Substance abuse in South Africa: The way forward |
Depression: The Signs to Look Out For
August 20, 2018
Broken Heart Syndrome
September 12, 2018

Substance abuse in South Africa: The way forward

Substance abuse in South Africa

Drugs of choice:

Statistics, feedback and research studies, other clinicians and my personal experience
indicate the following substances are the drugs of choice in South Africa:

  • Alcohol and Nicotine
    (included to provide a full picture although they are not considered a street drug).
  • Cannabis.
  • Amphetamines.
  • Cocaine.
  • Opiates (Heroin).
  • There is also a notable increase in the abuse of prescribed medication in South Africa
    i.e. medication containing Codeine and sleeping tablets.

  • Treatment and rehabilitation

    The following questions needs to be addressed prior to the discussion of treatment and treatment model

    1. What is a drug? A drug is any substance, natural or synthetic that alters the state of mind and changes the behaviour of a person. These drugs can be legal substances such as alcohol or nicotine, or illegal substances such as cannabis, heroin, cocaine and various other substances

    2. What is addiction and when are you an “addict”? Here we have to make a distinction between physical and psychological addiction. In the case of psychological addiction the substance is used for a purpose or the effect thereof. Physical addiction occurs when a tolerance develops, the user needs to take more of the substance to have the same effect.

    The second factor is that of withdrawal. The user suffers physical effects from withdrawal and has to endure symptoms like, pain, sweating and involuntary shaking. These withdrawal symptoms could be severe and require medical intervention.

    3. When is treatment required? Rehabilitation is required if the abuse becomes a habit, interferes with the users day to day functioning, causes conflict or even lead to criminal behaviour. Physical withdrawal is often one of the main reasons for treatment.

    4. What is a dual diagnosis? A dual diagnosis is the term used when a psychiatric disorders like bipolar disorder is present whilst the diagnosis of a substances abuse disorder like alcoholism or addiction is made simultaneously. These are two independent conditions and should be treated as such.

    Stages of Substance Abuse:

    People who become addicted to drugs and alcohol typically go through predictable stages of abuse. Understanding these stages can help you recognize a problem and seek help before substance use becomes a dependence.


    Alcohol or drug use starts with experimentation or voluntary use. In this stage, the use is infrequent and, in the case of teenagers, the substance is usually obtained from and used with friends in response to peer pressure to drink or use drugs.

    Older people who start to use drugs or drink heavily often do so in response to problems in their lives, such as losing a spouse or a job. Some people in this stage are able to stop using by themselves. Others, however, who believe their substance abuse is solving their problems or making them feel better begin drinking more alcohol or taking more drugs, thereby moving on to regular use.

    The use of alcohol or tobacco products by legal aged adults is socially acceptable and does not usually constitute abuse problem or risky use, or dependence as described below develops.

    Regular use:

    This stage is characterized by use on a regular basis. The person may continue to use with friends or acquaintances or may use the substance while alone. Regular use does not have to be every day, but is sometimes continued use in a predictable pattern (every weekend) or in predictable circumstances (when lonely, bored, or stressed).

    Problem or risky use:

    During this stage, the users begins to suffer legal, emotional, physical, or social problems. Adults may drink and drive or have problems at work or in their relationships. Teenagers may have bad grades, behavioural problems, and a significant change in friends, motor vehicle crashes, or speeding tickets.


    Someone who is dependent on drugs and/or alcohol will continue to use these substances regularly despite the harm their use is causing, including bodily changes causing altered reactions to the substance.

    These are characteristics of dependence:

    1. Chronic use of alcohol or other drugs that leads to failure to fulfil major responsibilities related to work, family or school.

    2. Repeatedly drinking or using drugs in situations that are hazardous, such as driving.

    3. Development of increased tolerance to use, meaning more of the drug or alcohol is needed to have the same effect.

    4. Withdrawal symptoms is a person cuts back on use.


    At this stage, substance use is compulsive and out of control. Addiction is a medical condition involving psychological and physical changes from repeated heavy use of alcohol, other drugs or both. The primary symptoms of addiction are uncontrollable alcohol or other drug craving, seeking and use

    The Five Steps in the recovery process


    The First Step:

    Structured environment and program–

    Treatment program – Early recovery can be a chaotic, emotional, and a delicate situation. A healthy treatment regimen and a stable environment are conducive to recovery. By establishing an effective routine with planned out activities and groups, the treatment provider creates a comfortable and trusting place for recovery to occur. At ZwavelStream, we structure the program to accommodate the individual. As recovery progresses, the treatment structure may change or adapt to meet the individual needs of each person.


    The Second Step:

    Medication-Assisted Treatment–

    Medication-Assisted Treatment of MAT has really become an integral part or addiction treatment. Termed the new “Gold Standard” for treating opioid addiction, MAT can help people addicted to various substances. Medicines that reduce cravings and block narcotic effects can help aid in alcohol and opioid addiction. Other medications, non-addictive, can help with anxiety and insomnia. As more medication are developed to assist in addiction recovery, MAT is only going to become more wide-spread.


    The Third Step:


    “IT IS OVER WHEN YOU SAY IT IS OVER” It is my opinion that the above-mentioned quotation is the key to successful recovery. This goes a step further that just admitting that you have a problem. It also highlights the issue of taking personal responsibility for recovery. To achieve and maintain this goal is not a once off decision. Most patients will relapse, often more than once, before reaching this point. Family, support of loved ones and spirituality is critical in their recovery process.

    Individual Psychotherapy–

    Individual psychotherapy is a critical part of the treatment of Patients suffering/struggling with Substance abuse/dependency and dual diagnosis disorders. For the purpose of this presentation I will use the term Substance use disorder. In order to individualize and understand your Substance use disorder, you need to really be honest with yourself and measure yourself against the stages of Substance Abuse. You might be able to identify and accept your stage of abuse or level of addiction.

    This should not be a case of “one shoe fits everybody”. Individual Psychotherapy should focus on the individual experiences and Psychological problems of patients, instead of generalizing treatment options.

    You should ask yourself the following questions:

    1. Why do I find myself in this situation?

    2. How has this condition affected my life on a personal level, my relationships with my significant others and other people?

    3. How has this situation affected my working performance?

    4. Is there any underlying emotions i.e. feeling depressed, anxious or any other emotions that I can identify leading to or present in my current situation?

    5. What have I done to address this problem and why was it not effective?

    6. Why did I relapse and why could I not abstain from using the substance again?

    7. Did I substitute by changing from my substance abuse to another?

    8. How am I going to cope with life and challenges if I had to stop my substance abuse today?

    9. What do I expect from being in the clinic, and what am I prepared to do?

    Can you see that these questions can lead to further self-exploration, setting goals and challenges? You, your Psychiatrist and Psychologist will agree to an individualized treatment plan of action in order to address your problem. Keep in mind that your addiction is not only a Psychological condition, or a sign of weakness. It is also classified as a mental disorder which should be treated and managed. I recently spoke to a patient and on my question on how he was doing, he replied “for today, I am doing fine for today”

    Psychologists have different approaches to Psychotherapy, the basic principles are the same. Psychotherapy is a relationship that is based on confidentiality, trust, empathy and respect. The general principles and desired outcomes are the same, dysfunctional thoughts and behavioural patterns need to be replaced with effective belief systems that would lead to positive changes in behavioural patterns.

    In-patient Individual Psychotherapy is based on short term outcome based solutions. It should be seen as a basis for ongoing therapy in order to reinforce and manage the long term goal or behavioural change and permanently abstaining from substance abuse

    Group Therapy–

    You will attend two group sessions during your period of your admission to the clinic. You will get the opportunity to share your experiences with the other members of the closed group (the same group will attend both sessions). Group therapy has been proven to be an effective outcome based therapeutic mode of treatment.


    The Fourth Step:

    Family Involvement and Reintegration–

    Often undervalued as a component of recovery, the family aspect can be crucial in successful treatment. In active addiction, the addict and the family are often involved in a co-dependent or toxic relationship. In early recovery, ZwavelStream encourages rebuilding of the family unit and helps each member of the family to recover in their own way. They encourage family members to play a healthy role in the individual’s recovery, without trying to “control” the situation. In the Systems Theory (family therapy) it clearly states: “If you change one part of the system (family) you change the whole system”. The first contact with the family or significant others should take place within the first 48 hours (a telephonic contact is sufficient) following the patients admission to the clinic.

    Family sessions will be scheduled according to the need of the patient and his/her family. It is my recommendation that the patient and his/her family should be seen on the last session prior to his/her discharge. This session is crucial in order to facilitate the patient’s reintegration into the family and general community.


    The Fifth Step:

    After care and ongoing treatment–

    After care is a crucial phase in the recovery process (value often underestimated). Existing support systems like the A.A (Alcoholics Anonymous) and N.A (Narcotic Anonymous) should be utilized. Patients should familiarize themselves with the mentioned support systems in their communities. It is also recommended that the patients should see their Psychologists/Psychiatrist at ZwavelStream Clinic on a regular bases as agreed on at the time of their discharge from the clinic.

    Those patients will be seen as out-patients on scheduled dates and times. Patients should complete a Maintenance plan consisting of scheduled individual and family therapy sessions, emergency numbers of their Psychiatrist, Psychologists, significant others and the clinic. Patients should set personal goals, understand their cravings and risk factors. They should be made aware of the concept of avoiding people, places and paraphernalia reminding them of their substance abuse. It is advised that personal relationships between patients following their discharge from the clinic is not recommended.

    Leave a Reply