The Treatment of Addictions in Portugal - What Future?

In the past 20 years, Portugal has been touted throughout the world as a role model in drug policy and addiction treatment. Nonetheless, in the same period, the official political discourse couldn’t be more distant from the everyday reality. In 2011, the IDT (Instituto da Droga e Toxicodependência), an autonomous government body responsible for defining and implementing drug and addiction treatment policies, was extinct. SICAD (Serviço de Intervenção nos Comportamentos Aditivos e Dependências) the surrogate agency, created with the same purpose as IDT, but operationally overseen by the regional health administrations (ARS Norte, Centro, Lisboa e Vale do Tejo, Alentejo and Algarve). Since then, we have been witnessing a systematic and relentless degradation of the specialized services in the treatment of addictions, particularly evident in medical staff hiring policy.

We aim to assess the impact in addictions treatment, namely the quality of care provided, due to the shift in regional health administrations (ARS’s) medical work policy, using ARS Norte as a case study. In the last decade, medical staff recruitment has changed from permanent labour contract offers to fixed-term contracts, usually renewed annually. We use descriptive statistical analysis and theoretical approach to this problem. Currently, the medical work in the ARS Norte outpatient clinics specialized in addictions treatment – CRI’s (Centro de Respostas Integradas) - is based mainly on temporary workforce. There are 31 (56%) physicians with fixed-term labour contracts, ranging from 6 hours to 37 hours weekly and 24 (44%) physicians with permanent contracts (40 hours/weekly).

The shift of work policy, resulting in high physician turnover, raises three major concerns: a) serious gaps in the access and continuity of specialized care; b) impersonal doctor-patient relationships, which are vital for favourable clinical outcomes; c) low morale, burnout and impaired teamwork communication. We suggest a reshaping of the medical team hiring policy.