Epidemiology of Drug Abuse Treatment in South Africa

By Ramlagan, Shandir; Peltzer, Karl et al. | South African Journal of Psychiatry, April 2010 | Go to article overview

Epidemiology of Drug Abuse Treatment in South Africa


Ramlagan, Shandir, Peltzer, Karl, Matseke, Gladys, South African Journal of Psychiatry


Empirical evidence collected in the late 1990s pointed to a gradual increase in drug-related problems and substance abuse in South Africa. The challenges associated with substance abuse continue to be perpetuated by socio-economic and developmental factors (1) and because South Africa is one of the world's largest producers of some drugs such as cannabis, most of which is consumed regionally, with shipments going to the Netherlands and the UK. (2) Both locally and at a global level, moreover, drug consumption and trafficking is very active. (3)

In South Africa, alcohol and drug abuse was highlighted by former President Nelson Mandela in his opening address to Parliament in 1994, (4) as a problem among the social pathologies that needed attention. Since 1994, there has been a dramatic increase in the establishment of private treatment services (both licensed and unlicensed). (5,6) An initiative to develop norms and standards for in-patient treatment centres has recently been completed. (7) Steps have also been taken to institute protocols for managing the detoxification of patients at secondary hospitals in several provinces. (8)

An international example of substance abuse patterns is in Texas, USA, where alcohol was found to be the primary drug of abuse in terms of dependence, death, treatment admissions and arrests, while cocaine was found to be the primary illicit drug for which Texans commenced treatment. (9) In 2003, cocaine (crack and powder) represented 27% of all adult admissions to the Texan Commission on Alcohol & Drug Abuse-funded treatment programmes. Abusers of crack cocaine made up 19%, and of powder cocaine 8%, of all admissions. (9)

In Nigeria, 367 substance abuse clients were admitted to a university's teaching hospital's cross-sectional study between 1980 and 1984. (10) Those between the ages of 15 and 30 tended to abuse cannabis and amphetamine more than alcohol, whereas those [greater than or equal to] 31 years old tended to abuse alcohol. (10) A Maldives rapid situation assessment (11) found among 204 drug users that 97% were male, with a mean age of 21.4 years. Almost half of these respondents (47%) were <20 years old. Primary drugs used in the previous month in the Maldives were opioids (76%), cannabinoids (12%) and alcohol (9%). Most of the key informants and focus group participants attributed their reasons for drug use to family problems, experimentation, peer pressure, lack of awareness, psychological problems, easy availability, lack of educational and employment opportunities, boredom and stress. (11)

In Cameroon, 454 respondents participated in a rapid-assessment, snowball-sampled study. (12) The ages of drug abusers ranged from 11 to 60 (mean 29), of whom 15% were <20 years old and 10% were >40 years old; 83% of the drug abusers were male, 46% of respondents had been introduced to drugs by friends, most shared their drugs, 13% had tried drugs out of curiosity, 11% wanted to enhance their work or academic performance, 11% were influenced by peer pressure, and 9% had been given drugs to sell. Of the respondents, 86% currently used cannabis, 6% used amphetamines, and 3% used cocaine. (12) The study also reported that alcohol consumption was common among drug users.

Wansi et al. (12) also showed that the reasons given by respondents in Cameroon for drug consumption could be categorised into three groups: psycho-social, economic, and therapeutic/ medical. Respondents stated that an inefficient legal system, the involvement of some law enforcement officers in drug trafficking, the relationship between drug abuse and criminality, heightened political awareness of the 1990s, and economic crises contributed to increased drug abuse. (12)

The above literature clearly shows that substance abuse is prevalent around the world. Of all illegal substances, cannabis is most widely used. Abusers start using illegal substances as early as 11 years old, and the majority are male. …

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