2010-09-25 00:00

THOUSANDS of people are struggling to shake a crippling substance abuse addiction in South Africa’s drug rehabilitation treatment facilities. But if they don’t have medical aid or private funding, their attempts to make their home in one of the country’s rehab facilities for a three- or six-week in-patient programme is a daunting, sometimes impossible, task.

Alcohol remains the drug of choice for South Africans, with a drinking population boasting one of the world’s highest rates of alcohol consumption, according to the most recent World Health Organisation report in 2004. Each drinker in South Africa is estimated to guzzle 16,7 litres of alcohol per year. More than 27% of South African men and nearly 10% of women admitted to being alcohol dependent, according to a 1998 survey in that report.

Other substances have a strong hold in the country as well. The Central Drug Authority, the monitoring body within the Department of Social Development that oversees drug issues, estimates that 3,2 million South Africans use marijuana, 100 000 use opiates, 290 000 use cocaine, and 320 000 used ATS.

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Brendon started on the road to addiction by smoking dagga on his 17th birthday. Today, the 33-year-old Johannesburg resident says that when he wanted to get help shaking his cocaine and alcohol addiction, it was nearly unattainable.

“There was also an economic obstacle as I couldn’t afford to send myself, and for a few years I never had medical aid after I left the bank [where he worked].When I was finally ready to speak to my family, I was worried they would not be able to help me because of the cost,” he said.

The cost of a private rehabilitation treatment facility typically begins around R17 000 for a six-week stay and can go up to more than R90 000. Most medical aids will cover up to 75% of that cost.

Only 16% of the more than 10 000 who entered rehabilitation facilities between January and June last year used medical aid to pay, according to calculations based on the most recently available statistics of the South African Community Epidemiology Network on Drug Use.

“It is obviously preferable to have someone [who has a serious addiction] in an in-patient facility, but availability and affordability are always a problem,” said Andres Pluddermann, senior scientist in the Medical Research Council’s Alcohol and drug abuse research unit.

Today, hundreds of people are on waiting lists for a government-subsidised spot — reserved for those who cannot afford treatment and don’t have medical aid — in drug rehabilitation treatment facilities across the country. Most will wait at least two months and sometimes more before a bed becomes available, according to more than a dozen rehabilitation facility directors who spoke with Health-e News Service.

Dr Stan de Smidt, manager of the Western Cape’s state-owned rehabilitation facility, De Novo Treatment Centre, said the 100-bed facility has at least 180 people on its waiting list. He said the waiting period is at least two months.

Madadeni Rehabilitation Centre, a state-owned facility in KwaZulu-Natal, will only admit new patients in October because of the influx of people on its waiting list

Government subsidises in-patient beds in drug-treatment facilities for impoverished addicts without medical aid. The subsidy covers a varying proportion of their care while the facilities fund the remaining balance — typically several thousand rands — of the patient’s expense through fundraising and donations.

According to the country’s leading nationwide rehabilitation organisation, the South African National Council on Alcoholism and Drug Dependence (Sanca), the total number of people in treatment has increased 34% to 11 682 addicts in 2010, from 8 713 in 2006. Their figures show a six percent increase over last year’s 11 012.

Sanca has 31 centres and 30 satellite centres nationwide; 10 are in-patient.

Meanwhile, some provinces, like Limpopo and Northern Cape, have no registered in-patient rehab facilities at all. Addicts there are sent to in-patient facilities in the Western Cape, Mpumalanga or Gauteng. There they are put at the end of waiting lists as out-of-province-residents awaiting the generosity of that province’s finances.

Riette van der Linde, director of Limpopo’s Far North Alcohol and Drug Centre, an outpatient facility, said that without an in-patient facility in the province, the burden of treating Limpopo residents with substance abuse problems falls on other provinces, which can encounter resistance.

“We struggle to get them in because [provinces] look at their people first,” said Van der Linde.

The implications to rural areas are far-reaching.

“People who enter treatment are often those who are at the last point or near the final point of their problem, so you would find a lot of problems with alcohol abuse in … rural areas where there aren’t any services and very little is being done by centres to do prevention work,” said Pluddermann. “Those problems are probably quite likely to continue unchecked.”

The lack of services has implications for broader society as well.

“If we don’t deal with substance abuse as being a major problem, all your other efforts in your problem areas are not going to be effective as they should be,” said Dr David Bayever, deputy president of the Central Drug Authority (CDA).

However, hope is not entirely lost. Letitia Bosch, substance abuse co-ordinator for the City of Cape Town, said outpatient facilities — which typically cost less — could help cut down on waiting lists.

“Traditionally people believe that it is better to send those with substance abuse problems away, but that is not always an option. The message we are trying to convey is that people do not need to be sent away for them to be treated.”

She acknowledged that outpatient treatment won’t work for everyone. The severity and duration of your addiction as well as the type of drug, such as heroin, also determine if you need in-patient care.

A new bill to update the current Prevention of and Treatment for Substance Abuse Act, enacted in 2008, proposes that the government establish at least one in-patient facility in each province to help address these problems.

Other regulations and restrictions included in the bill would create more stringent guidelines for rehabilitation centres to follow. The CDA is also drafting a new national drug master plan to address the evolving substance problem.

“The job is far bigger than what we are capable of dealing with, in that we are only 12 people,” said Bayever.

“The new act … will double the number of facilities so that already in itself is a move in the right direction. [It recognises] the importance of dealing with substance abuse as an underlying common thread beneath other social ills.”

Each South African drinker is estimated to guzzle 16,7 litres of alcohol per year


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