Substance Abuse Disorders Treatment in El Salvador: Analysis of Policy-Making-Related Failure

Abstract

Illicit drug use and substance abuse disorders have increased dramatically in developing countries during recent decades. Sadly, treatment for people diagnosed as manifesting and/or attributed with substance abuse disorders in developing countries is usually inadequate to meet demand, not evidence based, and of poor quality. In response, international health organizations have developed best-practice guidelines for substance user treatment in developing countries, although little research has evaluated their implementation. This opinion piece will examine one such effort to improve substance user treatment in El Salvador. It will be argued that the program failed (2007–2008) because of a lack of political will by the Salvadoran government through their Ministry of Health to effectively supervise, monitor, and subsidize substance user treatment.

Keywords :

• faith based
• substance abuse disorders
• substance user treatment
• developing countries

Notes

1 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

2 Treatment can be defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous; micro to macro levels), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer quality of life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.

3 The reader is referred to Hills's criteria for causation, which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated (Hill, 1965). Editor's note.

4 There are many definitions associated with the concept and process of recovery. The following definition is based on a consensus of 12 individuals representing and experienced in substance user treatment, research and policy-some of whom were in recovery—who met for 2 days during September 2006 at the Betty Ford Center. Recovery is a voluntarily maintained lifestyle composed characterized by sobriety, personal health, and citizenship. It moves beyond traditional models of abstinence and remission of symptoms to include functioning, well-being, perceived quality of life, and one's citizenship roles and responsibilities. Editor's note.

5 In July 2003, President Francisco Flores implemented Plan Mano Dura (Plan Iron Fist). Among other measures, Mano Dura “advocated the immediate imprisonment (for up to 5 years) of youths as young as 12 who displayed gang-related tattoos or flashed gang signs in public” (Jütersonke, Muggah, & Rodgers, 2009). Between July 2003 and August 2004, activities carried out through Mano Dura on the part of the PNC, with assistance from the Armed Forces, resulted in the capture of 19,275 youth suspected of being in gangs (“Aplicación de la Ley combate,” 2005). Ninety percent of those cases were immediately dismissed by the judicial system (Cruz, 2006).

6 In 2004, President Tony Saca passed Plan Super Man Dura, which included lengthier prison sentences. While it also included preventative measures, “Mano Amiga” (Operation Helping Hand; “Aplicación de la Ley combate,” 2005), these have received much less funding (USAID, 2006). Neither of these measures has reduced gang-related violence.