to expect locally. If you are not already getting help with your mental health from your local mental health team, a good first step is to make an appointment to see your GP. Your GP may offer you medication and therapy to treat your mental illness. They may refer you to a drug and alcohol service to help you with your drug use. If your needs are too complicated for your GP to deal with alone, you might need more specialist support. They should offer this support and work with drug and alcohol services to give you all the help you need. The Department of Health and Social Care says that people with dual diagnosis are a key group of people who should get help from mental health services. You should not be stopped from getting help if you have drug or alcohol problems and severe mental illness. They say that people who have a severe mental illness and drug or alcohol problem should get help under the Care Programme Approach CPA. Under the CPA you will have a care co-ordinator to plan your care. They will help to write a care plan. This should account for all the different needs you might have such as:. NICE also say that you should be able to give your views on the care plan to make sure that it meets your needs. And the care plan should be shared with your carers or family if you agree. You can read the NICE guidance online here: www. There may be a team in your area which helps people with dual diagnosis. It is sometimes called the dual diagnosis team. However, not all areas of the country have them, and it may have a different name. If there isn't one in your area, you could try contacting your local community mental health team CMHT for help. As well as NHS services, you could try contacting local charities. Many charities have support services or support groups for people struggling with substance misuse. You can find some national charities listed in the Useful Contacts section below. Some people with dual diagnosis have told us that it has been difficult to get the help they need. For example, you may have been told that mental health services cannot help you because of your drink or drugs problem. But the Department of Health and Social Care is very clear that mental health services should try to help you if you have dual diagnosis. The National Institute for Health and Care Excellence NICE also say that you should not be turned away from mental health services because you have a drug or alcohol problem. You can ask for a copy of their policy for eligibility criteria. You may then be able to use this to show you are eligible for their support. If you are not happy with the services you get, talk to the person in charge of your care. This might be your GP or your 'care coordinator'. They might be able to change things for you. An 'advocate' may be able to help you to get your point of view across. You might need to make a complaint to the NHS if you do not get the help you need. Supporting someone struggling with dual diagnosis can be difficult. It might help to speak to the person you are helping, to see what support they want. For example, some people might just want someone to talk with. Other people might want more practical help, such as with booking appointments or helping them speak to professionals. We Are With You and Adfam are two charities that offer support and advice to relatives, friends and carers of those struggling with substance misuse. You can find their contact details in the Useful Contacts section below. You might also feel that you need support for yourself. You may be able to get practical support to help you with your caring responsibilities. But this can only happen if the person who you care for wants you to be involved. Speak to the mental health team if you have ideas about what services should be available or how things could work better. Drinkline This is the national alcohol helpline. They provide information and selfhelp materials for callers worried about their own drinking, and to support the family and friends of people who are drinking. They are confidential, you do not have to give your name and they can provide advice on where to get help. Telephone : Open weekdays 9am — 8pm, weekends 11am — 4pm. Webchat Drinkchat : www. Adfam This is a national charity for families and friends of drug users. It offers confidential support and information. Frank Frank provides information and advice on drugs to anyone concerned about drugs and solvent misuse, including people misusing drugs, their families, friends and carers. Open 24 hours a day, every day Text : Email : Online form here: www. Website : www. Alcohol Change UK Alcohol concern is the national organisation for alcohol misuse. It does not provide services, but they do produce information on alcohol. We Are With You This is a drug and alcohol treatment agency. Their services deal primarily with drug and alcohol problems including support for families. Al-Anon Family Groups This is a service for families and friends of alcoholics. Al-Anon family groups provide understanding, strength and hope to anyone whose life is, or has been, affected by someone else's drinking. They are recovering addicts who meet regularly to help each other stay clean. They have groups around the country. Helpline : 10am — midnight Website : www. Alcoholics Anonymous AA AA provides an opportunity for people to get together to solve their problem with alcohol and help others to recover. Cocaine Anonymous CA CA is a fellowship of men and women who use the 12 step, self-help programme to stop cocaine and all other mind-altering substances. Telephone : Open 10am — 10pm every day. DrugWise DrugWise provides information and publications on a wide range of drug related topics. PostScript A charity committed to supporting individuals to reduce the harms caused by prescribed drugs that are associated with dependence and withdrawal. They do this through a wrap-around service of one to one therapy, group therapy and a telephone support service. Release They offer advice and information on drug problems. They have expertise in legal matters surrounding drugs. Email : ask release. Turning Point This is an organisation that works with people affected by drug and alcohol misuse, mental health problems and learning disabilities. Advice and information About mental illness Learn more about conditions Drugs, alcohol and mental health. Drugs, alcohol and mental health This section explains how using drugs and alcohol can affect your mental health. Download Drugs, alcohol and mental health factsheet. Share: Contact us:. Overview There are many reasons why you might use drugs and alcohol. Some people use them to try and deal with their symptoms of their mental illness. This is called 'self-medication'. Drugs and alcohol can make the symptoms of your mental illness worse. Some drugs may make it more likely for you to get a mental illness, and they may make it harder to treat. Mental health, and drug and alcohol services should work together to give you the support you need. If you have any problems getting help, you could make a complaint. Need more advice? If you need more advice or information you can contact our Advice and Information Service. Contact us Contact us. About How can drugs and alcohol affect my mental health? Needing to take more to get the same effect. High blood pressure and strokes. Problems with your liver and pancreas. Development of certain cancers e. Difficulty obtaining or maintaining an erection. Problems with orgasms. Difficulties becoming pregnant. Feeling like you must use the drug or alcohol. This is known as being dependent. Having sudden mood changes. Having a negative outlook on life. Loss of motivation. Problems with relationships. Being secretive. Having episodes of drug-induced psychosis. What is psychosis? Drugs and effects Which substances can affect my mental health? Alcohol Also known as: bevvies, booze Some people with a mental illness have problems using alcohol. The short-term effects of an NPS depend on what you take. These drugs can also affect your judgement, which could put you at risk. When you stop taking the drug, you may feel depressed and you might find it hard to sleep. Getting help How can I get help? This should account for all the different needs you might have such as: social care, housing, and physical health. Worried about your mental health? Care Programme Approach by clicking here. Problems What can I do if I have problems trying to get help? You can find more information about: Advocacy by clicking here. Complaints by clicking here. Carer's, friends and relatives What if I am a carer, friend or relative? NICE also says that if you are caring for someone with a dual diagnosis you can: be involved in their care planning, and work with services to help those services improve. You can find more information about: Supporting someone with a mental illness by clicking here. Confidentiality — for carers, friends and relatives by clicking here. Useful contacts Drinkline This is the national alcohol helpline.

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