Abstract
The aim of this article is to evaluate moral-psychological development, autonomy, and self-determination in patients with substance use disorder (SUD). Moral-psychological development was assessed using a tool to determine individuals’ decision-making ability. Our qualitative approach was based on ethnographic research and participant observation. Fifty per cent of the patients (n = 9) were found to be in the conformist stage, 39 per cent (n = 7) were in the conscientious stage, and 11 per cent (n = 2) were in the autonomous stage, according to Loevinger’s stages of ego development. Our field observations revealed issues of social belonging, symbolic aspects of the treatment, distinction between autonomy and self-determination, and re-signification of the meaning of autonomy. All patients were considered able to make decisions in their best interests, taking into account their stage of moral-psychological development according to Loevinger’s stages. They were also equipped to produce moral arguments to legitimize their actions.
Highlights
Substance use disorder (SUD) are a serious social and public health problem in many countries worldwide, including Brazil[1,2,3,4,5,6,7,8]
A survey conducted by the Brazilian Information Center on Psychotropic Drugs (CEBRID) between the years 2001 and 2005 made clear that the consumption of psychoactive substances has grown significantly in Brazil[9]
A study by researchers from São Paulo, Brazil, showed that of 131 patients treated at a hospital for crack cocaine use, about 10 per cent were arrested for involvement in illegal activities and 21 per cent were victims of homicide due to involvement in illegal activities[2]
Summary
Substance use disorder (SUD) are a serious social and public health problem in many countries worldwide, including Brazil[1,2,3,4,5,6,7,8]. According to the CEBRID survey, for example, the use of crack cocaine nearly doubled at the national level, and in southern portions of the country lifetime use increased from 0.5 per cent to 1.1 per cent — doubling in four years the number of individuals who use crack in their daily lives[9] This increased consumption of psychoactive substance, crack cocaine, brings with it a number of biological, neurological, cognitive, psychological and social consequences, such as increased urban violence and crime[11,12,13] and risk of transmission of infectious diseases such as HIV/AIDS[12,13,14,15]. These data indicate the seriousness of this problem and the need for a greater investment of resources, for research seeking to understand this complex phenomenon that involves different spheres of social life
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