Inter-versiones : un estudio sobre los tratamientos ambulatorios orientados a los consumos problemáticos de drogas en el sistema público de salud del Área Metropolitana de Buenos Aires


Epele, María Esther

Spatial Coverage




259 p.


Atribución-NoComercial-SinDerivadas 2.0 Genérica (CC BY-NC-ND 2.0)




Ciudad Autónoma de Buenos Aires (autonomus city)


This dissertation addresses therapeutics and drugs. Specifically, it examines outpatient treatments within the public health care system for problem drug consumers in the Metropolitan Area of Buenos Aires.

Although the number of institutions and services for intensive young and adult drug consumers has increased over the last decades, outpatient treatments have been recently promoted by legal regulations and by the academic sphere. According to official agencies, they are the most widespread therapeutic option in the country. However, certain segments of the population to which they are targeted still predominantly demand hospitalization in therapeutic communities. Taking into account recent changes in legislation, discourses and practices relevant to problem drug use, this thesis is framed within a field of tension regarding classic approaches for vulnerable drug user populations.

The research problem is analyzed from the critical socio-anthropological perspectives of health, and data gathering was based on an ethnographic approach. Fieldwork was conducted in a public, specialized and interdisciplinary outpatient institution, with a proven track record on managing problem drug use- specifically cocaines- located in a segregated neighborhood of the Metropolitan Area of Buenos Aires. Data construction techniques mainly included participant observation and semi-structured and in-depth interviews to those directly involved in outpatient treatment: health care professionals (psychologists, social workers and socio- therapeutic operators), intensive drug users (of cocaine, alcohol and blends of drugs and alcohol, mainly) and their proximity networks (women-mothers and heterosexual partners). Based on these techniques, different versions of outpatient treatments were linked and cross- referenced.

The main characteristic of these types of treatments is that they are based on a mobility regime that requires drug users to remain in their living space and to preserve close relationships, and implies inescapably revising and building on the everyday lives of drug users for its development. The hypothesis guiding the analysis is that public outpatient treatments for problem drug consumption tend to transform and normalize the ways of ambulating in areas and territories -directly or indirectly- marked by drug use, towards other different healthier and desirable ways of ambulating.

I first acknowledge the general trends of approaching drug users, reconstruct the current cartography of institutions and services aimed at treating drug users in Argentina, and identify the position of outpatient treatments.

I then describe therapeutic and support itineraries of young and adult drug users, I illustrate the differences between isolation and/or confinement and ambulatory treatments in disadvantaged populations, as well as the way in which they supplement each other and, and I show the chronic nature and expertise acquired by users and their proximity networks in their search for help in different public institutions.

Subsequently I describe therapeutic dynamics. I include team formation analysis, diagnosis construction and therapeutic circuits. I identify these treatments as part of the current trend granting a psycho- pathologic nature to social problems, I detail the implications of confessions during psychotherapy and I problematize considerations about “lies” and “responsibility”.

In addition, I address the dimensions of everyday life problematized by users and their proximity networks, which are reviewed during therapy. In the first place, I illustrate the problem of transactions in segregated neighborhoods. For this, I describe transformations in the labor market over the last decades and I outline youth and adult work trajectories, between job precarization, informality and illegality. I explain the mutations occurred in exchanges that used to be regulatory and I elaborate on the conflicts arising from the articulation between drugs and work. In addition, I analyze the use of money and domestic economies. Secondly, I describe and historicize patterns of local drug use. I then differentiate priority spaces for consumption and spaces safeguarded for shelter. I focus on complex relationships among peer groups and with the coercive State apparatus. I point out local morbidity-mortality patterns that are invisibilized in statistics. In the third place, I document bodily deterioration and overdoses, and I record a wide range of practices users apply to themselves when faced with scarcity of and multiple barriers to access to public institutions. In the fourth place I show the tension existing between care and control reviewing ways of bonding with proximate others. I also detail requirements, costs and practices in which proximity networks resolve extremely conflictive situations.

I finally identify the waiting of users and their proximity networks, and the distress of professionals as part of the effects produced by precarious public care. I show the different restrictions and potentialities of outpatient treatments. I state that the therapeutic modality focused on an approach based on listening and talking is insufficient for alleviating suffering directly or indirectly related to intensive drug use in disadvantaged populations.

Table Of Contents



El problema de la tesis
Segregaciones, economías y políticas públicas
Perspectivas generales sobre tratamientos a los/as usuarios/as de drogas
Cartografía de abordajes a los/as usuarios/as de drogas en Argentina
El abordaje etnográfico
El trabajo de campo
La estructura la tesis

1. Andar de acá para allá
Itinerarios terapéuticos y asistenciales
De andares y encierros
Delimitar lo difuso: lo ambulatorio
Cronicidades y expertizaciones

2. Hacia el ambular
Entretelones: El Punto
Diagnósticos: lo clínico y lo burocrático
En tratamiento
Cuando la mentira es la verdad
Perseverancias de responsabilidad y normalidad

3. Transacciones
Empleo y pobreza
La carne más barata del mercado
Drogarse para trabajar y trabajar para drogarse
Economías domésticas

4. Deambular
Tres lógicas
Casas, domesticidad y redes de proximidadBarrios, juntas y esquinas
Barrios, juntas y esquinas
Policías, patrulleros y comisarías
La muerte recurrente

5. Los cuerpos andantes
Historias de deterioro
Tocar fondo
La delgadez... y el camino al engorde
Encierro en el hogar, mudanza fuera del barrio
Modificaciones en la administración y sustituciones de sustancias
Curar(se) heridas

6. La espesura del acompañar
¿Quiénes acompañan?
Lo que implica acompañar
Requisitos y costos del acompañar
Revisiones del acompañar: entre el cuidado y el control

7. (Des)amparo
Versiones de lo posible: Pobres intervenciones para pobres
El abordaje desde la escucha y la palabra

Bibliografía citada

Título obtenido

Doctora de la Universidad de Buenos Aires en Ciencias Sociales

Institución otorgante

Universidad de Buenos Aires. Facultad de Ciencias Sociales

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