Many people are unaware of the state of addiction in South Africa in terms of treatment facilities and drug abuse. Adrienne Dodds, Director at The Recovery Foundation, conducted research on these areas to help inform the public…
The state of treatment facilities
According to the South African Medical and Research Council, there are 83 registered facilities that submit information for research purposes. Of this number, many are South African National Council on Alcoholism and Drug Dependence facilities, meaning that they are government funded.
We can break down the treatment facilities’ market as follows:
Registered facilities: These are mainly facilities where clients can claim from medical insurance. They are also registered with the Department of Health and Social Development and are inspected regularly. These facilities can include psychiatric facilities, 12-step facilities, and religious facilities.
Unregistered facilities: These can be run as non-profit organisations. They follow their own rules and are notorious for their ill treatment of addicts.
There are a small handful of facilities that offer alternative treatments such as therapeutic communities, which have programmes focusing on vitamins and saunas for detoxing. Ibogaine treatment is becoming popular for overseas’ clients who want to find a solution to their addiction problems.
Most facilities are found in Gauteng and in the Eastern and Western Cape. Other provinces have few facilities and their success rate is dismal due to lack of the correct facilities for their clients.
Drug abuse and the state of addiction in South Africa
In South Africa, addiction is seen as a social ill. However, on a global level, addiction is seen as a major health issue driven by poverty; lack of education, myths, and taboos. The Recovery Foundation views addiction as a bio-psycho-social issue. In essence, what your biology is, what psychological issues do you have, and what is or was your social structure? The answers to these questions all influence an individual’s inclination towards addiction as well as an appropriate treatment plan for them.
Specific demographics regarding the state of addiction can be found in the South African Community Epidemiology Network on Drug Abuse (SACENDU – Annexure One) latest report . From these reports, we can see what is happening in different provinces, who their clients are (by race, age, gender etc.) and the report also gives information about the different drugs that are being abused. Unfortunately, due to the limited research done in South Africa, there are only sporadic research reports that have been done. SACENDU provides information only about registered treatment facilities and the patients they treat. The real problem is much larger, and without research, is extremely difficult to gauge.
Some of the trends in our industry include the controversial policies on Marijuana and Medical Marijuana. Although it isn’t legal in South Africa, it has been decriminalised, which means that you may smoke in the privacy of your home, but you may not grow it or sell it. There is still research being done by the Medical Research Council on its medicinal properties.
There is a growing and urgent problem emerging as many of our township youth smoke Nyaope (a mixture of marijuana and heroin). This is a largely ignored substance and is reported upon sensationally. The problem is that the progression of smoking Heroin leads to the increase in people who inject Heroin and a surge in the rate of HIV, Tuberculosis and Hepatitis-C infections. There are a few organisations involved in needle-exchange programmes. This is one aspect of the NPO that we will be employing in the local communities in this area.
The most abused drug overall in South Africa is Marijuana, followed by Alcohol and then Cocaine. The drugs of abuse also differ between provinces. In the Cape, Tik (Chrystal Methamphetamine) is more common, while in Gauteng, it is Marijuana. In the Eastern Cape, admissions are mostly for Alcohol.
When it comes to detoxification, it is common to find that certain drugs like Heroin or Cat have been mixed with other drugs. This makes it difficult to know how to safely detox a client. In addition to this, clients coming from other African countries use a combination of drugs that often don’t show up in tests and their side effects are sometimes difficult to diagnose.
There has been an increase in drug-induced psychosis, which is difficult to treat and treatment is largely unsupported by overburdened public hospitals.
The misuse of Codeine has become an issue in South Africa and there has been some publicity surrounding this.
Room for improvement in South Africa
It appears that conducting awareness campaigns regarding the state of addiction is challenging. In the USA, campaigns are clearly produced in English and Spanish. In South Africa, each of the 11 official languages come with their own cultural identities, taboos, and issues. The language used for recovery-related issues for an addict in Sandton is radically different from the language used for a young Nyaope addict in Soweto.
Psychiatric illnesses and addiction (known as Dual Diagnosis) are often misunderstood by people in general, but this is an increasing problem in treatment and must be treated appropriately and with compassion. The LGBTQ community is a niche area where much work needs to be done, and treatment for adolescents is another niche that is not well catered for.
Medical insurance is still offering the same benefits that they did some decades back. These benefits must be increased and should be in line with trends overseas. Many facilities in South Africa rely on the 28-day treatment length because of these policies. Increasing the length of treatment would increase treatment success. Outpatient programmes are often excellent treatment options for those unable to stay in rehabilitation centres as a resident. They are prominent in the Cape but misunderstood in other areas.
Adrienne Dodds, Director at The Recovery Foundation and Intermediate Addictions Counsellor with the Board of Addiction Professionals of South Africa
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