“I lost my home because of my son, who was a drug addict,” said Leonor Miranda, her voice steady but marked by experience.
For four months, she lived on the streets of Rio de Janeiro, a city famed for its beauty, yet increasingly grappling with a deepening substance abuse crisis.
Today, Miranda is rebuilding her life. She now works at the Carolina Maria de Jesus Psychosocial Care Centre (CAPS AD) in São Cristóvão, in the northern part of the city.
The public facility supports people battling drug addiction, alcohol dependency and mental health challenges. Her journey from homelessness to recovery mirrors the stories of many who walk through the centre’s doors.
The scale of Rio’s drug crisis was brought into sharp focus during the Partnership for Healthy Cities Summit, where journalists were taken to the facility to witness firsthand how the city is responding to addiction as a public health issue rather than solely a criminal one.
Perched on the steep hills of Rio, where sprawling informal settlements overlook postcard-perfect beaches, a different reality unfolds.
These communities, commonly known as favelas, are on the frontline of a crisis driven by synthetic drugs, alcohol abuse and limited access to mental health services.
A drive through these densely populated areas leads to CAPS AD Carolina Maria de Jesus, a place of refuge amid the chaos. Inside, patients receive counselling, medical care and social support, critical interventions in a city where addiction is deeply intertwined with poverty, violence and inequality.
Speaking in Portuguese, Miranda reflected on her journey of recovery, describing how she is slowly reclaiming her life and dignity.
“My son became addicted to drugs and our house was taken by the dealers he owed. He recently reached out asking for help, and I would love for him to be supported. He is currently in rehabilitation at another centre,” she said.
I lost my children, the only people I truly loved. I want help, mental health treatment. I don’t have a life. Sometimes we are in a prison, but the prison has no bars. Our prison is in our minds. I’m trapped.
— Célio Vieira
Rio’s secretary of health Daniel Soranz said the accessibility of drugs remains one of the city’s biggest challenges.
“It is very easy to access drugs in Rio, including cocaine and synthetic substances. A significant number of young people are using drugs, and this has had a major impact on the city. As a municipality, we want to map this from a health perspective,” he said, adding that mental health issues often accompany substance abuse.
For many, the struggle is as much psychological as it is physical.
Célio Vieira, who is receiving care, described the weight of his experience.
“I lost my children, the only people I truly loved. I want help, mental health treatment. I don’t have a life. Sometimes we are in a prison, but the prison has no bars. Our prison is in our minds. I’m trapped,” he said.
He added that stigma continues to isolate those battling addiction.
“People are scared of my appearance. I just want a place to take a proper shower, to feel human again, to have normal conversations. I want to get out of this.”
Alessandra Peçanha, director of the psychosocial centre, said one of the biggest challenges is shifting away from a deeply entrenched “war on drugs” mindset.
“Most of the people we see are highly vulnerable and living on the streets. We are trying to break that cycle,” she said.
City representative Hugo Fagundes said Rio has identified 109 drug-use hotspots, highlighting the scale of the problem.
“Our approach is to treat and care for people in crisis, and to follow up with those who seek assistance through our facilities. We have 17 primary healthcare teams working specifically with people living on the streets. In 2023, we increased investment in services for this population,” he said.
The challenges seen in Rio echo a familiar and urgent crisis in South Africa. Across cities and townships, communities are grappling with rising drug use, from nyaope to methamphetamine, alongside widespread alcohol abuse and a growing mental health burden.
Much like in Rio, addiction in South Africa is often rooted in structural inequality: unemployment, trauma and limited access to healthcare. Families are frequently the first to absorb the shock, with many, like Miranda, losing homes, stability and relationships in the process.
Experts in both countries warn that without integrated responses combining healthcare, social support and community-based interventions, the cycle of addiction and mental illness will continue to deepen.
Rio’s CAPS AD model offers one possible pathway: treating addiction not as a moral failing or purely criminal issue, but as a complex public health challenge. For South Africa, where stigma and under-resourced mental health services remain significant barriers, such approaches may hold valuable lessons.
Miranda’s story is ultimately one of loss, but also of resilience, a reminder that behind the statistics are individuals and families navigating the long road to recovery.
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