Belling, of Dodgeville, studied addiction during her undergrad in psychology, where she first learned about Portugal’s policy. “When the opportunity presented itself to study abroad, I knew I had to go because it would be a ‘full circle’ moment for me,” she said.
“It was really cool to be in a society that had significantly less stigma and misinformation around mental illness and alcohol and other drug abuse as compared to the United States. I love that my understanding of these brain diseases allows me to educate others, encouraging acceptance and empathy toward folks who struggle.
“After visiting a country where everything related to mental health care is so different, it was hard at times to imagine how I could possibly make any difference in America,” Belling said.
“My classmates and I shared our sadness in this but will use our hope to propel us to be better clinicians. Although we might not be able to change the world, we have the privilege of playing a large role in the worlds of our clients. We have the power to provide a positive experience with mental health care," she added.
Johnson, of Suring, enrolled in the class because she wanted to see something new and “because it can be frustrating when you’re working within a system that sets people up to fail. I wanted to see in person a place where there are programs that work for the people.
“This experience gave me a new stance from which to advocate from professionally. I have a new approach for my future clients. Harm reduction makes sense in the classroom, but to see in person how it works and how accessible it can be was really cool to see,” Johnson said.
“Unfortunately, in the U.S., we’re not at the point where we can offer that. There are people who don’t believe in decriminalization; people who believe in the stigmas surrounding drug use,” she added.
A social service system devoted to harm reduction
In Lisbon, the class visited SICAD, the National Institute for Preventive Behaviors, which helps craft policies, maintenance and change. Students spoke with Elsa Maia, director of Intervention on Addictive, Behaviors and Dependencies, in the Ministry of Health.
Maia presented on Portuguese policy, its approach to harm reduction and the history behind the policy, which decriminalized drug use in terms of practice with less than a 10-day supply. “But that doesn’t mean it’s legal,” Bates-Maves added.
“Above all, a person with a substance use disorder is considered as a person in need of health and social care,” she said.
When someone is found with less than a 10-day supply, they are given an administrative citation to meet with a dissuasion committee of social workers, physicians and counselors, who determine if the person’s possession is for medical or recreational use. They then determine what care the person may need and if they opt in for counseling support, their care is paid for by government health care. Those found with more than a 10-day supply are arrested as a dealer/distributor and criminal proceedings take place, Bates-Maves noted.
In the U.S., a similar visit might take a half hour to an hour waiting in line to see a nurse and perhaps a therapist. Limited hours of operation, few facilities in a region and cost of coverage hinder accessibility and add barriers for people on their way to recovery, Bates-Maves said.
Johnson was amazed to learn that the worker’s employer was involved and supported his recovery. “In the U.S., people feel that they could be putting themselves at risk and looked at differently by their employer for their past drug use or recovery,” she said.
For Barry, the course was an academic, professional and personal opportunity. She has been in recovery from alcohol for seven years. She celebrated her anniversary of sobriety with her cohort on their trip.
“Seeing the mobile methadone unit in person was very emotional for me, in a good way. With my lived experience, it was very profound to witness a country that can go so far to help its people,” Barry said.
Careers in counseling and compassion
Johnson will graduate with her master’s this December. “You learn so many amazing things in the clinical mental health counseling program,” she said. “You’re learning knowledge of counseling, but it’s also a journey of personal growth. I think of who I was coming into the program and now as I’ll be graduating. To counsel someone else, you have to have that moment of vulnerability yourself. It’s about personal development.”
Johnson, who has a bachelor’s in criminal justice rehabilitation from UW-Stout, is currently interning with Lutheran Social Services in family therapy and children with high needs and worked as a residential treatment worker with Arbor Place, in Menomonie. During her undergrad, she interned with Cedar Ridge, a dual-diagnosis residential treatment center in Stillwater, Minn.
Barry is completing her practicum with Park Avenue Center, a drug and alcohol use facility in Minneapolis, with a goal to continue working with this population. She plans to earn dual licensure in substance abuse counseling and mental health. She will graduate in May 2024 and has her B.S. in psychology.
“I would move to Portugal in a heartbeat if I was able to work for them,” Barry said.
Belling is in her practicum at Dunn County Behavioral Health Services and will graduate in August 2024. She is most interested in working in trauma counseling but is keeping an open mind.
The course also included cultural immersion and sightseeing opportunities such as a Portuguese language lesson, a cooking class and visits to castles and palaces in the Lisbon area.