Crack-cocaine addiction in an indigenous Brazilian: a case report

A 20-year-old indigenous Brazilian moved to São Paulo for addiction treatment. He fulfilled DSM-5 diagnostic criteria for severe dependence for both crack-cocaine and marijuana. The patient first underwent inpatient treatment for detoxication, and was then referred to an outpatient facility. A multidisciplinary team managed his case. The patient identified as living in a sort of limbo; not part of indigenous culture, but not part of “the white man’s culture.” He had been moving his whole life, living some years in his home village and some years in the big city.

The indigenous population of Brazil has been growing. From 1991 to 2000, its growth rate was 10.8% per year.¹ According to the 2010 Brazilian census, there was 896,000 Indigenous Brazilians in the country, which represents 0.4% of the Brazilian population.² The coexistence of both indigenous and white culture, however, is not always harmonious. In recent years, their relationship has grown in intensity, though not always in harmony. Health care cannot be dissociated from a cultural comprehension-based approach. Although indigenous health has been investigated in Brazil, with particular focus on infectious diseases, metabolic syndrome and nutritional status, mental health is still a research gap.³,⁴

Although drug and alcohol dependence seem to be common among indigenous populations, a major gap in the literature remains. In a PubMed search, the only Brazilian study about this issue was an ethnographic investigation among the Kaingang people. It found that alcohol abuse was a stigmatized behavior, with the leader of each tribe being responsible for regulation of alcohol sales within the tribe. Furthermore, it is also the leader’s role to restrain inappropriate behaviors related to alcohol intoxication. Persons in a state of intoxication are usually tied to a trunk, where they remain until sober. This punishment process is public, in order to increase the odds of behavior change. Lately, in this tribe, Protestant leaders have been getting closer to indigenous culture in order to develop treatment and prevention strategies for alcohol abuse. In this situation, indigenous Brazilians are usually asked to abandon some aspect of their traditional culture.⁵

To enhance the treatment of this patient, the team decided to focus more on his cultural background. Therefore, an educator joined the healthcare team. Her interventions consisted of daily meetings, in which the history of the patient’s ethnicity and their language were taught to him. During the treatment, his grandfather, the tribe shaman, conducted a traditional healing ritual. After three months, abstinence was achieved. After he left São Paulo, he continued treatment in his home village, at Xingu Indigenous Park.

In summary, investment on research about indigenous mental health specificities is mandatory. Research should focus on epidemiological surveys and clinical trials that include traditional treatment approaches, as their data could lead to better health care for a specific minority group. Health professionals that deal with indigenous populations should be trained to identify common mental health disorders. Mental health networks must be developed to provide psychopharmacology and psychosocial treatments. A proper treatment plan must take cultural differences into account and should try to establish links between Western and traditional medicine.

References

• ¹
  Santos RV, Pereira NOM. Os indígenas nos censos nacionais no Brasil. Cad Saude Publica. 2005;21:1626–27.
• ²
  Instituto Brasileiro de Geografia e Estatística. Censo Demográfico 2010. Características da população e dos domicílios: resultados do universo. Rio de Janeiro: IBGE; 2011.
• ³
  Souza ML, Orellana JD. Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality. Rev Bras Psiquiatr. 2012;34:34–7.
• ⁴
  Azevêdo PV, Caixeta L, Andrade LH, Bordin IA. Attention deficit/hyperactivity disorder symptoms in indigenous children from the Brazilian Amazon. Arq Neuropsiquiatr. 2010;68:541–4.
• ⁵
  Ghiggi Junior A, Langdon EJ. Reflections on intervention strategies with respect to the process of alcoholization and self-care are practices among Kaingang indigenous people in Santa Catarina State, Brazil. Cad Saude Publica. 2014;30:1250–8.

Publication Dates

• Publication in this collection
  Sept 2015

History

• Received
  4 Apr 2015
• Accepted
  23 Apr 2015