Monitoring Alcohol and Drug Abuse Trends in South Africa (1996-2006): Reflections on Treatment Demand Trends
Parry, Charles, Plüddemann, Andreas, Bhana, Arvin, Contemporary Drug Problems
Following the collapse of Apartheid1 in South Africa in the early 1990s there has been a reduction of (negative) internal controls and a dramatic increase in air and land travel to and from this country. Both these conditions, together with other changes in the global production and marketing of illicit drugs, have stimulated an increase in drug transshipment through South Africa and an increase in local use of a wide variety of drugs that were not previously available.
In 1996 with funding from the World Health Organization, the South African Medical Research Council established the South African Community Epidemiological Network on Drug Use (SACENDU), an aggregate data collection system, to monitor alcohol and other drug use trends on an ongoing basis. SACENDU is a network of about 200 researchers, practitioners and policy makers from six sentinel areas (in five provinces) in South Africa: Cape Town, Durban, Port Elizabeth (PE), East London, Gauteng Province and Mpumalanga Province (Figure I).2 Plans are underway to expand the SACENDU network to other parts of the country; however, this paper will focus on the above areas for which longitudinal data are available.
Local epidemiological networks address many of the difficulties associated with national surveys: they are cost effective as they rely largely on existing resources; they limit the masking of location-specific differences; they use local data, increasing the likelihood of relating findings to specific denominator information; they help inform specific actions against alcohol and other drug-related problems in local community settings; there are increased opportunities for checking data validity as data are gleaned from multiple sources; and the networks are sustainable, providing infrastructure for further research at a local level (Sloboda & Kozel, 1999). AOD or drug only surveillance systems have been set up in various regions of the world (e.g., Latin America, South East Asia, and Western Europe), in different countries (e.g., USA, Canada, Mexico and Spain), in different states/provinces (e.g., Texas) and subregions (e.g., border towns along the US/Mexican border).
AOD surveillance systems typically comprise a network of stakeholders from within a certain location (e.g., city), and across locations, who collect information on AOD use patterns and consequences on an ongoing basis and report back such information at regular intervals (NIDA, 1998). Members of SACENDU meet every six months to provide communitylevel public health surveillance of alcohol and other drug (AOD) use trends and associated consequences through the presentation and discussion of various sources of quantitative and qualitative research data (Parry et al., 2002b).
The main data source currently used by the SACENDU project is primary and secondary substances of abuse as reported by patients at admission to specialist AOD treatment facilities. Data are now collected from more than 70 specialist AOD treatment centers in these sites, including state-funded and private institutions. The network incorporates all major state-funded AOD treatment centers. Data are collected from more than 90% of treatment centers in these sites and comprise an even higher percentage of patients in treatment in these sites. All AOD treatment centers are requested to join the network, but participation within the network is voluntary. A wide variety of centers form part of the system in terms of the treatment programs and services they offer, from expensive private inpatient centers, typically with a 4 week 1 2 Step program or similar, to low-cost outpatient counseling centers where patients attend individual and group counseling a few days per week. Treatment approaches in these centers are mainly based on 12 Step approaches, and to a lesser extent on Motivational Interviewing and Relapse Prevention. Across the country approximately half of treatment episodes are inpatient, although this differs by region. …