Compared to other European countries, Portugal has been successful in addressing problems related to substance dependence – it has the second-lowest fatal overdose rate in Europe, and, overall, low statistics for substance consumption.
According to the Portugal Country Drug Report, 8% of adults smoke cannabis, 0.2% consume MDMA, 0.3% cocaine, and 5.2% heroin.
Since the government decriminalised drugs in 2001, Portugal has emphasised rehab and addiction treatment. As a result, individuals receiving addiction treatment has increased by 60%.
Statistics show that heroin accounts for 39% of treatment entrants, with cannabis accounting for 37%, cocaine 17% and 6% other substances. (1)
This article will discuss drug and alcohol rehab in Portugal.
In Portugal, healthcare for those with a substance dependency is provided by the Referral Network for Addiction Behaviours and Dependencies.
The Network incorporates specialised public services that provide treatment for substance dependency.
This includes regional health administrations, non-governmental organisations, and various public and private clinics.
There are three levels of care available through these services: specialised care, differentiated care and primary healthcare.
Specialised care is provided in an outpatient setting. Outpatient treatment usually refers to treatment that does require an overnight stay at a facility.
This is usually more suited to an individual with milder dependencies or to those that have recently left a rehab facility. This can be arranged through a general practitioner.
Treatment commonly consists of supported medical detox, followed by daily or bi-weekly therapy sessions.
Differentiated care is primarily provided in an inpatient setting. Inpatient refers to treatments that occur at a facility for some time.
Facilities can include therapeutic communities and specialised addiction centres.
Drugs and alcohol rehab in Portugal is offered free of charge to individuals with a substance dependency and that are seeking treatment.
To enter one of these facilities, it is advised that individuals contact the facility and/or speak with their general practitioner. (2)
Commonly, there are five stages for admission to a rehab facility in Portugal.
Stage 1: contact a rehab facility to discuss your substance dependency.
Stage 2: speak with a general practitioner and obtain a formal referral letter that includes your medical history.
Stage 3: undergo a pre-admission psychological and medical assessment. This will determine the recommended treatment.
Stage 4: arrange a date to begin treatment
Stage 5: prepare for your stay. For example, by organising what to pack and bring to the facility.
Addiction can be both psychological and psychical.
Consistent use of a substance causes psychical dependence. This means that an individual will need a substance to function properly.
Without it, an individual can experience withdrawal symptoms, such as nausea.
Psychological addiction refers to an individual’s behaviour and compulsion to use a substance. Often this is done to obtain a certain mental or emotional state.
It is common for individuals with psychological addiction to use substances to alleviate mental disorders, such as depression or anxiety. (3)
For those struggling with substance dependency and seeking to recover from it, the first step is often detox. Detox is the process of removing toxins and harmful substances from the body.
Because the body, when substance dependent, relies on the substance to function, removing the substance from the body can cause unpleasant symptoms.
This is an important part of the rehabilitation process but can be a painful and difficult experience. The severity of the detox, however, often depends upon the substance.
Detoxing from Alcohol, for example, can cause alcohol withdrawal syndrome (AWS), which can lead to mild or severe withdrawal symptoms.
These can range from feelings of anxiety, headaches and nausea to abnormal breathing, hypothermia, and seizures.
Often, withdrawal symptoms will be used by medical professionals to determine which treatment is appropriate.
Symptoms from alcohol detox usually occur within 6-12 hours, sometimes increasing in severity after a longer duration.
Between 24-72 hours symptoms should begin to subside, but this can take between 4-5 days.
Mild symptoms are usually treatable at home under the supervision of a medical professional.
However, more severe symptoms will require medical attention and it is recommended that individuals seek immediate medical care. (4)
Cocaine, like alcohol, can also vary in its withdrawal severity. Some symptoms an individual might experience detoxing from cocaine are fever, chills, depression, disturbed sleep, sweats, and restlessness.
For cocaine, withdrawal usually begins 8-12 hours after the last dose and can last for 5-7 days. (5)
Heroin involves a more arduous detox process, as it is a very addictive substance. Withdrawal symptoms can occur within six hours from the last dose.
Symptoms can vary from nausea and vomiting to more severe symptoms, such as insomnia and hypertension.
Individuals will likely experience these symptoms for up to five days.
Some factors that contribute to the severity of heroin withdrawal include how long an individual has been using, the quantity taken, and how the substance enters the bloodstream – for example, injection versus inhalation.
Those with a more severe addiction might require a medical detox.
This means that an individual will need 24/7 medical supervision and will be provided medication, such as methadone, buprenorphine, or naltrexone. (6)
Rehab for alcoholism is available through public and private treatment facilities.
It is recommended that individuals should speak with their general practitioner to discuss potential treatment options.
Facilities offer inpatient options that provide medical and psychological support whilst detoxing.
Individuals will also receive therapy. This can include Cognitive Behavioural Therapy and group therapy.
Medication, such as benzodiazepines, antidepressants, and anxiolytics, are provided to those who require them.
These can help alleviate some of the withdrawal symptoms associated with alcohol detox. (7)
There are two recommended rehab processes for cocaine addiction: outpatient cocaine rehab and inpatient cocaine rehab.
Outpatient treatment is available for those that find residential programmes unsuitable for their needs or daily responsibilities.
Although individuals will not live in a treatment facility, they will regularly attend counselling and therapy. The length of the treatment can vary but it is usually based on the needs of the patient.
Inpatient cocaine rehab involves staying at a facility for the duration of a cocaine rehab programme.
This is considered more effective, as it removes potential triggers, and the individual will have more readily available support. (8)
Individuals will undergo detox, and then receive therapy, relapse prevention and aftercare.
As detoxing from heroin can be potentially fatal, it is recommended that individuals wanting to detox from heroin enter a rehabilitation facility.
Individuals will receive 24-hour care and have access to medical professionals that can help with the withdrawal process.
In Portugal, opioid substitution treatment (OST) is also available. Individuals can either undergo Methadone Maintenance Treatment (MMT) or receive buprenorphine at a treatment centre or therapeutic community.
Pharmacies can also provide buprenorphine. However, MMT is free of charge. (9)
Dual diagnosis is when an individual suffers from both a mental disorder, such as depression or anxiety and a substance dependency.
Both the mental disorder and the substance dependency interact and can affect each other in various ways.
For example, in some cases, an individual will suffer from a mental disorder and use substances as a coping strategy, which can lead to addiction.
Alternatively, an individual might have a substance dependency that then leads to depression, anxiety, paranoia, and personality disorders.
Treatment for dual diagnosis will often focus on treating both substance dependence and mental disorders.
In some cases, medication will be prescribed to deal with the mental condition whilst recovering from the addiction. (10)
The time an individual will stay in rehab can vary and is based upon several factors, such as the substance that an individual is dependent upon, and the treatment that is required.
In Portugal, for inpatient rehabilitation, 3- to 12-month residential treatment programmes are available.
However, this can be extended depending upon the level of treatment an individual requires. Treatment programmes can be extended up to three years.
In addition, more short-term 7-to-10-day programmes provide specialised withdrawal treatments. (11)
After detox, individuals will attend various therapies dependent upon their needs.
This process focuses on the psychological aspects of substance dependency and can range from psychoanalysis to group therapy.
This stage is aimed at better understanding the underlying reasons for substance dependency, the desires and triggers that cause it, and how to better cope with temptations.
Talk therapy, or psychotherapy, is a common therapy process when dealing with addiction.
This involves talking to a trained professional who will use psychological theories and methods to assess the patient’s needs.
This can include Cognitive Behavioural Therapy (CBT), which focuses on how thoughts can trigger certain behaviours, and vice versa. Individuals are guided in how to change their thought processes to be more positive, with the hope that this will lead to more positive behaviours. (12)
Individuals might also attend Dialectical Behaviour Therapy (DBT). Like CBT, it teaches individuals to develop positive coping strategies, such as emotional regulation and cognitive reappraisal – the process of thinking differently about situations and experiences. (13)
Another therapy is Contingency Management (CM). CM is a behaviour-focused therapy that encourages positive behaviour changes.
This is reinforced by a system that rewards individuals when behaviour goals are met or withholding positive reinforcement when they are not. (14)
One of the most used therapies is group therapy. Like the name suggests, this therapy involves talking amongst a group of peers – people that have struggled with similar experiences and substance dependency.
Group therapy has been shown to remove feelings of isolation and to encourage a culture of rehabilitation and recovery, which, in turn, encourages continued sobriety.
The 12-step programme was developed and is commonly used, by Alcoholics Anonymous (AA). It is a step-by-step process to help overcome addiction and the temptations associated with it. (15)
It encourages abstinence from substances but suggests that this is only possible by surrendering addiction to a higher power.
Although this can be religious, many treatment programs offer secular alternatives where the higher power can be anything from a connection with others to self-will.
The 12-steps are outlined by the AA as:
When finishing a treatment programme or leaving a facility, it is important that an individual must not relapse.
Relapse can take on many different forms, such as emotional, mental, or physical.
To prevent relapse, individuals finishing treatment will work alongside professionals to create a prevention plan.
This will include discussing possible triggers, such as negative emotions, stress, old social circles, and locations.
In addition, individuals are commonly provided with post-treatment therapy and progress reviews.
This might include skill-based cognitive behavioural therapy, coping skills training and cognitive therapy. (16)
Once completing rehab and finishing treatment, aftercare and fellowship groups are available.
Most rehab facilities in Portugal offer an aftercare phase that focuses on applying learnt skills into daily life. These facilities will provide continued, free support and counselling.
Outside of rehab facilities, in Portugal, there are community support groups that can offer support and fellowship.
It is advised that individuals contact their general practitioner, who will be able to guide them to potential community services.
In addition, both Alcoholics Anonymous and Narcotics Anonymous are available in Portugal.
Both provide fellowship programmes that encourage individuals to talk about their substance dependencies, experiences, and challenges – often in a group environment. (17)
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(3) Johnson, B., 2003. Psychological Addiction, Physical Addiction, Addictive Character, and Addictive Personality Disorder: A Nosology of Addictive Di. Canadian Journal of psychoanalysis, 11(1), pp.135-160.
(5) Wallace, B.C., 1987. Cocaine dependence treatment on an inpatient detoxification unit. Journal of Substance Abuse Treatment, 4(2), pp.85-92.