Rapid assessment of drug consumption at Santa Cruz de la Sierra, Bolivia

Sections

ABSTRACT
Introduction
Socio-demographic description of the city of Santa Cruz de la Sierra
Methodology
Analysis of the data
Analysis and interpretation of the data: the concept of drug abuse
Sociocultural groups at risk
Gender considerations: prompting further considerations
Conclusion

Details

Author: L. CARIS , R. SUAREZ , G. COVARRUBIAS , E. FERNANDEZ , E. ROCA
Pages: 99 to 119
Creation Date: 1996/01/01

Rapid assessment of drug consumption at Santa Cruz de la Sierra, Bolivia

L. CARIS Director of Studies, Drug Prevention Programme, Institute of Public Health, University of Chile, and Research Director, Ministry of Education Drugs Programme, Santiago, Chile
R. SUAREZ Director of the Council for Drug Abuse Prevention and Mental Health, Santa Cruz de la Sierra, Bolivia
G. COVARRUBIAS Drug Prevention Programme, Institute of Public Health, University of Chile, Santiago, Chile
E. FERNANDEZ Drug Prevention Programme, Institute of Public Health, University of Chile, Santiago, Chile
E. ROCA Director of the project "Facing the Drugs Challenge Together", Gabriel René Moreno Autonomous University, Santa Cruz de la Sierra, Bolivia

ABSTRACT

The present paper describes a rapid assessment carried out in 1996 at Santa Cruz de la Sierra, Bolivia, with a view to defining the sociocultural groups at risk and gaining insight, through the comments of those interviewed, into their perceptions of the phenomenon of drug abuse, their reasons for abusing drugs, the drugs most frequently abused and the psychological and social factors involved when they enter, remain in and finally leave drug-abusing circles.

By using qualitative methodology and techniques it was possible to gain access to the typical world inhabited by the interviewees, and thus to characterize the subjects of the study in the light of their closest social reference points (family, peer group, education and work). Among the conclusions of the study are the following: drug abuse is a complex and dynamic phenomenon that has occurred throughout the society of Santa Cruz, fostered by cultural and economic factors; there is a need for society, and especially the Government, to devise a specific, focused and diversified range of services, both in prevention and in rehabilitation, with integration and participation being key features of such initiatives; and the mechanisms for controlling the production of drugs and drug trafficking need to be strengthened.

Introduction

The continuing increase in the production, sale and abuse of psychoactive substances, and therefore in drug dependency, which has a particularly marked impact on children and young people, compels governmental and private bodies faced with the problem to engage in a constant quest for national and international cooperation to stem the rising trend in the consumption of psychoactive substances in the Bolivian city of Santa Cruz de la Sierra. [ 1]

As regards the drugs trade, Santa Cruz became a producer zone for coca paste at an early stage (in the 1970s), owing to the fact that it adjoins the Cochabamba administrative district where coca leaves are produced and large numbers of the rural population are engaged in their production. [ 2]

Subsequent improvement of prohibition mechanisms-the establishment of the Special Drugs Task Force that was given very substantial funds as a result of United States policies-is shifting the producing and processing zones for coca paste to Chapare in Cochabamba, which is being steadily converted into a transit zone.

As a result of improved prohibition mechanisms, administrative borders and international borders with neighbouring countries are being closed, the observed qualitative consequence being an increase in consumption. It is important to point out that drug trafficking, as an illegal activity, operates in two basic directions. On the one hand, there is the production of coca paste, which is converted to cocaine hydrochloride, and the export of products made from it. On the other hand, places where drugs are sold and consumed (formerly classified as "red zones"), which used to be confined to a few specific areas of the city, are now on the increase and spreading to other districts, presumably because they are connected with places where alcoholic beverages are sold. [ 3]

Mere phenomenological observation, supported by the available statistical studies, indicates that the epidemiological profile since the 1970s, when drug trafficking began in Bolivia, has changed, and that this change has speeded up. The present study seeks to assist in the understanding of the phenomenon and the ongoing changes found in the society of Santa Cruz in the 1990s. [ 4]

Socio-demographic description of the city of Santa Cruz de la Sierra

Santa Cruz is an administrative district which has experienced rapid growth; its vast uninhabited expanses of land, with their great potential for agricultural and stockbreeding development, attract migrants from all parts of the country. The city of Santa Cruz has become a major urban centre. The explanation for the growth of Santa Cruz, which is the highest in the country, can be found in the high birth rate, the high level of immigration and the low mortality rate. According to the 1976 census, the Santa Cruz administrative district has 710,724 inhabitants, and the city of Santa Cruz de la Sierra, 256,946.

The economy of Santa Cruz is based on agriculture and stockbreeding, the extraction of hydrocarbons and characteristic activity in the tertiary sector. The growth that began in these areas has now reached the financial and commercial sectors, which are undergoing vigorous development. It is important to take into account, in this respect, the emergence of significant capital receipts from illegal activities (drug trafficking, smuggling etc.) which have quickly found their way into the legal economic circuits.

Of the total number of homes at Santa Cruz de la Sierra, 74.3 per cent have no sanitation; 58.4 per cent have no access to piped drinking water; 21.9 per cent have to make do with waterwheels, wells or water tanks; and 19.7 per cent have to resort to rivers, springs and the like. Forty per cent of homes have electricity. The city is divided into concentric rings in accordance with the local urban development plan.

In 1994, the health services at Santa Cruz de la Sierra had 283 beds, in addition to the 1,547 beds for those covered by the social security funds, and eight social security funds covering 204,306 people.

The majority of the population of Santa Cruz is monolingual. Of the total population 79.9 per cent speak only Spanish, 1.3 per cent Quechua, 0.1 per cent Aymara, 12 per cent alternately Spanish, Quechua or Aymara, and 5.8 per cent speak oriental languages (Chiquitano, Guarani). The crude illiteracy rate in Santa Cruz is 21.1 per cent, 14 per cent for men and 28 per cent for women. [ 5]

Methodology

The study applied the rapid assessment methodology developed by the United Nations International Drug Control Programme (UNDCP) and applied in other countries in the region of Latin America (Ecuador and Chile). Rapid assessment represents a new application of an existing applied research methodology in social science.

Thirty-six semi-structured interviews with key informants were conducted. Among those interviewed, six were psychiatrists, psychologists and psychotherapists from rehabilitation centres; eight were neighbourhood leaders, researchers, parish priests or ministers and workers from non-governmental organizations; 10 were street vendors, glue sellers, taxi drivers, sex workers, homosexuals and junk dealers; eight were policemen, drug informants, inspectors and prisoners; and four were drug abusers.

Thirty-eight in-depth interviews were conducted with equal numbers of males and females for each category. A total of 8 were from the high socioeconomic class, 12 were from the middle class and 12 were from the lower class. A half of the interviewees were over 20 years of age and were non-abusers. 'Me other half were either occasional or habitual abusers. There were 12 students, 6 distressed women, 4 street children, 4 unemployed persons, 3 pleasure-seeking men, 2 unemployed youth, 2 prisoners and I abuser who was the son of a drug dealer.

In addition, 18 focus group discussions were held.

The 18 focal groups, formed according to the criteria of sex, age and socio-economic standing, are organized into three consumption levels. One is that of the non-user, the subject stating that he or she does not use illegal drugs but may consume alcohol or tobacco. Another is the occasional user, the subject defining himself or herself as a sporadic user of one or more illegal drugs, but without showing signs of addiction. The third category is that of the habitual user, this being a subject who has changed his or her lifestyle to adapt it to drug abuse, which has become an important factor in his or her life, and a person for whom drugs should preferably always be included among his or her activities. The composition of the focal groups is reflected in the table below.

Breakdown of focal groups according to consumption level

Level of consumption

sex

Socio-economic status

Age

Category

Non-user
Female
Low
Over 20
Street-walker
Non-user
Male
Low
Under 20
Students
Non-user
Female
Average
Over 20
Teachers
Non-user
Male
Average
Under 20
Students
Non-user
Female
Low
Under 20
Students
Non-user
Female
Average
Under 20
Students
Non-user
Female
High
Under 20
Students
Occasional user
Male
High
Under 20
Students
Occasional user
Female
Average
Over 20
Detainees (prison)
Occasional user
Female
Average
Over 20
Detainees (prison)
Occasional user
Female
High
Over 20
Students
Habitual user
Female
High
Over 20
Students
Habitual user
Male
Low
Under 20
Street children
Habitual user
Male
Average
Over20
Persons undergoing medical treatment
Habitual user
Male
Low
Over 20
Persons undergoing medical treatment
Habitual user
Male
Low
Over20
Drifters
Habitual user
Female
Low
Under 20
Street children

Analysis of the data

The interviews are recorded on magnetic tape and the material then transribed, producing the corpus for analysis. The Gophier text analysis program and WordPerfect were used in analysing the text.

Analysis and interpretation of the data: the concept of drug abuse

Drug abuse is an age-old practice in Santa Cruz society. It is a form of behaviour that is well within everyday norms. It lies on the blurred margin separating the normal from the normative. [ 6]

No consideration of the situation can ignore the form in which such behaviour occurs, collectively or individually. There is always a combination of silence and openness, depending on the context of the actual situation.

The actors who emerge in this context are the convert (respecting the cultural norm as originating from legitimate authority) or the subversive (questioning the norm and proposing alternatives) whose attitude towards drug abuse is conditioned by the continuing possibility of the practice being made legal or illegal, with the authority to define it as being permitted or prohibited.

The network of the subject's relationships is therefore the only valid parameter. Family, friends, fellow students or workmates function as the referential framework that sets boundaries and guidelines and makes the rules, in short, that makes it possible to distinguish between what is possible and what is expected from the practice of drug abuse.

The power of public use of dominant social speech patterns diminishes when confronted with perverse language (playing with the norm, standing apart from it with no intention of abolishing it) which is typical of the emerging counterculture, leading to a quest for satisfaction and focusing on the unexplained pleasure, this being a sufficient reason for taking up drugs and then continuing to abuse them. Perverse language states what it perceives as its right: to indulge in consumption as an inalienable, individual decision and style.

Within the subject, there is an internal discussion about the body and the world that requires each person to look after himself or herself according to a life project: self- control is a defence against self-destruction. Ultimately, it is a summons to believe that participation in the social order brings more benefits than risks; in essence the question raised by drug abuse involves one of the basic options of life: to fall or stay upright.

Without claiming to give a full account of the proposed explanation for consumption, the popular account should be noted, which places the source of the problem in the economic hardship and the poor working conditions and emotional problems of people exposed to a superabundance of drugs in a region combining deep social divisions and drug production for illicit trafficking to highly profitable markets.

In that context, the serious nature of the problem, in the view of some people, seems to be watered down and appears blurred when contrasted with the shortcomings inherent in a national and regional development plan that is perceived as inequitable and unjust.

From the information supplied by the various protagonists, it has been possible to construct the following relationship between reference sites for the purchase and consumption of drugs, which shows an interesting connection with the urban structure of Santa Cruz. This pattern of distribution according to areas of sale and consumption implies a degree of specialization and knowledge on the part of the subjects operating in the network of drug abuse.

Reference sites for the purchase and consumption of different types of drugs at Santa Cruz de la Sierra

Glue

Coca paste

Marijuana

Cocaine

Mercado Los Pozos
Second ring between
Barrio Hamacas
Plazuela Abaroa
Parque El Arenal
Ave. Grigot; and
Plazuela "Blacutt"
Calle Teniente Vega
La Ramada market
Ave. Piraí;
Equipetrol
Karaoke bars (located in
Avenida Uruguay
Barrio Braniff
Plazuela Don Bosco
various places, central area)
(pirate aircraft)
Pampa de la Isla
Villa I de Mayo
Ave. Canoto
Bus terminal
Barrio 4 de Noviembre
Plan Tres Mil
Radial 19 (Chiriguano
Barrio Los Chacos
Plan 3,000
Villa Brigida
shopping area)
Plazuela "Blacutt"
Villa 1 de Mayo
 
Canal Cotoca (end of fourth
Second ring between
Barrio Oriental
 
ring)
Ave. Grigot and Pirai
   
Second ring and Ave. Alemana

Sociocultural groups at risk

Within the sociopolitical context in which the present study has been carried out, there are voices calling for more decided intervention by the authorities wherever the problem has become apparent. Shortening the distance between those who have to implement political action and the civil society threatened by exposure to drugs is the crux of the ongoing discussion.

The sociocultural groups at risk that have been identified using the information obtained will now be considered. The research team succeeded in identifying 11 groups at risk. The categories are formed on the basis of the following criteria: age and sex; socioeconomic level; place of residence (permanent or temporary); social and economic environment (family, friends, study or work); patterns of drug abuse (circumstances in which it began, current consumption, type of drug, frequency of abuse, method of ingestion); patterns of conduct; associated factors (of risk and protection).

Category 1: young people who are non-users

The parameters of category 1 are as follows:

  1. Age and sex. The group consist of young people of both sexes whose ages range between 14 and 20;

  2. Socio-economic status.A broad cross-section of the socioeconomic spectrum is represented in this group;

  3. Residence.The group is distributed, according to the structural characteristics of the chosen sample, among the various neighbourhoods and sectors of the city of Santa Cruz.

1. The social and economic environment

The family. Members of the group tend to come from a family background characterized by strong ties of affection that provide protection against drug abuse. The family represents a space for dialogue and communication, in which the young person builds his or her identity. There are examples that follow the traditional marriage- family model in which the tendency is to preserve a combination of values that give it durability. However, it is also possible to find young people whose families have experienced a breakdown process. Family conflict, a situation which is inevitable in a human group, does not prevent effective communication.

Education and work. The group is included in the formal education system, in the later years of basic education or in middle-level education. Reference points in the school system offer the possibility of personal development and growth. In the case of the lowest socioeconomic stratum, education is associated with the opportunity for social advancement.

Friendship.The formation of a group of friends goes through difficult stages, as the permanent threat from outside influences relating to drug abuse is ever-present. The group is selective when establishing friendships.

2. Patterns of drug abuse

It is possible to observe a degree of solidity in formative and social settings, which operate as a protective mechanism against drug abuse. The explicit acknowledgement of non-use is viewed as highly positive.

3. Patterns of conduct

The behaviour of the group is oriented towards a positive use of free time.

4. Associated factors (identified by the group)

Risk factors. These include intrapersonal factors such as selfishness (understood as the damage caused by the drug abuser to his family and group setting), school and family problems and feelings of frustration. Interpersonal factors include: being and feeling marginalized; parents' divorce; not being listened to (a factor associated with communication with adults); and bad company.

Protective factors. These include: affection from the family; the demonstrated impact of the consequences of drug abuse; willpower; keeping occupied; and maintaining communication within the family.

The parameters of category 2 are as follows:

  1. Age and sex. The group consists of children of both sexes from the age of 7 up to 17 or 18;

  2. Socio-economic status. The group belongs to a low socioeconomic status.

  3. Residence.Members of the group are on the street for most of the day. At night, they seek shelter with charitable institutions, in squares and market areas and in abandoned buildings. [ 7] In the case of children on the street they go back home to spend the night.

1. The social and economic environment

Family.The family is characterized by an atmosphere of domestic violence and affective and economic vulnerability. Both elements determine the expulsion or flight of the children from the family home.

Education and work As a consequence of the process of family breakdown, the children leave school early and education loses the meaning conferred on it by society. Children start to drop out around the first four years of basic-level education, although complete absence from the school system is also a possibility. Life on the street compels them to develop strategies for survival in which skills and abilities come to the fore to maintain their existence.

Friendships.Friends appear at two distinct and emotionally very significant stages. The first relates to the stage prior to expulsion from the original family group. This is the period of childhood, with a shared space for play as the exclusive activity of childhood. Life on the street brings with it another method of forming friendships. The group formed on the street adopts the socializing role; it has its own codes and a structure to enable it to function.

2. Patterns of drug abuse

Entry into the drug-use network, which occurs in the group at a very early age, is mainly associated with curiosity, group pressure and the vulnerability of formative influences. Glue seems to be the only substance abused by street children, subsequently giving way to the combined abuse of alcohol, coca paste and crack cocaine, which they manage to combine with the irregular activities that supplement their meagre income. Drug-abuse occurs at least daily. As for the dose, it is found that one cannister is the necessary amount to get through a day. Glue is inhaled. The abuser has no difficulty in obtaining the glue, as it can be obtained in any hardware store in the city without restriction of any kind, and at a very low price. [ 8]

3. Patterns of conduct

The fact of living on the street without any fixed source of support results in children and adolescents developing skills and abilities that enable them to survive through begging, deception and robbery.

4. Associated factors

Risk factors. It is possible to identify in the street a space which, although it initially resolves the problem of survival, then becomes a place of menace for anyone without the cultural background and values to enable him or her to remain outside the drug-abusing circle.

Protective factors. The only protective factor which can be identified empirically comes in the form of care organizations that come forward from churches or on private initiative.

Category 3: convicted adults

The parameters of category 3 are as follows:

  1. Age and sex. The group consists of adults of both sexes aged between 20 and 60;

  2. Socio-economic status. The group occurs in all socioeconomic strata;

  3. Residence.The group is interned in penal detention centres where they are serving their sentences.

1. The social and economic environment

Family. The family origins of the subjects do not match any defined model; indeed, it is possible to find families originating in all social strata. As for their structural characteristics, both the nuclear and the extended family occur in a wide variety of friends.

Education and work It is not possible to establish a consensus on the topic, which appears in a number of discursive variants, limiting the scope for categorization.

Friendships.Prison inmates establish a dialogue with society, a dialogue that attempts to transfer the aetiology of drug abuse from the field of interpersonal factors to the heart of society itself, represented mainly by the group of friends.

2. Patterns of drug abuse

The heterogeneous make-up of the group, stemming from factors of a social economic, cultural ethnic and biographical kind, brings with it a discursive diversity such that it is not possible to give a brief summary of the topic. The subculture that forms in prisons is regulated by the phenomenon of drug abuse, leading to dealing and distribution mechanisms that facilitate and promote it.

The group is characterized by hard drinking (alcohol processed within the penal centres by fermenting fruit) and dealing in marijuana, cocaine and coca paste. The substances are ingested several times a day. Reports indicate a variety of methods of consumption, ranging from drinking alcohol, snorting "crystal" (cocaine) and smoking marijuana and coca paste, to some cases of injection.

3. Behaviour patterns

The behaviour of this group is marked by a breach from the norm, a norm that is increasingly seen in relative terms in Santa Cruz society.

4. Associated factors

Risk factors. The prison regime is overtaken by this subculture, which imposes its codes, language and discourse, and above all its practices of drug abuse. The prison subculture is the drug culture par excellence.

Protective factors.These include rehabilitation in a specialist centre and, religious conversion.

Category 4: young students

The parameters of category 4 are as follows:

  1. Age and sex. The group consists of young people of both sexes between the ages of 18 and 25;

  2. Socio-economic status. The groups belong to an average, average-to-high and high socioeconomic status;

  3. Residence.The young people generally live with their families of origin and, depending on their position in social structure, within the residential districts of the city.

1. The social and economic environment

Family.The family concerned is the family in which the parents are married, with very clearly defined roles and characterized by the middle and upper classes of the population under study. No especially conflictual situations are identified in the discourse, which might break up the family group.

Education and work Education and work are conceived as mechanisms incorporating and reproducing a sociocultural reality. Confidence is placed in both of them in maintaining acquired status. They constitute the central activity in formative terms, and in the formation and establishment of affective and instrumental networks of relationships.

Friendships.The group of friends provides a means of building individual identity within a participatory framework associated with recreation. In friends is found the affective adjunct that makes it possible to communicate effectively through shared codes and feelings.

2. Patterns of drug abuse

The period of adolescence is marked by curiosity and partying with the group of friends. The substances most commonly abused are marijuana, followed in sonic cases by cigarettes and, to a lesser extent cocaine. Later, consumption levels stabilize, as does the type of drug abused. The frequency of use is at least weekly and the most popular method is smoking and sharing the cigarette rolled by the actual user.

3. Patterns of conduct

There are no examples of maladaptive behaviour, involving radical breaks with the social or family environment. Drug abuse is stepped up in accordance with the capacity for self-control.

4. Associated factors

Risk factors. Intrapersonal risk factors include: the tendency towards depression; challenging responses to social rules; and evading one's own problems.

Interpersonal risk factors include: friends who are drug abusers (peer pressure); problems of lack of communication or violence in the family; excessive permissiveness or permissiveness on the part of the parents; curiosity about drug abuse by peers; excess supply of drugs.

Protective factors. These include: maturity; information; enhanced self-esteem; education; and the effect of demonstrating the impact of drug abuse.

Category 5: young employed or unemployed persons

The parameters of category 5 are as follows:

  1. Age and sex. The group consists of young people aged between l8 and 25, mostly male;

  2. Socio-economic status. The group belongs to the lower-middle or low socioeconomic status.

  3. Residence.The subjects live mostly in the parental home or with a close relative.

1. The social and economic environment

Family.The families of origin are disrupted, meaning that the characteristics identified are connected with the absence of the father, divorce and the abandonment of the family. There is aggression, violence, a lack of communication and authoritarianism. Marginalization occurs from within the family group, and the links are weak or non-existent.

Education and work. The subjects have little or no schooling. They rely on informal work producing a precarious income.

Friendships.The group of friends is important, because of the lack of affection experienced within the family. The same group of friends emerges as an influence that is capable of introducing the subject into the drug-abuse networks. [ 9]

2. Patterns of drug abuse

The group takes over in time from category 1. The consumption of inhalants and alcohol begins at a very early age. The current conditions of drug abuse are generally associated with the abuse of a drug that appears to be stable. This means that the process of experimentation culminates in a stage in which the young person discovers a specific drug with which he or she establishes a dependency relationship.

The drugs most used by this group are alcohol, marijuana and cocaine, which are drunk, smoked or snorted, on a daily basis.

3. Patterns of conduct

The phenomenon of drug abuse is especially marked in this group, which is extremely vulnerable to the weakness of a social system which is ever more permeated by the drug trafficking networks.

4. Associated factors

Risk factor. These include: the breakdown or absence of family support, situations of violence within the fancily; the presence of alcoholism or drug addiction on the part of the parents; a lack of affection; a peer group that tends to consist of drug abusers; aggressive behaviour; the lack of access to primary goods and services; little or no schooling; and an inability to deal with the world of formal work.

Protective factors. At the preventive level it could be said that the young people are totally without any means of defence. The availability of rehabilitation and treatment falls considerably short of demand, which is on a continuously rising trend.

Category 6: adult drug abusers

The parameters by category 6 are as follows:

  1. Age and sex. Individuals in the group are over 25 years of age, with as many men as women in the group;

  2. Socio-economic status. The group belongs to the upper-middle and upper socioeconomic level;

  3. Residence.A move is taking place from the most exclusive residential sectors to more peripheral areas of the city.

1. The social and economic environment

Family.Rebellion appears to be an element that sparks off behaviour favourable to drug abuse. This rebellion is the response to the traditional family structure within the sociocultural area of the city of Santa Cruz.

Education and work. The group has a direct link with professional classes, and has attained all the educational levels in its socioeconomic category.

Friendships.Within the group, friendship is directly linked to drug abuse. The group of friends of the adolescent appears to be a factor leading to drug abuse.

2. Patterns o drug abuse

Basically, the group begins to abuse drugs at two periods: adolescence, associated with the influence of friends and relationship problems with the family of origin; and at a later stage, associated basically with the influence of one partner or with problems inherent in married life. [ 10] Cocaine is referred to as the drug most frequently used. Its consumption is found to occur several times a day, and it is snorted.

3. Patterns of conduct

There is an ongoing search for affection, the origin of which seems to occur at a very early age, but which in this stage of life is manifested as a critical phenomenon.

4. Associated factors

Risk factors. Intrapersonal risk factors are: emotional instability; lack of affection and internalization of a discourse that legitimates drug abuse. Interpersonal risk factors are: the presence of drug dealing and drug abuse within the family group or the group of friends; problems with the family of origin; marital problems; exposure to the drug trafficking network; and stress at work.

Protective factors. In this group it is very difficult to identify any factor that inhibits drug abuse. The only possibility that can be found in the comments of informants is connected with a process of religious conversion, which brings about an existential change and a process of effective rehabilitation.

Categorie 7: habitual adult abusers

The parameters of category 7 are as follows:

  1. Age and sex. The members of the group are over 20 years of age and include both sexes;

  2. Socio-economic status. The group belongs to the medium-to-low and the low socio-economic bracket.

  3. Residence.There is some variability in this aspect, most frequently in the form of locations alternating between the street, the home of origin, hostels, temporary housing etc.

1. The social and economic environment

Family.There is resentment towards the family of origin. Observation of early family breakdown and consequent affective abandonment are characteristic of this group.

Education and work. Members of the group leave school at an early age. The phenomenon tends to lead to a kind of labour activity predominantly in the informal sector.

Friendships.There is an interpersonal factor that facilitates membership of a subculture m which drug abuse is one of the daily practices. The friends take the place of the family and supply other forms of solidarity and understanding of reality.

2. Patterns of drug abuse

There is high variability in the circumstances in which drug abuse begins. However, within the group, belated initiation to the practice of drug abuse has been identified as a constant In the group in which multiple abuse dominates, a combination of a fairly wide range of products such as cocaine hydrochloride, coca paste, marijuana and alcohol is noted. It is found that the drugs are consumed several times a day, and especially at night-abusers are accustomed to going to sleep under the effect of drugs. The commonest methods of consumption are inhalation and oral ingestion.

3. Patterns of conduct

The consumer profile involves behaviour that does not necessarily conflict with the norm.

4. Associated factors

Risk factors. These include: high availability of drugs; curiosity; family problems; friendships with drug abusers; emotional instability; frustration and failure; and rationalization of the legitimacy of drug abuse.

Protective factors. At the intrapersonal level, the will power of the subject is a major factor. At the social level, the possibility of social acceptance and access to some productive activity are major factors.

Category 8: habitual consumers in rehabilitation

In the city of Santa Cruz de la Sierra, there are roughly between 14 and 16 rehabilitation centres, of which 12 are of evangelical persuasion, 1 is Catholic and I takes a scientific approach. They are all in the private sector.

The parameters of category 8 are as follows:

  1. Age and sex. The persons receiving assistance are mostly men. In this connection, it should be pointed out that there are no centres for women. The subjects are over 17.

  2. Socio-economic status. The group consists mainly of individuals from the middle, lower-middle and lower classes.

  3. Residence.The geographical location of the rehabilitation centres varies: city centre (second ring), in marginal areas, Villa 1 de Mayo Plan and Tres Mil.

1. The social and economic environment

Family.There is a juvenile segment that gains access to rehabilitation through a family initiative. Basically, the family is playing the role played by the mother in the formation process. In this group, there is no family crisis leading to a breakdown such as that which, in other cases, tends to be expressed as a determining factor in drug abuse. [ 12]

The other segment consists of adult subjects with many years of experience of drug abuse, and whose family referent is predominantly the nuclear married couple. Among those subjects, rehabilitation has been treated as being through personal choice, frequently interpreted as a religi [ 11] ous revelation. For those subjects, rehabilitation takes on meaning not merely as a personal matter but also as having the purpose of possible reintegration into the family by marriage or the family of origin.

Education and work. There is a relationship between the pattern of work activity and drug abuse. An attempt is made to reconcile habitual drug abuse with regular work activity, the reason given to justify an addiction being that drug use increases the capacity for work.

Friendships.The group of friends appears as a referent that provides an introduction to drug abuse.

2. Patterns of drug abuse

Initiation into drug abuse generally occurs in early adolescence. It is possible to identify subjects whose initiation occurs later, that is, at the adult stage in association with conflict situations within their family groups. The drug most commonly abused is cocaine hydrochloride, and no other drug has been found that causes a subject to be admitted to care. During periods of drug abuse, the frequency has been found to be several times a day, and the most frequent method of ingestion found to be inhalation, although some cases have also been recorded of injection.

3. Patterns of conduct

There is a pattern of continuous entry and discharge from various treatment and rehabilitation centres, as well as premature deviant behaviour involving minor offences such as stealing, and small-scale drug-dealing.

4. Associated factors

Risk factors. There is a social environment of overexposure to drugs, in which the phenomenon of socialization includes initiation to alcohol use, as a socially accepted practice, and from there transition to the full range of drugs found in the environment.

Protective factors. Rehabilitation is seen as salvation or experienced as a divine revelation.

Gender considerations: prompting further considerations

Using sociocultural categories 5 and 6, and in response to the need to contextualize the study both historically and culturally, a distinction is drawn from the viewpoint of gender. This produces two abstract categories with certain distinctive characteristics, which will be constructed on the basis of the following criteria: patterns of conduct; circumstances of initiation; and risk factors. The cultural impression is expressed clearly at the level of practice and of social discourse. The starting point for establishing relationships for analysis is the historical and social inequality to which woman has been subjected, whether she is of urban or rural origin.

Category 9: distressed women

The abstract category of distressed women retains the characteristics typical of category 6 of adult drug abusers, except for its age distribution, which in this group is increasingly centred on adolescent age groups and is exclusively female in its make-up.

1. The social and economic environment

With regard to its family, ethnic and formative relationships and its working relations and friendships, the group retains the characteristics of category 6.

2. Patterns of drug abuse

The age of initiation, occurring during adolescence, is marked by the emergence of personal conflicts such as existential and interpersonal crisis, which is usually manifested as a breaking with the family and educational structure. The initiating drug most frequently mentioned was found to be marijuana, access to which appears to be facilitated by the presence of the group of friends, college and university companions or of their partners. Drug abuse becomes a practice that is adopted in a natural fashion, and that involves a minimal degree of conflict. The frequency of drug abuse is daily, and the form of ingestion is inhalation.

3. Patterns of conduct

With regard to their behaviour, a significant distinction must be drawn between two stages of drug abuse: an early stage, associated with conflict and breaking-off processes, questioning and challenging the family structure and the educational system; and a second stage, at more mature ages, when an attitude is adopted that involves less conflict with the environment. In that discursive context, the drug acquires a highly specific significance, a particular and well-defined meaning. The drug becomes an element necessary for personal stability, and emerges as the factor enabling the closest relationships to continue, while guaranteeing the maintenance of the precarious family equilibrium.

4. Risk factors

Risk factors include the deterioration of family relationships and frustration arising from unfulfilled life expectations.

Category 10: pleasure-seeking men

The abstract category of pleasure-seeking men retains the characteristics typical of categories 6 and 7. Sex is the only structural criteria determining its specificity.

1. The social and economic environment

With regard to its family, ethnic and formative relationships and its working relations and friendships, the group retains the characteristics of categories 6 and 7. One element typical of the group is the horizontal nature of its occurrence, so that subjects can be identified among all the socioeconomic strata of Santa Cruz society.

2. Patterns of drug abuse

The consumption of alcohol provides an occasion to create friendship networks. This is a legitimate practice that begins with friends from college, the factory, the farm, the office, the sugar refinery and all activities that bring together groups of men. In association with this cultural phenomenon is found the consumption of cocaine, which is used as a means of mitigating the effects of alcohol in order either to continue or to recover from alcohol abuse. The circumstances remain constant over time. There is an instrumentalization of cocaine abuse as a means of remaining within the reference social group and of carrying on with work activities and recreation. The consumption of alcohol is combined with that of cocaine. The frequency of drug abuse is at least weekly, although in some cases cocaine is abused on a daily basis.

3. Patterns of conduct

No conflictive attitude to consumption is found, this being part of the referential universe in which friendships are constructed and reconstructed on a permanent basis. Drug abuse appears to enjoy a certain degree of functionality, being associated with recreational activities among men in Santa Cruz.

4. Risk factors

Risk factors include the legitimation of alcohol use as a recurrent social practice, associated with relaxation and recreation; high availability; and ready access.

Category 11: sex workers

The sociocultural group of sex workers is derived from a hypothesis of the research team based on the presence of the group in other Latin American social contexts, the high availability of drugs in the Santa Cruz urban environment and the actual behaviour of a subculture that is subject to discrimination.

The parameters of category 11 are as follows:

  1. Age and sex. The group consists of women and homosexual men over the age of 18;

  2. Socio-economic status. The subjects are from the poor mixed-race sector of the population;

  3. Residence.They are found in brothels, night clubs, bars, karaoke bars, the street and marginal urban sectors.

1. The social and economic environment

The structural position and cultural characteristics associated with this group leads to the conclusion that the subjects come from families in which relations have broken down and in which conflict situations are present. Their educational level is at the bottom of the Bolivian educational system, very rarely reaching the final years of basic schooling. The establishment of friendships will be determined by the exercise of the activity on the basis of private codes of behaviour and moral standards.

2. Patterns of drug abuse

In this group, drug abuse takes on an instrumental character, being accepted in so far as it contributes to and facilitates the practice of the profession. Likewise, it helps in counteracting states of mind resulting from the same activity, such as depression and anxiety. Alcohol, marijuana, coca paste and cocaine are mentioned by the informants as the drugs that circulate most in such an environment. Consumption occurs daily by means of drinking, snorting and smoking, with some cases of injection.

3. Risk factors

Risk factors include economic, affective and educational vulnerability; the existence of an excess supply of drugs; and the internalization of a discourse that accepts drug abuse as legitimate.

Conclusion

Drug abuse in the city of Santa Cruz de la Sierra is within the bounds of everyday practice, and can be indulged in by anyone who wishes to do so, because of the high level of availability of drugs and the proximity of the city to the drug-producing area.

The phenomenon of drug abuse permeates the society of Santa Cruz without distinction as to socioeconomic level or gender. Hence, in the light of the study, it cannot be said that drug abuse is associated with poverty or youth.

The reasons frequently given for continuing drug abuse were economic hardship, unemployment, emotional deprivation and lack of opportunity, as well as high availability of drugs.

From the interviews it has been possible to locate a number of sites in Santa Cruz where it would be easy to acquire various substances for consumption. These sites were specified according to the drug abused: glue or other inhalants, marijuana, coca paste or cocaine.

The progression of drug abusers from experimental to occasional use and then to habitual abuse is not the norm; many drug abusers remain in a state of occasional use, and when this changes to more frequent use it is generally due to greater risk factors, whether individual, family-related or social.

With regard to women, it was found that in various social sectors women were consuming marijuana or cocaine when affected by personal problems or problems within a partnership. Although some of them are habitual abusers, there are various degrees of abuse, so that it is difficult to gain access to the group in order to help them.

Family problems are found to be a common factor among the various groups of abusers, for whom the family does not act as a socializing force, being characterized rather by child abuse, matrimonial disputes, single-parent families and lack of family monitoring. This means that efforts aimed at improving relationships between adults and young people and between parents and children are one of the central factors involved in prevention.

The city of Santa Cruz de la Sierra has become a metropolitan centre involving large-scale migration to the city because of the presence of people without work or only sporadic employment who are likely to become marginalized and who, in order to find a place in the society, may become involved in drug-dealing.

Awareness of the concept of prevention is poor, and in many cases is confused with advertising campaigns or rehabilitation. What is required is a suitable message and preventive programmes aimed at the various population categories.

The detention centres, according to the continents of people in them, are perceived as places where it is extremely easy to obtain drugs, where availability is greater than outside the prison system and where the process is facilitated or tolerated by the police officers responsible for the prisoners.

In the detention centres of Santa Cruz, there are no treatment programmes, although some of the inmates are habitual users or are addicted to drugs.

The persons concerned identify non-governmental organizations as being the bodies that carry out preventive activities, especially advertising campaigns.

Institutions providing rehabilitation are few and far between, as compared with the numbers of drug abusers. There is no government-level response to the problem, and the people who come to such centres are mostly those who have a recurring druguse problem.

It is important that the non-users, who form the majority of young people in Santa Cruz, should receive a positive message, going further than a simple "no" to drugs. It is also important to create a feeling of identity and to persuade them to value such an attitude, thus enabling them to resist the offers they will inevitably encounter.

The government Council for Drug Abuse Prevention and Mental Health is an institution with a low profile, and little is known about its activities and its results. It is therefore important to enhance its image.

It has been possible to identify 11 categories of users by means of the survey data, according to characteristics such as age, origin, socioeconomic level, family category, friends, drug-abuse patterns and protective and risk factors. These are important in order to appropriately target preventive and rehabilitation measures on the specific group that could be identified, with possible programmatic implications in Santa Cruz.

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