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Chapter 15
Themes
Key
LitCharts assigns a color and icon to each theme in Chasing the Scream, which you can use to track the themes throughout the work.
Drug Legalization and U.S. Policy
Addiction and Human Connection
Prohibition and the Cycle of Violence
Stories and Human Psychology
Summary
Analysis
Hari’s next stop is Portugal, the only country in the world that has decriminalized all drugs. He walks around beautiful, sunny Lisbon, then meets João Goulão, the doctor who pioneered the country’s drug policy. When Goulão was 19, Portugal was suffering under a repressive dictatorship. Goulão secretly joined the resistance movement, even though his father was a loyal employee of the regime. In April 1974, he joined the bloodless revolution that overthrew the dictatorship and established democracy. He credits the revolution with teaching him that it’s always possible to change powerful systems when they aren’t working.
Thus far, Hari has discussed small-scale victories, like Vancouver’s safe injection site, to wider-ranging experiments, like Switzerland’s system of heroin clinics. Now, in his final section, he looks at the most radical and transformative drug policy of all. In addition to explaining Goulão’s push for reform, Portugal’s 1974 revolution also serves as a metaphor for the nation’s revolutionary drug policy (and the anti-drug war revolution that Hari hopes to help launch). But it’s also evidence of Portugal’s strong commitment to true democracy—namely, the principle that everyone in society has equal value and an equal right to lead a dignified life. As the reader will soon learn, Portugal is one of the only countries in the world that extends this dignity to drug addicts.
Themes
After the fall of the dictatorship, the beautiful Algarve region in southern Portugal saw an unprecedented influx of tourists—and drugs, especially heroin. Goulão was working there as a doctor. The medical system had little experience treating heroin addicts, and the government adopted “the international prohibitionist playbook” of criminalizing drugs. But throughout the 1980s and 1990s, Portugal’s serious heroin and AIDS epidemics only got worse and worse because addicts were afraid to seek medical care.
By the 1980s, countries like the U.S. had built a strong political and cultural consensus around the “international prohibitionist playbook” over the course of decades. In contrast, Portugal faced an overnight drug epidemic and had to build a new system of drug policies all at once. This gave Portuguese leaders more latitude to experiment with new and innovative drug policies. Of course, they stuck to the U.S.’s drug war playbook at first, but they faced far less political pressure to adhere to these policies in the long term.
Themes
Goulão set up an addiction treatment center in the Algarve. In 1997, he became the nation’s chief addiction doctor, and in 1999, he joined a government commission to redesign the national drug policy. The commission recognized that most drug users aren’t addicted, and that criminalizing addicts only worsens their issues. It declared that the government should treat addicts with compassion and help them build better lives. It proposed reintegrating drug users into society, decriminalizing all drugs, and shifting money from policing and prisons to education and recovery programs.
Just as Switzerland’s drug policy succeeded in large part because Ruth Dreifuss actually consulted with drug addicts and doctors, Portugal’s succeeded primarily because the nation gave an experienced addiction doctor the power to set national drug policy. This starkly contrasts with countries like the U.S., which treat drug policy as a law enforcement issue. By presenting drugs as a health issue instead, Portugal built an effective, science-based drug policy that applied the insights of leading researchers like Gabor Maté and Bruce Alexander.
Themes
Portugal’s heroin epidemic was so massive, Goulão argues, that almost everyone personally knew and sympathized with an addict. This helped persuade Portugal’s parliament to pass the commission’s plan. The nation decriminalized drug use and possession, but it did not legalize the drug trade, which would have triggered significant international backlash. While prohibitionists were predicting a massive spike in drug use, Goulão was busy repurposing “the big, lumbering machinery of the drug war” to focus on treatment and prevention instead.
Throughout this book, Hari has argued that people’s political attitudes toward drugs are based in their emotional responses to drugs—which, in turn, depend on the drug users they may know and the stories they believe about drugs. Goulão made this same observation, and he turned it to his political advantage. Rather than harnessing people’s resentment and anger toward addicts, like Anslinger did in the U.S., Goulão channeled their love and sympathy—just like Gabor Maté and Bruce Alexander suggest. It’s crucial to distinguish between Portugal’s decriminalization policy, which still restricts the supply of drugs to the black market, from legalization policies that create well-regulated drug markets and cut criminal gangs out of the equation. Of course, decriminalization is a crucial step toward legalization, and Hari argues that Portugal very well may have chosen legalization if it weren’t for the political pressures it faced.
Themes
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Hari visits the Dissuasion Commission, the office where the Portuguese police send any drug users they encounter. A psychologist interviews each user to see if they just do drugs recreationally, or if they have a serious addiction. Recreational users then meet professionals like the sociologist Nuno Capaz, who offer advice about how to use drugs safely. For instance, Hari watches Capaz tell a 17-year-old boy who was caught smoking marijuana about how the drug might affect his concentration in school. The Commission also directs riskier users and addicts to the services they need, ranging from needle exchanges to immediate, free treatment.
In Portugal, decriminalization doesn’t mean simply leaving drug addicts alone. Rather, it means proactively offering them the services that they need to overcome addiction and build more meaningful, socially connected lives. Thus, Portugal has a drug control system, just like the U.S. and other countries committed to the drug war do. The difference is that Portugal’s system prioritizes public health professionals who take drug addicts’ needs and autonomy into account, instead of police officers and prison guards who view addicts as criminals to be captured and controlled through force. Needless to say, these professionals are far better equipped to identify and remedy the actual problems they encounter. For instance, unlike many officials in the U.S., Nuno Capaz and his colleagues don’t automatically assume that all drug use is problematic—instead, they follow the scientific evidence, which shows that only a minority of drug users develop serious addictions. As a result, they work to dispel drug war propaganda rather than spreading it.
Themes
Next, Hari visits a Portuguese drug rehabilitation center, where he watches addicts receive massages designed to help them deal with withdrawal pain and learn to relax without drugs. Goulão understands that addicts choose drugs in order to escape internal pain, so he has designed the facility to help patients develop insight into themselves. Over the year and a half that addicts spend in treatment, they learn to acknowledge and express their emotions through group games. This approach couldn’t be more different than the U.S.’s prison system.
The rehabilitation center is an example of how Portugal has built a comprehensive network of services for addicts. It recognizes that they don’t all have the same needs, and it offers them treatment options depending on what they need. Again, its system is based on scientific evidence and treats addicts with dignity.
Themes
After recovering addicts go through the treatment center, the Portuguese government helps them find dignified work. It gives companies tax breaks to hire them, and it helps them start small businesses. Hari again notes that the drug war does the opposite: it marks addicts for life with a criminal record, making it nearly impossible for them to find work.
Portugal’s economic programs again show that the country’s government is committed to helping addicts through every stage of recovery. It treats them with dignity by affirming their ability to become responsible and productive members of society. And most of all, it focuses on repairing harm, not punishing the people who commit it.
Themes
Portugal also has a solution for the addicts who aren’t yet ready to quit. At Lisbon housing project, Hari watches a line of addicts receive methadone and counseling at a parked van. The psychologist knows them all, and his job is to help them make safer decisions, like smoking heroin instead of injecting it. Hari points out that these addicts are standing in public, where “their friends and neighbors and employers” can see them—he argues that this is why treatment can’t succeed without decriminalization. Later, he follows the social workers who help the city’s most vulnerable, homeless addicts, particularly by offering them clean needles. Again, he’s struck by the addicts’ reaction: under drug prohibition, they would panic and run away.
The methadone van is another example of how Portugal’s drug treatment system reduces harm by providing addicts with relevant resources, no matter where they are in the cycle of addiction or the process of recovery. Moreover, it puts addicts in the driver’s seat by respecting their right to make their own autonomous decisions about drug use and treatment. This helps them build the sense of control and dignity that the drug war often denies them. In fact, Hari’s point about “friends and neighbors and employers” seeing drug users take methadone highlights one of the most powerful advantages of Portugal’s approach: it eliminates the stigma surrounding drug use, which is one of the main reasons that drug users tend to suffer more and more as they fall into addiction.
Themes
In Oporto, Hari meets Sergio Rodrigues. Years ago, during the age of drug prohibition, the police used to beat Sergio up for fun. His friends were addicts, and they were constantly dying. Then, when Portugal’s drug policy changed, a street team approached Sergio to offer clean needles, safety advice, and a pathway to recovery. He went to a treatment center, but it didn’t work, so he tried a “therapeutic community,” where he received methadone and counseling. He found a job, started a relationship, and almost entirely quit using drugs. Now, he’s an ordinary citizen, a taxpaying family man. Hari thinks about how differently Sergio’s life would have turned out in a prohibitionist country.
Rodrigues’s story shows how Portugal’s network of treatment programs works to gradually transform addicts’ lives over the long term. When the police beat Rodrigues under prohibition, they sent him the message that his life had no value. In contrast, under decriminalization, treatment services helped him rebuild connections, understand the factors that led him into addiction, and value himself as a human being. Thus, Rodrigues’s story embodies the healing power of Portugal’s revolutionary system, which can help even the most marginalized, desperate addicts transform themselves into healthy citizens.
Themes
Hari explains that his main concern about drug legalization is how it might affect children. For instance, scientists know that regular marijuana use permanently damages teenagers’ brains. To understand how the Portuguese system affects them, he visits a high school, where the class watches a video of a man offering cocaine to a girl and then debates what she should do. The students openly discuss their own drug use, while the teacher patiently mediates the conversation and explains the true risks of cocaine use. The class decides that the girl should say no. By prioritizing honest conversation, Hari argues, the Portuguese approach helps young people make better decisions.
One of the most common defenses of drug war policies is that they deter vulnerable young people from trying, getting addicted to, and damaging their brain development with drugs. In admitting that he shares this concern, Hari reminds the reader that he takes the risks of drug use and the harms of addiction extremely seriously. However, Hari’s experience in the Portuguese classroom quickly resolves his concerns because it shows him that decriminalization doesn’t convince children that drugs are harmless or good. If anything, it takes away some of drugs’ allure by removing the taboo that surrounds them in prohibitionist societies.
Themes
Hari acknowledges that decriminalization scares many people, who fear that it could backfire and increase drug use. This is how João Figueira, Portugal’s top drug policeman, once felt. He passionately opposed decriminalization, and then was astonished to see it work. He tells Hari that Portugal’s overall rate of drug use is well below the European average, while its number of addicts, overdoses, and HIV cases fell sharply after decriminalization. Teenage drug use is also very low. Drug-related crime has disappeared, Figueira explains, and poor people no longer fear the police, which makes investigations far easier. Regardless of their political leanings, most Portuguese people are happy with decriminalization, which they view as common sense, or a settled issue.
Figueira’s change of heart shows how successful drug policy can transform public attitudes about drugs, even among the staunchest and most powerful prohibitionists. Like Vancouver’s safe injection site, John Marks’s prescription program in Liverpool, and Switzerland’s heroin clinics, Portugal’s approach has achieved all of the drug war’s aims while erasing virtually all of the violence associated with it. Some of its benefits even exceeded drug reformers’ expectations—like the way it has fostered goodwill between law enforcement and the communities they police, and the way it has brought the country together politically.
Themes
After meeting João Figueira, Hari wanders around Lisbon “lost in a head-rush of optimism.” Figueira’s change of heart proves that reformers can win over even staunch “drug warriors.” Hari believes that most of these warriors are compassionate and well-intentioned (like Figueira), not paranoid and resentful (like Harry Anslinger). In this way, they’re just like the reformers: they want to save lives, protect young people, and reduce addiction. Portugal shows that there’s no contradiction between embracing compassion and crushing addiction. Rather, compassion for addicts is the way to crush addiction. If the U.S. took Portugal’s approach, it would save $87.8 billion per year. People like Leigh Maddox are already fighting for this.
Hari’s “head-rush of optimism” reflects his conclusion that Portugal has found the solution to the drug war. It’s true that, in the past, power has consistently trumped truth in the drug war—in other words, people like Anslinger imposed the policies they preferred, even when all the evidence contradicted the reasoning behind those polices. But for the most part, drug policy reform isn’t about noble heroes fighting coldhearted villains. Instead, both sides want the same thing—reducing addiction and the harms it causes—but just disagree on how to achieve it. Hari now believes that it’s possible to persuade both sides through case studies like Portugal.
Themes
But as Hari wanders around Lisbon, he also meets many drug dealers. He admits that, with the drug trade still illegal, users still have to buy from criminal gangs. Still, Goulão knows that it’s just a matter of time before a changing international consensus makes it possible for Portugal to legalize the drug trade, too.
Yet while Portugal’s policy represents a monumental step forward, it’s still far from perfect. Most countries around the world continue to favor the drug war, which Hari has previously suggested is because the U.S. influences other countries. Thus, drug policy is an international issue—and this means that policy reform in one country could potentially influence other countries to make similar changes.
Themes
Hari closes with the story of Antonio Gago, a boy who started using heroin in the Algarve in 1996. During drug prohibition, Dr. Goulão helped Gago find help and deal with childhood trauma. After decriminalization, Gago moved into one of Goulão’s therapeutic communities and quit using drugs. Now, like many former users throughout Portugal, he spends his mornings driving around and reaching out to addicts on the street. Gago’s story shows Hari that while drug prohibition spreads violence and suffering across society, decriminalization spreads “a healing ripple.” Hari concludes that Portugal’s drug policy is the truest expression of the 1974 revolution’s democratic spirit: it treats everyone, including addicts, as equally important.
Like Sergio Rodrigues, Antonio Gago puts a human face on Portugal’s successful decriminalization policy. In a country like the U.S., he would likely be dead, homeless, or incarcerated. In other words, other nations would have chosen to sacrifice his life, while Portugal chose to save it. Moreover, Gago’s outreach work shows that, just as networks of drug users can worsen addiction by drawing people into drug-use subcultures, they can also heal it by providing people with pathways out of addiction. This is why Hari describes “a healing ripple”: when decriminalization helps addicts, they start to help one another, too.
Themes
