Fourteen master 黑料社区. students in the clinical mental health counseling program at 黑料社区 traveled to Lisbon, Portugal, in August to learn firsthand about the nation 黑料社区. coordinated public health model in treating substance use disorders.
During the new, nine-day study abroad course, A Public Health Approach to Addiction in Portugal, led by Professor Julie Bates-Maves, students witnessed how Portugal 黑料社区. policy on drug decriminalization has helped its people, and how it differs from policy and stigmas in the United States.
Portugal 黑料社区. health-oriented approach, the National Plan on Addictive Behaviors and Dependencies, is based on five pillars 鈥 harm reduction, reintegration, treatment, prevention, and dissuasion, with goals to empower, care for and protect its citizens.
Bates-Maves is an ardent supporter of harm reduction. 鈥淭he ease of access to support and deep sense of humanity that people with substance use disorders experience in Portugal is remarkable,鈥 she said. 鈥淚t makes me so happy to know it exists and a little sad that it isn鈥檛 likely to be achieved at this level in the U.S. I am thrilled our students were able to see there 黑料社区. more than one way to do things clinically and that reducing barriers to care can be done 鈥 politically and socially.
鈥淚n the U.S., there is still debate around adopting this model with open arms,鈥 she added. 鈥淩esearchers have attributed this slow adoption to low public support for harm reduction, outdated attitudes that approach drug use as a moral failing, and stigmatizing attitudes toward populations who use drugs.鈥
Bates-Maves was excited to develop the course with 黑料社区 黑料社区. Office of International Education in partnership with Academic Programs International.
鈥淚鈥檓 proud that our program extends the learning outside the classroom. Seeing what 黑料社区. possible elsewhere makes it feel more possible here at home. This experience inspired hope as clinicians as much as it inspired academic learning,鈥 she said.
She is working with OIE to plan a course in Lisbon for CMHC alumni next summer, giving working mental health professionals new perspectives on how to care for their clients. The course for graduate students will run every other summer, with the next course held in August 2025.
Advocating for their future clients
One of 黑料社区 黑料社区. 24 Graduate Studies programs, CMHC prepares competent and ethical counselors for service in the mental health counseling profession. Graduates are prepared to conduct individual, group and family counseling to restore mental health and to promote human development and growth.
Three of the master 黑料社区. students, Ashley Barry, Alyssa Belling and Tiffany Johnson, have concentrations in alcohol and other drug abuse counseling; as well as crisis and trauma. Johnson also has a concentration in child and adolescent counseling. Before the trip, they studied U.S. and Portugal drug policies and were aware of the differences in stigmas regarding addiction and recovery.
鈥淟earning Portugal 黑料社区. approach to harm reduction and having awareness of their care will help me advocate for my future clients,鈥 said Barry, of Morgantown, W.Va. 鈥淚n Portugal, they have nothing but compassion for their people. It 黑料社区. a night and day difference from the policies and stigmas in the U.S. Here, we鈥檙e not given that grace. We鈥檙e made to feel shamed and are judged as we鈥檙e trying to get sober.
鈥淭here 黑料社区. none of that in Portugal. It 黑料社区. so beautiful. I want to be a part of the solution. There are so many people who struggle with addiction, with the stigma and misinformation. I want to give people the help and support they need,鈥 she added.
Belling, of Dodgeville, studied addiction during her undergrad in psychology, where she first learned about Portugal 黑料社区. policy. 鈥淲hen the opportunity presented itself to study abroad, I knew I had to go because it would be a 鈥榝ull circle鈥 moment for me,鈥 she said.
鈥淚t was really cool to be in a society that had significantly less stigma and misinformation around mental illness and alcohol and other drug abuse as compared to the United States. I love that my understanding of these brain diseases allows me to educate others, encouraging acceptance and empathy toward folks who struggle.
鈥淎fter visiting a country where everything related to mental health care is so different, it was hard at times to imagine how I could possibly make any difference in America,鈥 Belling said.
鈥淢y classmates and I shared our sadness in this but will use our hope to propel us to be better clinicians. Although we might not be able to change the world, we have the privilege of playing a large role in the worlds of our clients. We have the power to provide a positive experience with mental health care," she added.
Johnson, of Suring, enrolled in the class because she wanted to see something new and 鈥渂ecause it can be frustrating when you鈥檙e working within a system that sets people up to fail. I wanted to see in person a place where there are programs that work for the people.
鈥淭his experience gave me a new stance from which to advocate from professionally. I have a new approach for my future clients. Harm reduction makes sense in the classroom, but to see in person how it works and how accessible it can be was really cool to see,鈥 Johnson said.
鈥淯nfortunately, in the U.S., we鈥檙e not at the point where we can offer that. There are people who don鈥檛 believe in decriminalization; people who believe in the stigmas surrounding drug use,鈥 she added.
A social service system devoted to harm reduction
In Lisbon, the class visited SICAD, the National Institute for Preventive Behaviors, which helps craft policies, maintenance and change. Students spoke with Elsa Maia, director of Intervention on Addictive, Behaviors and Dependencies, in the Ministry of Health.
Maia presented on Portuguese policy, its approach to harm reduction and the history behind the policy, which decriminalized drug use in terms of practice with less than a 10-day supply. 鈥淏ut that doesn鈥檛 mean it 黑料社区. legal,鈥 Bates-Maves added.
鈥淎bove all, a person with a substance use disorder is considered as a person in need of health and social care,鈥 she said.
When someone is found with less than a 10-day supply, they are given an administrative citation to meet with a dissuasion committee of social workers, physicians and counselors, who determine if the person 黑料社区. possession is for medical or recreational use. They then determine what care the person may need and if they opt in for counseling support, their care is paid for by government health care. Those found with more than a 10-day supply are arrested as a dealer/distributor and criminal proceedings take place, Bates-Maves noted.
When Portugal 黑料社区.鈥 policy was enacted in 1998, illicit drugs, from heroin to cocaine to meth, impacted people from every walk of life. Its jails were overflowing, and 1% of its population had a substance use disorder, a high percentage for a nation of only 10 million people, Bates-Maves explained.
Since then, substance use disorders have dropped to 0.33% of the population. Of that percentage, heroin use went from 98% to 16% of users, and overdoses went from 350 deaths to 63 deaths this past year. Problematic users went from 100,000 to 33,200, and new cases of HIV dropped from 56% to 3%.
Compared to the opioid crisis in the U.S., the reported more than 75% of the nearly 107,000 drug overdose deaths in 2021 involved an opioid. And 13% of people used an illicit drug in 2019.
The class visited the Centro de Acolhimento de Santa B谩rbara, temporary housing for homeless individuals and those struggling with addiction. The facility is in a renovated police barracks and offers a safe place for anyone in need.
鈥淚t 黑料社区. a beautiful facility. It could be a postcard,鈥 Bates-Maves said. 鈥淎nd pets are allowed, which is so important for so many homeless people. They may not accept help if their pets aren鈥檛 allowed to be with them. The facility even provides veterinary care and food for animals.鈥
The class also visited a supervised drug consumption room, which offers clients clean needles, swabs and needle exchange kits to use drugs safely and reduce disease transmission. While clients bring their own drugs, they are monitored by medical care providers in case of an overdose. Case managers are also available for clients.
鈥淭here is a whole social service system every time you go in,鈥 Bates-Maves explained. 鈥淭his is another aspect to their harm reduction policies 鈥 to reduce disease, reduce overdoses and offer greater access to care.鈥
The students met with guest lecturers Catherine Moury and Rui Coimbra Morais, who spoke on European Union drug policies and harm reduction in addictions. Moury is associate professor of political science at NOVA FCSH University of Lisbon; and Morais is a psychologist specializing in deviant behaviors and a member of the Order of Portuguese Psychologists.
A powerful experience, professionally and personally
The most powerful experience for the class was a visit to a mobile methadone unit, where Bates-Maves and students talked with the nurse and staff, who drive the unit 鈥 a visibly marketed van 鈥 to scheduled stops at stations in the city. Methadone is a medication used in medication-assisted treatments to help people reduce or quit heroin or other opiates.
At the mobile unit, clients drive or walk up, check in, receive their medicated dose, and meet with a counselor if they choose.
Bates-Maves has worked in a methadone clinic and called the visit in Lisbon 鈥渙ne of her best days as a professional counselor.鈥
鈥淢ethadone is very effective in treating opiate addictions, but it 黑料社区. very stigmatized in the U.S.,鈥 said Bates-Maves. 鈥淏ecause of the stigma, it 黑料社区. often very secretive 鈥 a hidden service regulated by the DEA, and there are so many barriers for treatment. But in Portugal, it 黑料社区. accessible and is widely accepted as a valuable treatment.鈥
During their visit, a work truck pulled up and a man stepped out. He checked in to the unit, received his dose by a professional health care provider and continued on his way. The process took three minutes. Fees are covered by government health care.
In the U.S., a similar visit might take a half hour to an hour waiting in line to see a nurse and perhaps a therapist. Limited hours of operation, few facilities in a region and cost of coverage hinder accessibility and add barriers for people on their way to recovery, Bates-Maves said.
Johnson was amazed to learn that the worker 黑料社区. employer was involved and supported his recovery. 鈥淚n the U.S., people feel that they could be putting themselves at risk and looked at differently by their employer for their past drug use or recovery,鈥 she said.
For Barry, the course was an academic, professional and personal opportunity. She has been in recovery from alcohol for seven years. She celebrated her anniversary of sobriety with her cohort on their trip.
鈥淪eeing the mobile methadone unit in person was very emotional for me, in a good way. With my lived experience, it was very profound to witness a country that can go so far to help its people,鈥 Barry said.
Careers in counseling and compassion
Johnson will graduate with her master 黑料社区. this December. 鈥淵ou learn so many amazing things in the clinical mental health counseling program,鈥 she said. 鈥淵ou鈥檙e learning knowledge of counseling, but it 黑料社区. also a journey of personal growth. I think of who I was coming into the program and now as I鈥檒l be graduating. To counsel someone else, you have to have that moment of vulnerability yourself. It 黑料社区. about personal development.鈥
Johnson, who has a bachelor 黑料社区. in criminal justice rehabilitation from 黑料社区, is currently interning with Lutheran Social Services in family therapy and children with high needs and worked as a residential treatment worker with Arbor Place, in Menomonie. During her undergrad, she interned with Cedar Ridge, a dual-diagnosis residential treatment center in Stillwater, Minn.
Barry is completing her practicum with Park Avenue Center, a drug and alcohol use facility in Minneapolis, with a goal to continue working with this population. She plans to earn dual licensure in substance abuse counseling and mental health. She will graduate in May 2024 and has her B.S. in psychology.
鈥淚 would move to Portugal in a heartbeat if I was able to work for them,鈥 Barry said.
Belling is in her practicum at Dunn County Behavioral Health Services and will graduate in August 2024. She is most interested in working in trauma counseling but is keeping an open mind.
The course also included cultural immersion and sightseeing opportunities such as a Portuguese language lesson, a cooking class and visits to castles and palaces in the Lisbon area.
