OPEN ARMS, CLOSED FISTS An Ethnographic Analysis of Crack Treatment Programs in São Paulo, Brazil

Abstract

With an estimated one million crack users, Brazil has the highest number of crack users in the world, after the United States. In large urban areas across the country, crack-using communities have begun to develop in run-down sections of the city. Users gather in these areas to score a hit and smoke, and as long as they remain within the designated space, they do not face legal consequences. The largest and most prominent of these neighborhoods is in São Paulo. Known as Cracolândia, or Crackland, anywhere from 100-200 people inhabit the area at any given time. The phenomenon of crack use has spawned polemical debates in Brazil regarding the appropriate intervention strategies. In São Paulo in particular, two distinct treatment approaches, one funded by the city and the other funded by the state, were implemented at the same time. While on the one hand, the city-run program aims for harm reduction in its treatment strategy, on the other hand, the state-run program requires strict drug abstinence. Through ethnographic analysis, this thesis engages with the disharmonious treatment programs in São Paulo's Cracolândia and tries to make sense of them. This thesis traces the history of these programs, observes how they unfold in real time, and explores what conundrums emerge with implementation. This research shows that the two treatment programs in Cracolândia create a culture of futility, in which both the treatment providers and the users believe that treatment is pointless unless the individual possesses the will to succeed. I argue that this must be combatted with a sustained structurally competent intervention, in which careful attention is paid to the sociopolitical forces that impinge on a crack user's ability to recover. This research also demonstrates how health and politics are intimately entangled, and any attempt to address the problem of crack must necessarily attend to the questions of politics. Emerging from this project is a call for ethnography as a crucial methodological tool in policy analysis.