Understanding substance abuse and addiction

Drug and alcohol abuse take their toll on thousands of South Africans every day, but no matter how hopeless the situation seems, it is never too late to turn things around by seeking help.

Thursday, November 29 2018

Substance abuse is an enormous social problem in South Africa, as elsewhere, and it’s increasing every day. Alcohol, marijuana (dagga), cocaine, tik and heroin are some of the most frequently used substances in this country, according to the South African Depression and Anxiety Group (SADAG). Although there is no magic wand when it comes to treating substance abuse and addiction, help is available for patients and their families.

“Given some of the frightening statistics on substance abuse in the country, there is an urgent need to educate people on the dangers and the treatments available,” says Marna Acker, an Occupational Therapist at Akeso Clinic Nelspruit. “South Africa has no regular representative surveys on substance abuse, which makes it difficult to understand the full extent of the problem. The stats are available only for people admitted for treatment. But we do know that the South African Community Epidemiology Network on Drug Use (SACENDU) project, which is an alcohol and other drug (AOD) sentinel surveillance  system, and is operational in nine provinces, shows that there was an increase in the number of people admitted for treatment – from 8 787 in 2016, to 10 047 in 2017, across 80 centres.”

What drives people to abuse substances?

Certain people are more at risk for substance abuse and for developing addiction disorders than others. “There are many factors that may make people vulnerable, including genetics, family background, mental health issues, work stress, financial pressure, and relationship problems,” says Acker.

“These factors can make the person at risk value substance abuse as a coping mechanism, even though it is against their interest in the long term. There are also other factors involved, such as peer pressure – particularly when substance use is a norm; boredom, and the feeling of not having a sense of purpose can also be contributing factors, as can feelings of depression, anxiety, and lack of control.

Long-term effects of substance abuse

The longer an addiction lasts, the more stress and strain it puts on the individual and, while different substances have different effects, depression, anxiety and paranoia are among the most common long-term results of substance abuse. “Cannabis users, for example, may experience poor attention span, as well as memory and learning loss,” says Acker. “Poor performance, permanent cognitive impairment, lack of motivation, immunosuppression, and cardiac and lung complications are all common effects.

“In addition, cannabis-induced psychosis may occur. Several studies have linked marijuana use to increased risk for psychiatric disorders, including schizophrenia, depression, anxiety, and substance use disorders, although whether and to what extent it actually causes these conditions is not always easy to determine. On top of all these possible outcomes, sustained cannabis use can also have a negative impact on interpersonal relationships, work performance, financial management, and more. The list is endless.’

An added complication is that all substance abuse can lead to impulsive behaviour and poor judgement. Alcohol abuse contributes to risky sexual behaviour, increasing the chances of contracting HIV and other sexually transmitted diseases, as well as liver diseases, neurological disorders, and chronic memory disorders, while opioids, such as morphine and the illegal drug heroin, can result in accidental overdose. Sometimes, drug abuse can actually increase a user's risk of developing a mental disorder.

“Long-term drug abuse can also affect the physical health of the user, especially the kidneys, liver, heart and lungs,” Acker adds. “Increased tolerance is dangerous as it causes the individual to use more and more of a drug to achieve the desired euphoric or stimulated state. This increases the person’s risk for overdose and even death.”

Signs and symptoms to look out for

If you or someone you love is addicted to drugs or alcohol, they may exhibit some or all of the following physical, psychological and social signs and symptoms:

  • Weight loss, skin colour change, skin outbreaks
  • Intense urges or cravings as the addiction develops
  • Withdrawal symptoms leading to suboptimal performance and physical craving
  • Isolation, depression, anxiety and paranoia
  • Unhealthy friendships with people who have similar habits
  • Financial difficulties due to large amounts of money being spent on drugs or alcohol
  • Neglecting responsibilities, such as work or personal obligations
  • Poor judgement, including risky behaviours such as stealing, lying, engaging in unsafe sex, selling drugs, or crimes that could land the person in jail

What types of treatment are available?

Outpatient programmes are offered by organisations like the South African National Council on Alcoholism and Drug Dependences (SANCA), Alcoholics Anonymous (AA), and Narcotics Anonymous (NA). Short-term inpatient programs – 21 to 30 days – including detoxification, and longer-term in-patient programs -- 90 days to a year or more – are offered by addiction clinics throughout the country. For example, Akeso Clinics offers an inpatient programme which focuses on addictions and other psychiatric issues (dual diagnosis), with a multi-disciplinary team approach.

“The recovery process is life-long, there is no recipe for success, and relapse is very common, says Acker. “That’s why it is extremely important for people with addictions to have ongoing counselling and therapy, to belong to support groups, and to have an accountability partner.”

If you believe a friend or family member has an addiction, encourage them to seek help from a professional. Do not try to be that professional yourself. Be supportive and remember that substance use disorder is an illness. Put up boundaries, be careful of manipulation and do not do anything that enables the disorder. Make sure that you also have support sessions for the family as this can be helpful and informative.

  • It’s estimated that up to 60% of crimes committed involve the use of substances
  • The rate of foetal alcohol syndrome in South Africa is five times that of the US
  • 80% of male youth deaths are alcohol-related
  • Drug consumption in South Africa is estimated to be twice the world norm
  • According to the South African Community Epidemiology Network on Drug Use (SACENDU), cannabis and alcohol are the substances most likely to be abused
  • Males over the age of 20 are the biggest abusers of alcohol
  • Male youths are the main abusers of cannabis

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