South Africa and ICASA - Part 2


Addiction Treatment and Research in South Africa

Yesterday we headed for meeting professionals working in the field of addiction treatment. Dr. Lize Weich, psychiatrist at the Stikland Hospital for mental health guided us.

The people we met, the addiction treatment centres we saw, and Cape Town itself had a huge impact on me. We visited the outpatient drug treatment ward, Sinethemba. A department of the SANCA organization (South African national organization on substance abuse treatment) in Athlone, a very poor suburb of Cape Town. With very little resources the team serves approximately 400 patients per year. They have an abstinence oriented treatment based on the MATRIX model, a very cognitive behavioral oriented approach. Most of the staff members are social workers. There is one mental health nurse (sister Brown), and dr. Weich serves as the psychiatrist, seeing patients once a week.

We visited Sultan Bahu, a private organization in Mitchell’s Plain, one of the largest townships in Cape Town. Approximately 40 patients follow 6 weeks programs also based on the MATRIX model. Mr. Shafiek Davids runs Sultan Bahu.

Staff members at Sinethemba Staff members at Sultan Bahu

At Sultan Bahu patients using all types of substances are treated. The centre has a very important role in the community of Mitchell’s Plain. Former patients often are involved in helping the centre: painting the walls, cooking meals etc.

At the Stikland Hospital for mental health we visited an inpatient opiod detoxification ward. With 10 beds it is the only ward for this population in Cape Town! And we visited an alcohol rehabilitation ward. Finaly we were at a day-centre for dual diagnoses patients. With only 2 staff members, they organize daily programs for this very difficult group. Every day 12-30 patients (their attendance is not mandatory, so the level of attendance varies day by day) are present.

I have countless impressions, but I will summarize a few of these:

There is no opiod maintenance treatment possible for poor patients. Allthough the WHO guideline on opiod dependence treatment recommends availability of this treatment, it is not in South Africa.

Addiction treatment is mainly considered as a social/ motivational problem, not as a psychiatric/ medical disorder.

Allthough there is awareness of many mental health problems in patients, the level of expertise on mental health issues is very low.

Drug and alcohol use is a wide spread phenomenon in the poor regions of South Africa. It dominates social life in many ways. Given the high prevalence there are a lot of patients who are said to have pure substance use disorders, without additional comorbid psychiatric disorders.

The case load for professionals in addiction treatment is unbelievable. 300 patients for a single mental health nurse. 2 Hours medical/psychiatric consultation of a psychiatrist for a centre with 400 patients each year. Hardly any medical doctors for these patients.

Although there are huge populations of both Muslim and Christian people there are not any religious oriented problems. Neither in the community, nor in treatment wards.
Alcohol and methamphetamine seem to be the most commonly used substances. The packages of poly-drugs being used varies, based on the several communities, on habits in these communities and on the availability of drugs.

The addiction treatment is highly intertwined with crime. Many addicts (patients with a substance use disorder) are involved in crime, leading to stressing the social aspects of addiction.

The level of trauma in patients coming to addiction treatment centres is extremely high. Violence (in extraordinary proportions) and sexual abuse are very common.
South Africa has the highest rate of fetal alcohol syndrome in newborns. It has the highest rate of teenage pregnancies. And of course South Africa, and also it’s patients with substance dependence suffer from the HIV/AIDS epidemic.

Funding resources for both treatment and research are very very limited.

I was overwhelmed by the magnitude and by the scale of the problems. I was also overwhelmed by the strength of the professionals we met. Under such very difficult circumstances, the spirit and enthusiasm are remarkably high.

It seemed strange to discuss in these centres the reasons for our visit: setting up collaboration for research on ADHD and Substance Abuse. It seemed that ADHD was on the very bottom of the list of priorities.

The reaction of the staff members in fact was the opposite. They were very keen on learning more about the issue. Shafriek Davids (head of Sultan Bahu) immediately said that he would send one of his team members to the expert meeting, Friday 26th November, to make sure that Sultan Bahu would be involved in the collaboration. He saw this as an opportunity for striving for two goals:

  1. Adding to the knowledge on a subgroup of his patients;
  2. Enhancement of the skills of his team members.

I can write endless stories on my impressions of today, but I should not make this blog too long.

I do want to report that we met, apart from the addiction treatment centres, representatives from three universities in South Africa: Cape Town, Stellenbosch and Durban. We learned about the need for addiction research, about the variation in populations and tribes, about the different ways addiction is viewed upon in these populations.

We discussed how research on ADHD and Substance Abuse might serve as a vehicle for improving addiction research and the quality of addiction treatment. We will discuss this further in the expert meeting, Friday 26th November.

Tomorrow we will do a tour in the Townships. We will try to learn what normal live looks like for the majority of Cape Town inhabitants.

Thanks for reading my blog. If you have comments or suggestions, do not hesitate to post a comment! 



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