The Director-General of Arrisca points out that it is important to understand that “drug addiction is a chronic disease, a disease of the central nervous system” and that it should be treated in the same way as other pathologies. At a time when there is increasing talk of addiction, Suzete Frias, Director-General of ARRISCA – Regional Association for Rehabilitation and Socio-Cultural Integration of the Azores, takes stock of the situation at the institution she heads. “Daily demand varies, because we have those who take their daily doses under supervision, and we also have scheduled appointments and an open-door policy, where anyone can come in without an appointment and be assessed by whoever is on duty,” the director points out.

ARRISCA is not only an institution that has a methadone hydrochloride administration program, it also provides rehabilitation and treatment for drug addicts, which can be done in various ways. Through the Director-General, our newspaper confirmed that in 2023, 1,691 users were treated, of whom 291 were women and 1,400 were men. The following year, ARRISCA treated around 1,702 individuals (333 women and 1,369 men). By September of this year, around 1,561 people had already been treated.

Of the 1,702 people treated in 2024, most were drug addicts. Within this group, many people begin their treatment through a process of withdrawal. Immediately afterwards, psychiatric stabilization is sought. “There is always an assessment; the team is multidisciplinary, and we have medical, psychological, and social assessments,” says Suzete Frias. In the initial phase, an assessment consultation is always carried out to determine the person’s needs. The director points out that it is important to understand that “drug addiction is a chronic disease, it is a disease of the central nervous system,” and that it should be viewed in the same way as other pathologies.

ARRISCA identifies three types of patients. The first type is the patient who can be treated behaviorally and who may no longer use drugs. The second type is users who need pharmacological support for a few years, in this case through methadone, but who can maintain a stable life over several years. The third type of patient is one in which intervention occurs only to reduce harm, i.e., the goal is to reduce their consumption. “They consume less often, so they are less likely to become infected with STIs, less likely to infect others, less likely to steal, because instead of consuming four times, they consume only once or twice, we are reducing harm. It is not a treatment program, it is a harm reduction program,“ defines the Director General.

Suzete Frias believes that the key is to convey the message to the community that withdrawal can also be achieved without methadone hydrochloride, since, according to her, the community ”puts methadone in a big bag.” For withdrawal without the substance, the individual must meet certain requirements, such as having skills and a stable support network. If these criteria are met, withdrawal can take place in three weeks or one month with medication. The director emphasizes that physical withdrawal is the easiest part; the problem is maintaining abstinence and skills training. According to the director, the main reason that community members contact ARRISCA is “when there is a family breakdown, social exclusion, and when physical signs begin to appear, or even through referral by the court and the Directorate-General for Reintegration and Prison Services.”

However, it is the satisfaction of basic needs, provided by the association, that makes many users not give up on the process and remain connected to the organization.

As for success, Suzete confirms that the rate is tailored to each individual. “For example, in the case of a low-income person in extreme social exclusion with extreme psychiatric disorganization, if we can get them to switch from injecting to smoking, that’s already an added value. If we can get them to access a more organized residential structure instead of sleeping on the streets, that is already an added value.”

In addition to supporting the treatment of various pathologies, ARRISCA also provides psychological support. According to the president, this has had positive results, especially in preventing relapses, maintaining abstinence, and regaining lost skills.

In addition to medical and nursing consultations and daily supervised medication, the institution has a treatment room where daily dressings are applied and pre-hospital services are provided to users. They provide psychological and psychiatric support, since in addition to being drug addicts, many suffer from other pathologies.

“These people don’t go to the health center or the hospital, they come to us because we are the faces on the ground, who go to them every day,” says the general director of ARRISCA.

They provide support for the social and professional integration of patients, who, once they are stable, begin to work on their skills so that they can reintegrate into society. The sociologist in charge of this service creates a vocational profile and prepares them for a possible job interview. Some users are placed in occupational programs.

ARRISCA also has two workplaces and a social reintegration apartment for these citizens. They have a carpentry workshop in the Chã do Rego D’Água area and a ceramics workshop on Avenida D. João III, both of which are open to the public.

“I must say that in these occupational spaces, 10% of these people are already our employees, so we not only try to get others to integrate them, but we are also an example of this,” says the president.

As for the social reintegration apartment, it is located in Lagoa, and according to the interviewee, “it is not a residential solution, it is a therapeutic solution that happens to have a residential solution attached to it.”

People go there not because they are homeless, but to train skills such as daily life management, money management, leisure time management, community integration, knowing how to do laundry, knowing how to cook, that is, they learn “skills for an independent life,” reinforces the director.

When it comes to the difficulties in reintegrating these people into social life, Suzete Frias points out that one of the problems is the lack of response from the community. “We spend our lives changing the place where we administer medication with the vans, because one neighbor complains that they made noise, another complains because they threw trash, another complains because the drug dealer went there.”

“We cannot dissociate poverty from drug addiction intervention. And one thing that concerns me at the moment, and which could arise and which it is important that we prevent and find answers to, is that poverty indicators are rising. And tourism is also on the rise. These two components, if left unaddressed, could lead to this vulnerable group of poor people being exploited in tourism for sexual purposes or substance trafficking,” emphasizes the interviewee when asked about the most vulnerable audience.

For the future, ARRISCA plans to launch a mobile clinic project, aiming to reach those who do not visit the organization and to develop more effective responses to emerging consumption patterns. They also intend to continue with decentralized consultations in Rabo de Peixe, Matriz da Ribeira Grande, Ribeirinha, Maia, Fenais da Ajuda, Povoação, Vila Franca, Lagoa, and the prison. “It is an organization that has an integrated view of the whole person in all aspects and that aims to move towards a bioecological intervention that takes into account not only the person but also the territory,” concluded Suzete Frias.

Serving the most vulnerable

It should be noted that ARRISCA is a private social solidarity institution classified as a health unit by the Regional Health Directorate. The organization provides treatment services to people with mental illness, people with disorders due to abuse or dependence on psychoactive substances, and support to people in situations of social exclusion. “Our main focus is on treatment, reintegration, and rehabilitation. But we also have a service that promotes health and community empowerment, where we intervene in schools and the community in general,” emphasizes the general director.

ARRISCA provides clinical services with a team of six doctors, five drivers, 11 nurses, and one sociologist. The health promotion and community empowerment service team consists of one psychologist, one nurse, and one social worker. The psychology service has six psychologists. The social service comprises 6 social service technicians and 1 sociologist, whereas the social and labor integration service is conducted by 1 sociologist. It also has a home support unit for mental health care, called Pill Post, which has been operating since 2012. This team is responsible for treating patients who are unable to leave their homes for various reasons.

In Correio dso Açores-Natalino Viveiros-director

Translated into English as a community outreach program by the Portuguese Beyond Borders Institute (PBBI) and the Modern and Classical Languages and Literatures Department (MCLL), in collaboration with Bruma Publication and ADMA (Azores-Diaspora Media Alliance) at California State University, Fresno. PBBI thanks Luso Financial for sponsoring NOVIDADES.