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that the situations of use, harmful use, and substance dependence require distinct
professional and political responses. Dependence, in particular, necessitates spe-
cialized and multi-professional support, as well as specic preventive and protective
measures, including harm reduction strategies. Furthermore, it is important to rec-
ognize that there is a broad spectrum between use and dependence (Silva etal.,
2015). In both harmful use and dependence, the association with violence may
occur, leading to signicant biopsychosocial consequences (Dahlberg & Krug,
2002; Galduróz, 2011).
Studies on family violence associated with the use of psychoactive substances
point to a series of vulnerability factors, which, in a cross-cutting and recursive way,
contribute to the maintenance of both the use of violence and the harmful use of
psychoactive substances, by people whose relationships and self-views can become
increasingly weakened. The aggravation of violence and the progressive increase in
the use of psychoactive substances, which are often discriminated behaviors, can
generate stigma, which in turn, affects even more the people in question and their
relationships (Feijó etal., 2017; Mardani etal., 2023; Monari etal., 2024; Silva &
Noto, 2022; Substance Abuse and Mental Health Services Administration, 2020).
Living conditions, relationships, and health inuence substance use, while, con-
versely, the harmful use of psychoactive substances has a reciprocal impact on the
health and life of individuals who engage in such use (Ronzani, 2018; Silva etal.,
2015). The type of use and the specic substance involved should also be consid-
ered. Alcohol, as a legal substance, is widely consumed in society, and the progres-
sion of alcohol dependence can be gradual and less perceptible within social groups
that normalize its use, despite the potential adverse effects on relationships and the
associated risks, such as accidents. Other substances include depressants, such as
benzodiazepines, solvents, or inhalants; hallucinogens, such as marijuana, LSD,
and ecstasy; and stimulants, such as amphetamines, cocaine, and nicotine. The
effects, characteristics, and potential harms of these substances are diverse (Masur,
2004; Masur & Carlini, 2004). In families with children, the use of violence and
psychoactive substances by adults signicantly affects child development (Silva
etal., 2015).
13.3 Integrative Perspective onHealth
andBioecological Development
Systemic and new paradigmatic authors offer an integrative perspective on health,
encompassing physical, psychological, and social dimensions, which inuence
each other in a recursive manner (Capra & Luisi, 2014; Morin, 2011). These authors
address the concept of “unique health,” representing a complex and multifaceted
approach (Centers for Disease Control and Prevention [CDC], 2024; Langdon &
Wiik, 2010; Morin, 2011), which includes the recursive relationship between
humans, as well as the interactions between humans, other animals, and the
13 Intrafamily Violence, Substance Use, andGender
172
environment. This perspective aligns with the bioecological view of development
(Bronfenbrenner, 1996).
In the elds of Social Psychology, Health Anthropology, and other Health
Sciences, the concept of vulnerability can be understood as an “analytical alterna-
tive,” as described by Oviedo and Czeresnia (2015, p. 238). This perspective is
framed as a possibility for understanding human behavior, social practices, and the
processes of health and illness, including substance use and dependence, from a
relational, complex, and dynamic approach (Reichert etal., 2019; Reichert, 2024).
In this regard, it proposes a rupture with the biologicist, universalist, and individual-
ist view of the biomedical model (Alves & Rabelo, 1998; Engel, 1977, 1980;
Langdon & Wiik, 2010; Oviedo & Czeresnia, 2015; Sodelli, 2016).
Risk is generally dened as the probability or likelihood that an individual will
contract a disease, experience violence, or suffer other forms of harm (Ferreira
etal., 2021). Unfavorable social, economic, and political conditions are recognized
as factors contributing to social vulnerability, which, in turn, weaken individuals
and relationships. According to Ayres etal. (2003), individual vulnerability (includ-
ing beliefs, knowledge, and behaviors) intersects with relational vulnerability fac-
tors (such as family and broader social contexts) and programmatic vulnerabilities,
which refer to the needs for public policies, government actions, and social protec-
tion networks (Amato etal., 2015; Ayres etal., 2003; Reichert etal., 2019; Silva
etal., 2015).
Violence is a factor of vulnerability for harmful use and for dependence on psy-
choactive substances, which in turn, is a factor of vulnerability for violence. Soares
etal. (2021), in an integrative review conducted between 2013 and 2019 on the
relationship between psychoactive substance consumption and domestic violence,
indicated that psychoactive substances are one of the main factors in the occurrence
of domestic violence, insofar as violent acts can be facilitated, inuenced, moti-
vated, or triggered by the use of psychoactive substances. They also showed that the
use of psychoactive substances can be a consequence of violence, reinforcing that
the latter is not a unicausal phenomenon.
3
Early recreational or sporadic use of psychoactive substances can progress and
evolve into dependence, which, in turn, rarely occurs in isolation from broader fam-
ily and social difculties. These situations are associated with the expression of
psychological distress, which is aggravated by and interconnected with broader
social issues, such as consumer culture, as well as ideals of pleasure and beauty
(Feijó & Macedo, 2022). However, Walsh (2012) and Reichert etal. (2021a, 2021b)
highlight the importance of identifying environmental variables (protective
resources) that promote coping and adaptation repertoires, which emerge from
3
Complementarily, in Sociologie de la drogue, Bergeron (2012) argues that the use or dependence
on psychoactive substances does not constitute a determining or explanatory factor for violent
behaviors or situations in a causal relationship. This is because (1) it is not a necessary condition,
given that violence can occur independently of substance use, and (2) it is not a sufcient condi-
tion, since the use of psychoactive substances alone does not inherently trigger violent acts.
M. R. Feijó et al.
173
individuals’ interactions with their environment and contribute to dealing with life’s
challenges—a concept Walsh (2012) refers to as “resilient forces.”
Resilience is understood as the process through which individuals, families, or
groups continue to develop in the face of adversity, shaped by the social and envi-
ronmental conditions in which they are embedded, as well as the protective resources
available to them (Reichert et al., 2021a, 2021b; Souza, 2011; Walsh, 2012).
Resilience and vulnerability are, therefore, interwoven with life contexts and should
not be perceived as immutable individual traits, in order to avoid reinforcing preju-
dices (Amato etal., 2015; Ayres etal., 2003). Factors such as access to secure and
meaningful employment for adults, quality education for children and youth, oppor-
tunities for continuous learning, healthcare, adequate housing, food security, and
well-planned leisure spaces are recognized as protective factors. Furthermore, fam-
ily bonds and social support networks can serve as protective mechanisms, contrib-
uting to resilience processes that may persist across generations (Dalbosco etal.,
2019). In contrast, certain relational dynamics and behaviors, such as the use of
psychoactive substances and the adoption of violence as strategies to manage con-
ict and distress, can exacerbate vulnerability (da Silva, 2021; Minayo & Assis,
2017; Silva etal. 2015).
13.4 Substance Use, Violence, Inequalities, andGender
Tondowski etal. (2014) described intergenerational patterns of family violence
associated with harmful alcohol use, evidenced through genograms. In alignment
with multigenerational family theories (Bowen, 1978; Cerveny, 2011), the authors
demonstrated the intergenerational transmission of family violence associated with
harmful alcohol use. This phenomenon involves the recurrence of behaviors, rela-
tional dynamics, and family patterns across generations, encompassing ways of
managing conicts, frustrations, deprivations, and difculties, including relational
and marital challenges (Tondowski etal., 2014).
To analyze intergenerational patterns of family violence associated with harmful
alcohol use, Tondowski etal. (2014) conducted a study with 42 family members
who had a history of such violence across generations. Using genograms con-
structed through interviews with a semi-structured script, the researchers identied
distinct patterns of intergenerational repetition of family violence associated with
harmful alcohol use, with more frequent recurrences observed in direct kinship lines
(e.g., father-son relationships) and through marriage. The study also highlighted
similarities in alcohol consumption patterns, types of violence, family responses,
and specic stages of the family life cycle in which family violence associated with
alcohol use intensied.
The ndings of Tondowski etal. (2014) reinforce the notion of repeated patterns
of violence and substance use across generations as a vulnerability factor, as high-
lighted by Feijó etal. (2017). These aspects contribute to the perpetuation of alcohol
use and intimate partner violence, which is often reciprocal between spouses.
13 Intrafamily Violence, Substance Use, andGender
174
However, women tend to be more severely affected due to structural inequalities,
including gender disparities (Carvalho etal., 2012; Hochgraf & Brasiliano, 2023;
Feijó etal., 2017).
Although violence is a global public health issue, certain populations are dispro-
portionately affected, as social differences are transformed into structural inequali-
ties, exacerbating both suffering and violence itself. The COVID-19 pandemic,
which recently impacted populations worldwide, intensied processes of violence
and psychological distress, particularly among groups historically marginalized
from access to rights and quality of life
4
(Centro de Estudos e Pesquisas em
Emergências e Desastres em Saúde [CEPEDES], 2020; Hien etal., 2022; Khanlou
etal., 2022).
Women and transgender people are identied as populations in need of continu-
ous prevention and care, sustained by effective public policies and the social decon-
struction of stereotypes, prejudices, and power relations that marginalize and leave
them unprotected (Carvalho etal., 2012; Conselho Federal de Psicologia [CFP],
2019, 2024a; Oliveira, 2009). Children and the elderly, who are often affected by
various forms of domestic violence, are also highlighted in the chapter as groups
that should be prioritized in research and interventions. Even when they are not
women, these individuals can be subjugated and weakened by power relations that
are rooted in expectations of production, income, heteronormativity, and submis-
sion within their relationships—dynamics that persist in misogynistic, consumerist,
ageist, and structurally violent contexts (Chang etal., 2021; Fang etal., 2022; Niu
etal., 2024; Pillemer etal., 2016). Racism, particularly the intersection of condi-
tions targeted by prejudice in society, should also be the focus of attention and serve
as a guiding principle for preventive actions and care (Carvalho etal., 2012; CFP,
2017, 2022; Cunningham & Saleh, 2024; Ferrugem, 2019).
4
In the Brazilian context, the COVID-19 pandemic highlighted signicant disparities in access to
healthcare services, which severely affected the homeless population (Reichert etal., 2021b;
Reichert, 2024). A 2022 survey identied 236,400 individuals experiencing homelessness, repre-
senting one in every thousand people in the country. The Southeast region accounted for 62% of
this population, with São Paulo having the highest number, housing 95,195 individuals (40% of the
total). Key factors associated with homelessness included family problems (44%), unemployment
(39%), alcohol and other psychoactive substance use (29%), and loss of housing (23%) (Ministério
dos Direitos Humanos e Cidadania [MDHC], 2023). During the pandemic, the homeless popula-
tion faced increased risks due to the high prevalence of respiratory issues, raising concerns among
experts regarding the impact on physical and emotional health, particularly for individuals with
anxiety and depression. Additionally, exposure to violence, substance use, and the deprivation of
fundamental rights exacerbated this situation, emphasizing the need for public authorities to
implement targeted care actions for this vulnerable group (Reichert etal., 2021b; Santiago, 2020).
In São Paulo, the Tem Sentimento Collective, which supports women and LGBTQIAPN+ people
experiencing homelessness and using alcohol, crack, and other substances, provided assistance
during the COVID-19 pandemic and continues to engage with this population in the area.
Additional information about the Collective can be found in Reichert (2024) and Silva and
Campos-Boulitreau (2024). These references offer a comprehensive view of the psychosocial vul-
nerabilities, social inequalities, and structural violences to which women and LGBTQIAPN+
people are subjected, including gender-based violence and rights violations resulting from prohi-
bitionist policies and the repression of substance use.
M. R. Feijó et al.
175
In Brazil, a country marked by deep inequalities, social, economic, and political
conditions contribute to the exponential increase in violence, including crimes such
as rape. At the same time, individuals are exposed to media appeals that equate
social status and satisfaction with consumption, while many lack adequate social
support, access to leisure opportunities, and essential services and rights necessary
for survival (Campello etal., 2018; Ferreira etal., 2021; Magalhães etal., 2007).
These dynamics reect power relations that exacerbate the nature of violent acts and
disproportionately impact groups already affected by exclusion and discrimination.
Within these contexts, individuals may also internalize violence and perceive the
consumption of psychoactive substances as a means of alleviating suffering (Soares
etal., 2021; Zaluar, 2004).
Structural and macrosocial aspects further sustain violence, such as the neglect
of elderly individuals and children, the exposure of young people to the allure of
employment in drug trafcking—particularly those who see no future prospects in
education or formal employment—and the precarious working conditions often
imposed on Black and Brown individuals, who, when employed, frequently receive
lower wages than others (Feijó & Macedo, 2022; Fernandes et al., 2022;
Zaluar, 2004).
In a cross-sectional study conducted between 2016 and 2020 in São Paulo,
Fernandes et al. (2022) investigated violence against homosexual, bisexual, and
transgender individuals. The study analyzed 4828 notications of suspected or con-
rmed cases of interpersonal violence, revealing that 51% of reported incidents
involved Black and Brown individuals. Furthermore, 64.5% of the violent acts were
committed by men, often linked to sexism, homophobia, transphobia, and genera-
tional conicts. The study also identied a correlation between violence and alcohol
consumption in many cases, as well as a higher incidence of violence among indi-
viduals with fewer years of education.
Although many reports document physical violence, it is important to consider
the invisibility of other forms of violence, such as psychological abuse, as well as
the underreporting of violence in private or closed environments, such as residences.
Sexual violence, in particular, often remains concealed, while other forms of vio-
lence may take time to be reported—or may never be—due to psychological and
nancial factors (Izumi, 2015; Minayo & Assis, 2017; Rutherford etal., 2007;
Soares etal., 2021; WHO, 2002).
A recent cross-sectional study (Mota etal., 2024), conducted between 2019 and
2021, examined transvestites and trans women over 18 years of age residing in
Brazilian cities, specically São Paulo, Porto Alegre, Salvador, Manaus, and Campo
Grande. The study found that 49.3% of participants reported multiple psychoactive
substance use in the past 12months, with alcohol (65.5%), tobacco (52.9%), and
marijuana (40.1%) being the most commonly used substances. The ndings indi-
cate that those engaged in multiple substance use were more exposed to situations
of violence, unemployment, and unstable employment, in addition to being more
frequently involved in transactional sex, possibly due to limited economic opportu-
nities. The authors suggest that this pattern of substance use may serve as a strategy
to cope with suffering and social marginalization, despite being associated with
13 Intrafamily Violence, Substance Use, andGender
176
various health risks and harms. The study underscores the importance of ensuring
comprehensive care for this population, guided by the principles of the Brazilian
Unied Health System (SUS) —universality, equality, and integrality—given that
transvestites and trans women often face stigma and abandonment, including exclu-
sion from their own family circles.
Regarding domestic violence against children, Domingues (2024) highlights
that, despite advancements in child protection laws, the data remain alarming. In
2022, police reports indicated a 16% increase in cases of rape and sexual exploita-
tion of children and adolescents. Among the victims, 90% were female, 61% were
under 14years old, and 56% were Black. In 68% of cases, sexual violence occurred
at home, and in 86% of cases, the perpetrators were family members or individuals
known to the child or adolescent. A study conducted by the Institute of Applied
Economic Research (IPEA, 2021), a Brazilian government-led research organiza-
tion, found that 29% of sexual violence victims were children under 11years old,
and 45% of perpetrators were family members. Additionally, data from the Ministry
of Women, Family, and Human Rights’ Dial Denunciation service reported 197,401
violent incidents against children up to nine years old in the rst half of 2022. The
primary types of violence recorded were physical violence, psychological abuse,
and neglect.
Reichenheim etal. (2011) conducted an extensive study on violence and high-
lighted research on intimate partner violence across sixteen major Brazilian cities.
The study revealed that 78.3% of the cases involved psychological violence, 21.5%
involved minor physical abuse, and 12.9% involved severe physical abuse. Izumi
(2015) provided a detailed sociodemographic prole of women in situations of vio-
lence and at risk of death, who were attended at a Women’s Reference Center
(CRM) and referred to a shelter house between 2011 and 2014. According to the
author, power relations are reproduced within the domestic space, reecting the
hierarchical and asymmetric gender roles that have been socially and historically
constructed. Men are legitimized to exercise force and power, while women are
relegated to positions of subjugation and subordination. An analysis of 967 records
of women attended by the CRM Casa Brasilândia from 2011 to 2014 showed that
among the 72 women who were sheltered, there was a predominance of those aged
between 20 and 29years, with relatively few years of schooling. Most of the shel-
tered women (45.8%) had incomplete primary education, meaning less than eight
years of schooling. Additionally, 55.6% were Black, and 41.7% did not have formal
employment. 63.9% of these women had no income, and 83.3% had between one
and four children.
Exclusion, along with the experience of prejudice, discrimination, and stigma, is
a factor that increases the potential for exposure to harm (Monteiro & Villela, 2013).
For example, people living on the streets may suffer violence from those they inter-
act with daily. This occurs within the microsystem of relationships, as seen in cases
of intrafamily violence (Silva & Noto, 2022). In addition to the homeless popula-
tion, individuals with disabilities, LGBTQIAPN+ people, brown and Black people,
Indigenous peoples, immigrants, women, the elderly, and sheltered children may
experience violence (CFP, 2017, 2019, 2022, 2024a, 2024b, 2024c, 2024d; Oliveira,
M. R. Feijó et al.
177
2022; Pagot, 2012). This is especially true when they are deprived of spaces and
opportunities for self-expression, legitimacy, work, income, or other means of
development. These groups may live in relationships that are violent and devoid of
dignity. Such relationships impact their family dynamics and are inuenced by
them. The internalization of violence and stigma follows individuals in their differ-
ent living environments. Collectives, however, can act as islands of exception, offer-
ing greater protagonism and resilience building (Minayo & Assis, 2017; Silva,
2024). Nevertheless, public policies are essential to ensure access to rights and
greater equity. They should be coupled with effective public security that respects
and guarantees the dignity of individuals. The diversity of their characteristics,
behaviors, and relationships must be valued in interactions between different groups.
13.5 Public Policies andDifferent Actions ofCare
withFamilies
Care for families experiencing suffering, difculties, and seeking professional help
has evolved since the inception of family therapy to the present day. Systemic-
cybernetic family therapy, characterized by the greater participation of profession-
als in interventions aimed at changing family relationships, remained predominant
until 1980. At that time, new scientic paradigms, theories, and epistemological
foundations began to support practices referred to as new-paradigmatic systemic,
constructionist, narrative, collaborative, appreciative, or restorative. These contem-
porary practices share complex thinking as their foundation, focusing on dialogue
and the joint construction of new meanings according to the needs and values of the
people involved, as well as their surroundings (Anderson, 2016; Grandesso, 2019).
They seek to avoid colonization, blaming, and promote the recognition of different
ways of living, loving, and being a family (Feijó & Macedo, 2022). These practices
are based on complex systemic thinking, which holds that relationships, processes,
and contexts require a careful examination for a multilevel understanding that
includes recursive circularity.
An example of such an understanding is Bronfenbrenner’s bioecological model
(1996) for understanding human development and health, called the PPCT model
(Person, Process, Context, and Time). Individual, procedural, micro, meso, exo, and
macrosocial aspects intersect at certain times and places and should be considered
when a person or family narrates experiences of violence, their needs, and care
demands. The professional seeks to identify aspects of vulnerability and resilience
intertwined at different instances and levels to collaboratively work with the family
in constructing new living possibilities, means of protection, and the interruption of
violent processes.
Care for families where violence is present requires, in addition to non-
discriminatory dialogue, the avoidance of amplifying stigma in the attempt to build
human security (Minayo & Assis, 2017; Monteiro & Villela, 2013; Oliveira, 2020;
13 Intrafamily Violence, Substance Use, andGender
178
Rocha, 2017). This approach aims to guarantee the survival of both individual and
relational bonds within the family system, ensuring well-being with dignity in social
coexistence. Friede (2021) emphasizes that the existence of a territory with quality
of life is related to the expansion of equity and access to rights, such as coexistence
and leisure in more peaceful, diverse, and sustainable cities. Public security, inte-
grated and associated with other violence reduction strategies, is ineffective without
adequate social, economic, educational, and political conditions that allow families
to experience quality of life. The expansion of development perspectives, the pres-
ervation of family relationships, access to work, and relationships that allow for
greater equity and access to rights are paramount.
Individuals and families present singularities and commonalities, in addition to
aspects of resilience and exposure to vulnerability factors. Resilience, according to
Souza (2011) and Walsh (2012), is a set of strengths of a person or a group that
allow them to face adversities and continue developing despite them. Among the
family strengths is the way people take care of each other and how they divide and
lead functions and tasks. The family conguration should not be questioned, as
there are many types of families,
5
and what matters are their bonds and the sense of
belonging of each of its components. The promotion of strengths and the legitimiza-
tion of the various ways of being a family, of conducting life and facing difculties,
should be the focus of professional action, which collaborates with the construction
of new possibilities and new meanings, with support to reduce vulnerability factors
that affect people, their relationships, and behaviors (Amparo etal., 2012; Minayo
& Assis, 2017; Teixeira, 2017; Teixeira & Carloto, 2020).
It is understood that individual, microsocial (family), macrosocial, and program-
matic aspects intersect and result in certain vulnerability factors, which affect indi-
viduals and, therefore, families. This aligns with the idea that individuals and
5
Carloto (2020) e Ceará-Silva etal. (2020) operate under the premise that history is not free from
ideological construction and analyze the inuence of this ideology on the concept of family, dis-
cussing the constitution and denition of the “model family” throughout history. The authors
address the importance of a counter-ideological force in public policies related to families, with the
aim of promoting social policies linked to counter-hegemonic projects and enabling the construc-
tion of new paths. In dialogue with authors such as Bauman (1999), Agamben (2010), Mbembe
(2020), and Butler (2017), the authors discuss the paradigms of contemporary society and the way
in which policies were constituted, considering that certain lives—those of individuals, social
groups, and populations—may be disqualied, invisibilized, or eliminated. Moreover, the critique
addresses how affective bonds that sustain families and communities can be undone in favor of
economic development within capitalist logic. In this context, it becomes essential to make histori-
cal connections, that is, to promote the exercise of thought regarding what is understood as family,
avoiding simplications that do not encompass human plurality and its countless possibilities of
arrangements. Thus, it is necessary to engage in a complex process to criticize the hegemonic fam-
ily model, centered on heterosexual, nuclear, and gendered marriage. In a reality where homocen-
tered, single-parent, Black, and poor families are disregarded, it is essential to qualify their lives so
that they are recognized as deserving of protection, paying attention to the diversity of ways of
existing and perceiving their real needs, which means recognizing these groups as human beings
and subjects of rights (Carloto, 2020; Ceará-Silva etal., 2020).
M. R. Feijó et al.
179
families should not be blamed but understood in context, taking into account struc-
tural issues—therefore, cultural, economic, and political (Silva etal., 2015).
Research on substance dependence, supported by notions of vulnerability and
resilience at individual, social, and programmatic levels (Feijó etal., 2017, 2024;
Soares etal., 2021), demonstrated that in situations of recurrent violence and psy-
choactive substance dependence, vulnerability factors stand out compared to resil-
ience factors, which require various care strategies to be enhanced.
Dependence on psychoactive substances, when the reason for seeking health ser-
vices, should also be understood in a complex and bioecological way, which
includes family and macrosocial history. Individual, microsocial, and macrosocial
aspects should be understood, considering the process of repeating patterns (behav-
ioral, relational, vital conditions), histories of violence, and family and marital dif-
culties. Lack of income and work tend to amplify marital and family difculties,
aggravate conicts, psychological suffering, and the use of violence associated with
the progression of psychoactive substance use (Feijó etal., 2017).
The family clinic, an important space for care and interruption of patterns of
violence and harmful substance use, should be made more widely and democrati-
cally available to the population, which also lacks public policies aimed at equity
and various means of reducing social vulnerability. Despite violence being pre-
sented as a global phenomenon that affects different groups, those who already
suffer from a lack of decent living conditions and who have historically been more
frequently victims of discrimination should be prioritized in such policies.
It is also worth noting that, from the point of view of Bioethics, a distinction must
be made between existential vulnerability and programmatic vulnerability or viola-
tion
6
(Cruz & Taquette, 2020; Junges etal., 2018; de Morais & Monteiro, 2017;
Rodrigues & Schramm, 2022). The latter is a condition of social, psychological, and
6
The scientic bioethics literature distinguishes the concepts of existential vulnerability and pro-
grammatic vulnerability or violation (which, in Brazilian bioethics literature, is translated as “vul-
neração”, a new analytical category). Existential vulnerability refers to an intrinsic condition of
the human experience, while programmatic vulnerability or violation pertains to exposure that
exacerbates this fragility, with implications such as rights violations, intensication of inequalities,
and worsening conditions for affected individuals (Cruz & Taquette, 2020; Gomes etal., 2022;
Junges etal., 2018; de Morais & Monteiro, 2017; Rodrigues & Schramm, 2022). In the context of
substance use, these concepts are particularly relevant, especially when considering programmatic
vulnerability, which amplies the risks and potential harms of substance use, exacerbated by inef-
fective and iatrogenic policies. The case of women and LGBTQIAPN+ people experiencing home-
lessness and substance use in the Luz region of São Paulo, pejoratively known as “Crackland” (a
public space where substances such as alcohol and crack cocaine are openly consumed), exempli-
es this dynamic. When analyzing the trajectories of this population, it is observed that many cis,
trans, and transvestite women have been marginalized by their families and communities, with the
streets becoming the space for survival and socialization, exposing them to risks such as discrimi-
nation, physical and psychological violence, sexual abuse, among others (Reichert, 2024). In this
context, these people face exclusion in educational, professional, and political spheres, hindering
access to social and healthcare services. Prohibitionist policies, often aimed at social and racial
hierarchization, intensify repressive measures and deepen inequalities, resulting in violations of
the fundamental rights of this population and exacerbating the scarcity of resources, both material
and immaterial, such as emotional support, access to information, and support networks (Reichert
13 Intrafamily Violence, Substance Use, andGender
180
physical health misery, that is, complete abandonment. Families in a state of pro-
grammatic vulnerability or violation often stay away from inclusive public policies
and, therefore, tend to live situations of constant violence and abuse on the streets,
which end up reproducing them in their own bonds, thus forming a “spiral of vio-
lence”. Building public policies for families with their participation in the process
is more than necessary in Brazil. This construction goes beyond welfare benets—
also necessary—but the construction of guarantees of legitimate rights to a digni-
ed life.
In the context of international drug
7
policies, signicant disparities persist,
necessitating an intersectional approach to understanding how gender, race, and
class shape the experiences of specic social groups. The intersection of gender and
racial biases has a particularly pronounced impact on racialized women, as well as
on their children, families, and communities (Csete etal., 2016; Ferrugem, 2019;
Perussolo etal., 2019). Given this scenario, the development of gender-sensitive
policies is essential to mitigating the adverse effects of drug laws and policies on
women and their families. Among the possible strategies, particular emphasis
should be placed on reducing prison sentences for women convicted of non-violent
offenses. This consideration is especially relevant since women are disproportion-
ately incarcerated for drug-related offenses compared to men. Additionally, expand-
ing access to social and healthcare support services—including substance use
treatment tailored to gender-specic needs—is crucial to promoting more equitable
and effective drug policies (Csete etal., 2016).
Another possible analysis of the international family-level impacts resulting
from prohibition and repression policies on psychoactive substances highlights the
adverse consequences of these measures, particularly regarding coercive practices
targeting people who cultivate crops used in substance production, such as coca
leaf, opium poppy, and cannabis. The forced displacement of rural families in vul-
nerable situations, often without secure land tenure, exacerbates poverty and food
insecurity and, in some cases, leads them to migrate to more marginal regions to
sustain cultivation. Furthermore, the geographical isolation resulting from these
etal., 2023). These processes generate ethical-political suffering, characterized by the denial of
basic rights and the perpetuation of a cycle of exclusion and violence (Sawaia, 2014).
7
At this point in the text, the use of the term “drug” refers to the arbitrary classication of psycho-
active substances in international policies, which divides them into legal and illegal categories,
with moral, medicinal, and legal implications (Bergeron, 2012). However, there are numerous
controversies in the health eld regarding its denition, as pointed out by Fiore (2006).
Etymologically, “drug” originates from the Dutch word “droog,” meaning “dry products,” a term
associated with cultural exchanges during the Crusades and the Age of Exploration. Throughout
history, cultural and political factors, such as cosmological, aesthetic, and hygienist views, have
inuenced the use and conceptions of substances, leading to the eradication of local psychoactive
plants by colonizers and the consolidation of a coloniality of knowledge. This process was marked
by the opposition of Christianity to other religions, the pursuit of a monoculture of Christian
thought, and economic and geopolitical interests. Currently, the knowledge about “drugs” is
largely inuenced by the biomedical perspective and criminalization, with social and structural
impacts that primarily affect vulnerable individuals, families, and communities (Costa, 2021).
M. R. Feijó et al.