Resumen:
This study aims to reflect on public health policies directed at people who use alcohol and other drugs in the municipality of Salvador, Bahia, analyzing the services provided, the disputes between paradigms guiding such policies, and the conflicts surrounding public funding. A descriptive-explanatory methodology was adopted, based on a bibliographic review (theses, dissertations, and academic articles) and documentary research (laws, institutional reports, and regulations), articulating critical references from Social Work with the Marxist theoretical tradition. The research seeks to understand the complexity of the relationship between human beings and psychoactive substances, framing them as commodities that respond to specific needs, while rejecting moralizing perspectives that portray drugs as inherently harmful, which serves to obscure structural social problems. It also problematizes the intersections of race, class, and gender that sustain the prohibitionist perspective legitimizing the genocide of Brazil’s Black and poor youth. The results reveal that the Psychosocial Care Network (RAPS) in Salvador offers insufficient and fragmented coverage, marked by weak articulation among CAPS, Primary Care, and the Urgency and Emergency Network. A hybrid model was found, in which community-based services coexist with asylum-like practices, such as psychiatric hospitals and therapeutic communities, highlighting setbacks and contradictions in the Psychiatric Reform process. The scarcity of CAPS III units, which provide overnight care, as well as CAPSad and Therapeutic Residential Services, was also identified, along with weaknesses in intersectorality and psychosocial reintegration actions. It is concluded that mental health policy in Salvador, although it has advanced over the last two decades, remains unfinished and permeated by tensions between biomedical and psychosocial paradigms, as well as by disputes over funding and the influence of prohibitionism. The study reaffirms the need to strengthen the RAPS through a Harm Reduction perspective, recognizing users’ autonomy and protagonism, and to confront the inequalities of race, class, and gender that structure both drug policy and the genocide of Black and poor youth in Brazil.
