Tag Archive for: addiction

‘In Portugal, every half hour at least one person dies from smoking’

Despite restrictions imposed in recent years, the prevalence of tobacco consumption in Portugal increased from 48% to 51% and that of alcohol consumption from 49% to 56% in the past five years, according to the 5th National Survey on Psychoactive Substance Use in the General population.

Tobacco is the second most widespread psychoactive substance (after alcohol), with about half of the adult population declaring to have smoked at some point in their lives. However, the good news is, that young adults between 15 and 35 don’t seem to be keeping up with the upward trend. In this age group tobacco consumption fell from 37 to 28%, and in girls even to 20%.

More than 80% of the Portuguese consider themselves exposed to tobacco smoke outdoors, a percentage that places Portugal among the EU countries with the highest level of exposure, according to a study by the University of Beira.

These figures come at a time when the government has approved a proposal to amend the Tobacco Law, equating heated tobacco with conventional tobacco, limiting the points of sale and places where smoking is permitted, banning smoking on hospital and school grounds, outside cafés and restaurants and on covered terraces.

Our tobacco law proposal is not prohibitionist’, declared Margarida Tavares, State Secretary for Health in Parliament. ‘What we want is to regulate and help those who want to quit smoking.’ Unfortunately, the definitive elimination of smoking will – according to the proposed law – only come into force in 2030! ‘We’ll give business time to adapt’, she said.

Contrary to a decrease in smoking, alcohol consumption is rising in youngsters. Nine out of ten 18-year-olds say they have taken alcohol in the 12 months prior to a survey carried out by the Addictive Behaviour and Addiction Intervention Service (SICAD). For the first time consumption among girls surpassed that of boys.

Although the prevalence of binge drinking (rapid and excessive consumption of alcoholic beverages to reach drunkenness at least once in the last year), has remained stable (around 10% in the general population), more than one-third of the 18-year-olds admitted to having drunk alcohol in a ‘binge’ way in the past 12 months.

Furthermore, the survey points to an significant increase in dependent alcohol consumption (from 2% to 3.5%) in the past five years. ‘We must detect these patients and treat them,’ said Joana Teixeira, a psychiatrist at Lisbon Psychiatric Hospital, to avoid an increase in diseases attributable to alcohol, such as liver cirrhosis, vascular diseases, and certain types of cancer (i.e. breast cancer in women).

But despite the increase in alcoholic consumption, the government maintains its resistance against public health warnings on the labels of alcoholic beverage bottles just like the Republic of Ireland has done. According to the Ministry, such warnings are ‘incompatible’ with EU regulations and against the interest of the national wine sector, since the export of Portuguese wine is worth almost one billion euros per year.

Enjoy your week                   Aproveite a semana      (pic Público/Sapo)

‘It is not just about administering methadone, you have to maintain a relationship’

In 2001 Portugal became  – under the leadership of prime minister António Guterres, nowadays UN’s  Secretary-General – the first country to ‘decriminalize’ the possession and consumption of illicit substances, even heroin, and cocaine.

Despite predictions at the time of an increase in drug use and drug tourism by opponents of decriminalization, the opposite happened with huge drops in drug use, overdose deaths, drug-related crime, and HIV infection. New cases of HIV among people who inject drugs (PWID) fell from 907 in 2000 – when the country had the highest rate of HIV among PWID in Europe – to just 18 in 2017.

The country’s policy rests on 3 pillars: (i) there is no distinction between so-called soft and hard drugs, (ii) an individual’s unhealthy relationship with drugs often masks unsatisfactory relationships with the world around and (iii) the eradication of all drugs is an impossible goal.

What did and what did the country not do?
It did not change laws on drug trafficking: dealers still go to prison. And it did not ‘legalize’ drug use but rather made the purchase or possession of small quantities (up to a 10 day supply) not a crime.

Methadone clinics, clean needle handouts, supervised injection sites, drug consumption facilities and a pan-ministerial network of support were set up and are still operational today.

There are currently two Threshold Mobile Units in Lisbon – attending approximately 1,200 people a day – and 170 recovery facilities in a country of 10 million people for treatment and education about the harmful effects of drugs.

This public health approach reflects the view that addiction is more a medical challenge than a criminal justice issue; a chronical disease that requires medical care rather than punishment. An additional benefit of the Portuguese model is that it’s far cheaper to treat people than to jail them.

While other states have developed various forms of de facto decriminalization – whereby substances perceived to be less harmful (such as cannabis) rarely lead to criminal prosecution – Portugal remains the only EU member state with a law explicitly declaring drugs to be ‘decriminalized.’

Bom fim de semana           Enjoy the weekend         (pic Público/NYT/Cato)


If something bad happens, we drink to forget.
If something good happens, we drink to celebrate.
If nothing happens, we drink to make something happen       
(Charles Bukowski)

Global consumption of alcohol will rise another 17% over the next decade, after a 10% rise in the last 25 years. Nowadays one-third of all adults drink alcohol, by 2030 half of them will. The highest alcohol intakes are recorded in Europe with Moldava claiming top spot with more than 15 litres of pure alcohol per adult per year.

While in most European countries alcohol consumption among 15-years-old has been halved in the last decade – in Portugal from 16% to 8% – the Portuguese consumption with 12.3 litres per adult per year is still far above the European mean (9.8 litres) and even higher than in Russia (11.7 litres). Three quarters of the Portuguese men and half of the women drink. Excess drinking is on the increase in adults above 45 years of age, especially in women.

What does this mean for the health of the Portuguese? Excessive alcohol intake is associated with road traffic accidents, cancer, diabetes, heart disease, domestic violence, and suicide attempts.
In 2017 more than one-third of the Portuguese drivers – who died on the road – had too much alcohol (>0.5 g/l) in their blood. The highest number in 5 years.

Drinking is an important cause of cancer in the over-50s, particularly in women. Research in the UK showed that one in 13 breast cancers are alcohol-related and a quarter of cancer deaths in women over 50 linked to drinking habits.

In 2018, the medical journal The Lancet concluded that although alcohol use among youngsters has declined, risky drinking behavior – like binge drinking – remains concerning high.

A more recent study analyzing alcohol consumption under 500.000 adults and published in the same journal, showed that alcohol increases the blood pressure and the risk of stroke. A finding that should ring bells in Portugal, that hasn’t only a substantial alcohol consumption but also the highest prevalence of stroke in Europe.

Given the fact that there is no safe level of drinking, the public health policy should be to prioritize measures to reduce drinking through increasing taxation, setting the price according to the strength of the drink, curbs on marketing and restricting the places where people can buy alcohol.

But the consumer also has the right to be informed about the dangers. Labeling of bottles of wine and cans of beer with ‘alcohol causes cancer’ – like the Irish government proposed last year – might help to inform the general public in a better way. How many women actually know that alcohol causes breast cancer?

One day someone mentioned to Fernando Pessoa ‘ You drink like a sponge’. Portugal’s most famous poet replied ‘Not like a sponge. Like a sponge shop, and with a storeroom attached.’ He died from booze at the age of 47.

Bom fim de semana                Enjoy the weekend
            (pic Sapo/Público)


Het merendeel  van de Portugese bevolking is het eens met de onlangs door de regering voorgestelde accijnsverhoging op alcohol en tabak. Maar de vraag blijft of zo’n prijsstijging wel voldoende is om de consumptie ervan af te remmen.

Alcohol veroorzaakt doden in het verkeer
Lunch  – o almoço – is in Portugal van oudsher de belangrijkste maaltijd van de dag. Het is volkomen normaal om daar dan bier of wijn bij te drinken. Of een kopje koffie daarna altijd voldoende is om weer veilig achter het stuur te kunnen zitten?

picture1Behalve dat alcohol, vooral bij overmatig drankgebruik, schadelijk is voor de gezondheid – hersenen en andere organen, zoals de lever kunnen worden aantast – is rijden onder invloed een veel voorkomend probleem in Portugal.
In een onlangs gepresenteerde studie van de Universiteit van Coimbra bleek dat bij een derde van de 500 verkeersslachtoffers, die jaarlijks in Portugal overlijden, een te hoog promillage alcohol (meer dan 1,2‰) in het bloed werd aangetroffen.

picture2Of je nu veel of weinig rookt en of je er nu zelf een opsteekt of passief meerookt, roken is altijd slecht voor de gezondheid. In Portugal rookt een op de vijf ( dat zijn 2 miljoen) mensen boven de 15 jaar en is roken de belangrijkste doodsoorzaak.

Meer vrouwen roken
De afgelopen jaren is het aantal jongens dat rookt weliswaar afgenomen, maar baart de toename van meisjes die roken en het aantal vrouwen dat longkanker krijgt, grote zorgen.

Accijnsverhoging onvoldoende
Hoewel de verkoop van tabak de Portugese overheid per jaar 1,5 miljard euro oplevert, weegt dat bedrag niet op tegen de kosten van de met roken-gerelateerde ziekten – behalve longkanker ook hart/vaatziekten en chronische longaandoeningen.

De Wereldgezondheidsorganisatie heeft berekend dat een prijsverhoging voor sigaretten van 10% leidt tot een afname in de consumptie van 4%. De door de regering voorgestelde accijnsverhoging van 3% op tabak zal dus onvoldoende zijn om de Portugese bevolking minder te laten roken.

Geniet van het weekend   –   Tenha um excelente fim-de-semana !