A literature review on strategies for building autonomy in Brazilian healthcare services for drug users

Abstract

The theoretical and practical frameworks that comprise the psychosocial paradigm in the field of drugs, featuring harm reduction and health promotion, focused attention on the suffering individual in relation to the social reality. Such frameworks value the uniqueness of users and healthcare workers for understanding the health-disease process and building effective health policies. The concept that underlies and unites these characteristics is autonomy. However, there are diverse definitions and practices pertaining to autonomy, with intrinsic plurality in the development of mental health and drug policy in Brazil. The article aims to describe the strategies for building autonomy for persons with abusive drug use. The method was an integrative review, searching the PsycInfo, PubMed, Virtual Health Library (VHL), and Web of Science databases for studies that analyzed the process of care for drug users. The review systematized actions that build autonomy and the barriers to care. Twenty-two studies were selected, of which 18 were studies in CAPS AD (Centers for Psychosocial Care for Alcohol and Drug Abuse) and 4 in primary care services. The review highlighted actions aimed at reclaiming individual social value, unique individual treatment plans, and harm reduction workshops. Barriers include the requirement of abstinence, lack of inter-sector collaboration, lack of social rehabilitation through work, and lack of participation in community and political spaces. The evidence points to a set of contradictory and diffuse practices, with some that build autonomy and others that impose control over users. Even so, the actions by CAPS AD and primary care are essential for reclaiming autonomy in the face of stigmatization and marginalization.