Prevalence and Demographic Correlates of Substance Use among Adults with Mental Illness in Eastern Cape, South Africa: A Cross-Sectional Study (original) (raw)
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By: Cindy van Wyk (The South African Depression and Anxiety Group) "The basic thing nobody asks is why do people take drugs of any sort? Why do we have these accessories to normal living to live? I mean, is there something wrong with society that's making us so pressurised that we cannot live without guarding ourselves against it?"-John Lennon Substance use and abuse is becoming a major public health problem, both internationally and in South Africa. Globally, the United Nations Office on Drugs and Crime (UNODC) estimates that between 155 and 250 million people, or 3.5% to 5.7% of the population aged 15-64 years, had used illicit substances at least once in the previous year. The 2010 World Drug Report published by the UNODC states that cannabis (marijuana) users comprise the largest number of illicit drug users (129-190 million), with amphetamine-type stimulants (e.g. methamphetamine) being the second most commonly used illicit drugs, followed by opiates and cocaine. South Africa appears to be suffering from a drug pandemic, with drug consumption being twice that of the world norm according to the Department of Social Development's Central Drug Authority (CDA, 2009). Their statistics indicate that nearly 15 percent of South Africa's population have a drug problem, with substance abuse being a major contributor to poverty, reduced productivity, unemployment, dysfunctional family life, political instability, the escalation of chronic diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), injury and premature death. These statistics are mirrored in the results from the first nationally-representative study of psychiatric morbidity, the South African Stress and Health Study (SASH), were published. The SASH study, undertaken by Prof. Dan Stein, Williams and Kessler through the first decade of democracy in South Africa, determined that in South Africa there is high lifetime prevalence (13.3%) and early onset (21 years) of substance use. According to the CDA alcohol, the primary drug of abuse in South Africa, is a factor in nearly half of the motor accidents in South Africa every year, resulting in the loss of some 7 000 lives and a cost to the country of nearly R20 billion. Additionally, the South African Police Service (SAPS) claim that 60 percent of crimes committed nationally were related to substance abuse, with the figure rising to 80 percent in the Western Cape. While it is true that drug-addicted individuals often need more than one treatment episode, there a large international repository of research with evidence to suggest that drug and psychotherapeutic interventions are effective in the treatment of individuals suffering from substance use disorders. Indeed, even though the chronic nature of the disease of substance abuse often requires a lifetime recovery process to sustain treatment-induced changes, most practitioners believe that providing treatment at an early stage has the potential to prevent enormous disability before substance abuse as an illness becomes more severe and more difficult to treat. South Africa, however, appears to have a number of barriers to effective treatment and rehabilitation for substance abuse. Despite the high prevalence of substance use the SASH Study revealed that only 27.6% of South Africans who met criteria for substance use disorder received treatment in the year preceding the interview. Compounding this is the research done by Professor Malaka at the University of Limpopo who determined that most drug rehabilitation centres have a success rate of less than 3 percent. Additional international research has criticised the service delivery for the treatment of substance use in low and middle income countries, including South Africa. Findings from this and local research done by Professor Charles Parry of the Medical Research Council of South Africa state that when available, treatment is usually oriented to tertiary treatment of dependence with an emphasis on long-term residential treatment.