Working Paper Series THERAPEUTIC COMMUNITIES IN BRAZIL Editors Mauricio Fiore Social Science Research Council Taniele Rui One Pierrepont Plaza, 15th Floor Brooklyn, NY 11201 www.ssrc.org JUNE 2021 Working Paper Series THERAPEUTIC COMMUNITIES IN BRAZIL Editors Mauricio Fiore Taniele Rui Social Science Research Council | Drugs, Security and Democracy Program JUNE 2021 PROJECT COORDINATOR ABOUT THE SSRC Cleia de S. Noia The Social Science Research Council (SSRC) is an independent, international, nonprofit organization founded in 1923. The SSRC fosters innovative research, nurtures EDITORIAL TEAM new generations of social scientists, deepens how inquiry Clare McGranahan is practiced within and across disciplines, and mobilizes Christopher Takacs – English copyedit necessary knowledge on important public issues. Vanessa Rosa – Portuguese copyedit David Rodgers – English translation ABOUT THE DSD PROGRAM The Drugs, Security and Democracy (DSD) Program supports PUBLICATION DESIGN AND LAYOUT research on drugs in Latin America and the Caribbean with Beth Post a goal of producing evidence-based knowledge to inform Juni Ahari drug policy in the region and beyond. The program seeks to foster a global interdisciplinary network of researchers engaged with drug policy, committed to policy-relevant outcomes, and able to communicate their findings to relevant audiences. ACKNOWLEDGEMENTS In addition to the co-editors and authors of the series, the This work carries a Creative Commons Attribution- SSRC and the DSD Program would like to thank Gabriela NonCommercial-NoDerivs 3.0 License. This license permits Barros de Luca, Lucio Costa, Andrea Domanico, Gislene you to copy, distribute, and display this work as long as Aparecida dos Santos, Andrea Gallassi, Maria Paula Gomes you mention and link back to the Social Science Research dos Santos, Henrique Hollunder Apolinario de Souza, Council, attribute the work appropriately (including both Cristiano Maronna, Cesar Pinheiro Teixeira, Roberto Rocha author and title), and do not adapt the content or use it Coelho Pires, Daniela Skromov de Albuquerque, and Luís commercially. For details, visit http://creativecommons. Fernando Tófoli for their invaluable input and contributions org/licenses/by-nc-nd/3.0/us/ throughout the project. This research project was funded by the Open SUGGESTED CITATION Society Foundations (OSF). The content of this Rui, Taniele and Mauricio Fiore, eds. Working Paper Series: publication is the sole responsibility of its authors and Therapeutic Communities in Brazil. 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Table of Contents THE PHENOMENON OF THERAPEUTIC COMMUNITIES IN BRAZIL: 1 EXPERIENCES IN ZONES OF INDETERMINATION Mauricio Fiore and Taniele Rui REGULATORY FRAMEWORK OF THERAPEUTIC COMMUNITIES IN 8 BRAZIL: DISPUTED MEANINGS AND LEGAL KNOTS Noelle Coelho Resende PUBLIC FUNDING OF THERAPEUTIC COMMUNITIES: 28 FEDERAL EXPENDITURE BETWEEN 2010 AND 2019 Renata Weber INSPECTION OF THERAPEUTIC COMMUNITIES BY A MUNICIPAL 44 HEALTH REGULATORY AGENCY AND ITS PRACTICAL IMPLICATIONS: THE CASE OF A LARGE BRAZILIAN MUNICIPALITY Jardel Fischer Loeck INSPECTING THERAPEUTIC COMMUNITIES: AN ANALYSIS OF 63 THE EXPERIENCE OF PUBLIC DEFENDER’S OFFICE OF THE STATE OF SÃO PAULO Carolina Gomes Duarte and Mathias Vaiano Glens “WE’RE SHARING EXPERIENCES!”: CONVERGENCES AND 85 DIVERGENCES IN THE POLITICAL ARTICULATION OF TC REPRESENTATIVES IN BRAZIL Priscila Farfan Barroso INTERFACES BETWEEN RELIGION, PROBLEMATIC DRUG USE, 106 MORALITIES, AND GENDER IN THERAPEUTIC COMMUNITIES Janine Targino THERAPEUTIC COMMUNITIES: A STUDY OF ACCESS AND 121 BARRIERS TO HEALTHCARE Leandro Dominguez Barretto and Emerson Elias Merhy IMPRISONED ON THE OUTSIDE: THERAPEUTIC COMMUNITIES 139 AS ZONES OF URBAN EXILE Carly Machado BIBLIOGRAPHY 157 Working Paper Series: Therapeutic Communities in Brazil MAURICIO FIORE1 AND TANIELE RUI2 While this working paper series on therapeutic communities (TCs) in Brazil was being prepared, the Netflix documentary series SanPa: Sins of the Savior was launched about an Italian TC that had been the largest in Europe in the 1980s. When asked why a documentary had been produced on the topic, its director replied that the series is “about the power of drugs, about the power of people, about the power of ideas, about the power of politics.”3 Though distant in time and space, this working paper series could also be presented in these terms. It is impossible to investigate the phenomenon of TCs in contemporary Brazil without discussing the role assumed by the state in response to drugs—its drug policy, in effect—especially its position concerning the network of care and attention for people with problems related to the consumption of psychoactive substances. Reflecting on the TCs also entails asking about the everyday experience of the thousands of people who turn to them to alleviate their suffering and stay for months, sometimes years, engaged in a project of giving new meaning to their life. And, of course, discussing TCs means debating what is represented by the fact that this type of institution is one of the main political and financial investments of the federal government and various state governments in Brazil, given that their activities are frequently questioned in terms of more radical aspects of discipline and religiosity—with strong evidence of rights violations. Spread across the country and attaining an unparalleled political force, the TCs are as inescapable in the debate on drugs as they are complex to define. As shown in the articles making up this series, indeterminations concerning their structural characteristics and their role appear to be an integral part of their political potency. The TCs practice isolation but cannot be defined as either clinics or psychiatric hospitals. They shelter those in a vulnerable situation but are not to be confused with therapeutic residences or social assistance facilities like shelters. The practice of religiosity is quotidian, usually unconditional, yet these institutions do not present themselves as churches, nor are they seen as such. In this ambiguous zone, TCs are no longer limited to self-funding—they acquire strength through their 1 Researcher for the Brazilian Center of Analysis and Planning (CEBRAP). Master in Social Anthropology from Universidade de São Paulo (USP) and Doctor in Social Sciences from Universidade Estadual de Campinas (UNICAMP), he was scientific coordinator of the Brazilian Drug Policy Platform and editor of Platô: drogas e políticas, the first scientific journal dedicated exclusively to the theme in Brazil. He is the author of various works on different aspects of psychoactive drug use, including the books Substâncias, Sujeitos, Eventos: uma autoetnografia do uso de drogas (2020) and Uso de “drogas”: controvérsias médicas e o debate público (2007). 2 Professor of the Department of Anthropology at UNICAMP and Master and Doctor in Social Anthropology from the same university. She is the author and coauthor of various works on urban poverty, vulnerability, and marginality, whose empirical specialties include the political interfaces of the association between street, drugs, peripheries, and social assistance, public health, and punishment facilities, like prisons and therapeutic communities, among which we can highlight the books Novas Faces da Vida nas Ruas (2016) and Nas tramas do Crack: etnografias da abjeção (2014). 3 Interview with Carlos Gabardini, one of the directors of the documentary series SanPa: Sins of the Savior, produced and broadcast by Netflix in 2020. Available at https://www.netflix.com/br-en/title/81010965. 1 Working Paper Series: Therapeutic Communities in Brazil own associations, and have regularly received increasingly substantial funds from different spheres of the public sector. It is important to mention that TCs are not a Brazilian creation, nor is their expansion exclusively a national phenomenon. On the contrary, emergent as an alternative mental health care facility/model in the 1950s, from early on these entities have specialized in receiving people with problems related to the use of drugs in the United States and Europe. Operating in Brazil since the 1960s, they began to expand more significantly from the 1990s. In 2015, the most comprehensive study of the subject estimated that at least two thousand TCs were operating in the country4—a methodologically conservative estimate since the difficulty of defining these entities makes counting them a somewhat challenging task. To provide a scale of comparison, a survey published in 2014, which established 2011 as a cut-off point, identified that there were 1,160 TCs operating across the entire European Union.5 If, as stated, defining them is not simple, this does not imply an absence of general principles guiding their objectives and the paths for attaining them. For example, the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) defines the therapeutic community as follows: TCs offer a drug-free environment in which people with addictive (and other) problems live together in an organized and structured way in order to promote change and make it possible for them to lead a drug-free life in the outside society.6 Or, again, in the definition of the United States’ National Institute on Drug Abuse (NIDA): TCs encourage participants to examine their personal behavior to help them become more pro- social and to engage in ’right living’—considered