SUBSTANCE ABUSE

SITUATION ANALYSIS

129. Substance abuse is recognised as one of the greatest health and social problems in South Africa. It has wide-ranging

consequences, which include physical debilitation, chronic impairment, injuries, marital and family problems, child abuse, violence in families and communities, trauma, depression, crime, traffic accidents, work stress, social misery and economic costs.

130. Alcohol remains the most popularly abused drug, and alcoholic beverages are growing in popularity, especially in informal settlements and rural areas. The abuse of over-the-counter medication and prescription drugs is on the increase. Regarding other drugs, the South African market is dominated by dagga, mandrax, cocaine, ecstasy, heroin and LSD. The simultaneous use of dagga and mandrax is widespread in South Africa. Glue sniffing is also prevalent. The increase in liquor outlets (shebeens in particular) and drug smuggling and selling as a means of income, is a grave concern.

131. It is estimated that approximately 5,8% of the South African population over the age of 15 is dependent on alcohol12. High-risk groups include the youth, sexually active young girls and pregnant women, children, especially street children, homeless adults, people living in townships, informal settlements and rural areas, prisoners and athletes. Although there are indications that the abuse of drugs and illicit substances is increasing, the extent of the abuse has not yet been established.

132. Services in the overcrowded townships, informal settlements and rural areas are grossly inadequate compared with those in urban areas. Detoxification services, at hospitals in particular, are often inadequate. Community-based services as well as treatment programmes and services for highrisk groups are very limited. Insufficient funds and personnel threaten existing services and their further development. After-care services providing for the reintegration of patients into the community are inadequate. Primary prevention programmes are a priority.

133. A network of specialist welfare organisations, together with the departments of welfare, render specific services regarding substance abuse in all the provinces. Other organisations and support groups are visible in most urban areas. A number of bodies exist which provide research services to inform policy and programme development. Guidance classes can serve as a corrective resource but can also be utilised for broader preventative programmes such as alcohol safety schools.

APPROACH

Comprehensive and intersectoral

134. The approach to substance abuse should be comprehensive and intersectoral. Combatting substance abuse should be done in partnership, through networking and co-operation between all relevant role players at all levels. International networking is very important to combat the substance abuse problem. The reduction of the demand and supply of abusive substances should be addressed simultaneously.

Services must be made accessible to people with disabilities.

Prevention

135. Communities have the right to information and education about substance abuse and to receive quality care and services.

Communities should contribute financially where possible. Programmes should be aimed at all dimensions of human life: physical, psychological, social and spiritual. Prevention programmes will promote a healthy life-style free from substance abuse. Pro-active media campaigns are needed to educate the public.

Co-responsibility

136. The Government is responsible for treatment and prevention programmes. It should focus on vulnerable and high-risk groups and disadvantaged communities. Co-responsibility for the prevention and treatment of substance abuse rests with the individual, the family, civil society, schools, employers and business, religious organisations and the Government.

Community-based treatment

137. Community-based treatment and development will be promoted, particularly in under serviced areas. More appropriate community-based structures should be developed, for example day-care centres, out-patient services, mobile clinics and transit houses. Social services should also be available not only to the person abusing substances, but also to the family, especially children.

Capacity building

138. Specialised knowledge in respect of substance abuse should form the basis of generic social welfare services, voluntary service rendering and interventions by other professionals, as well as religious and indigenous care-givers.

Evaluation

139. Planning, policy formulation and legislation should be regularly updated in consultation with the relevant role players. The problems of drug and alcohol abuse will be assessed through ongoing and appropriate research.

GUIDELINES FOR STRATEGIES

Prevention and education programmes

140. Primary intervention will be aimed at awareness, information and education programmes for the public. These programmes will be targeted at school-going children, youth and parents. The focus of secondary prevention will be on high-risk groups with the aim of providing specific education, making use, among other things, of employee assistance programmes and youth forums. Tertiary prevention will focus on holistic community-based treatment programmes with the aim of re-integrating the person into society and preventing the recurrence of abuse. Appropriate information, education, development and prevention programmes will be provided to promote a healthy lifestyle, free of substance abuse. Strategies will also be devised to curb the demand for abusive substances, at the same time linking up with supply reduction strategies. Community development programmes in disadvantaged communities will promote empowerment and self-help strategies.

Re-integration into the community

141. Interprofessional treatment and after-care programmes will ensure the effective reintegration of the dependant into the community.

Expansion of services and facilities

142. Services in under serviced communities will be expanded through community-based strategies. Existing residential facilities which are not being fully utilised will need to become more efficient and effective in meeting needs. Residential facilities will only be expanded after rigorous assessment of needs. Consultations will be held with the Department of Health about the provision of detoxification and medical care services at all provincial hospitals.

Funding options

143. Funding mechanisms such as medical aid societies and medical insurance will be sought to meet the cost of treatment for substance abuse.

Accredited training

144. Specialised accredited training units will be made available to provide adequate training for allied personnel and volunteers in the field.

Data and research

145. A reliable database on substance abuse will be developed. Appropriate programmes to combat substance abuse will be undergirded by research.

Co-ordinated efforts

146. Substance abuse forums networking at the national, regional and local levels will be encouraged to lobby for the establishment of more effective prevention and treatment services. A strong representative consultative and co-ordinating body is needed which will foster partnerships and ensure the implementation of a national strategic plan for combatting substance abuse.

Legislative reform

147. Comprehensive legislation will be introduced to address the fragmentation in present legislation.