Treatment for Substance Abuse in the 21st century: A South African Perspective

Background: It has become increasingly difficult to assist an individual to maintain long-term recovery from substance abuse. Irre-spective of which treatment centre the individual has been to, none guarantees a successful recovery. This is frustrating to individuals, their families and service providers. The reason for this trend is not absolutely clear. Many treatment centres are rigid in the use of their programmes and depend on aftercare to improve recovery rates.1 Service providers are increasingly acknowledging that there is no one “best treatment” option, as there are too many variations and complexities in reaching the goal of freedom from dependence and social reintegration.2 Hence the focus of this article is on research that has been undertaken to identify the strengths and weak- nesses of the different models/programmes used in different residential treatment centres in South Africa with a view to recommen-ding changes to accommodate such complexities and sustain recovery. Methods: Qualitative methodology was used to assess the strengths and weaknesses of programmes at three key residential rehabilitation centres in South Africa. The sample comprised both patients and service providers at each centre and the research instrument was focus group discussions with the former and individual, semi-structured interviews with the latter. Non-probability criterion sampling was employed to secure the participation of the required categories3 of treatment centres, and probability sampling was used thereafter, based on availability of respondents (both patients and staff) and easy access to them. Results: Despite tradition dictating a fairly rigid programme, most of the centres' staff and patients requested attention to the full biopsychosocial self of the patient, instead of being unidimensional such as paying more attention to one aspect at the expense of another such as to the physical as in the case of the disease model. A key finding was the need for a paradigm shift away from the disease model, with its accompanying helplessness, to that of a holistic approach that emphasises empowerment, embraces alternative strategies such as massage, sauna for detoxification, dietary improvements and physical activity, and uses language that is consistent with power and control. The centres also employed a multidisciplinary team, consistent with a focus on the “mind, body and spirit”, albeit requesting additional staff to comprehensively and effectively address all aspects of the holistic approach. Thus, they accorded importance to the spiritual dimension of the patient, although this did not always translate to action or programme content. Conclusion: The weakness of existing programmes was clearly found to lie in a unidimensional philosophy and a programme that was repetitive and unchanging. Staff and students identified the need for more holistic, comprehensive and creative approaches. These had to complement traditional strategies, rather than replace them, in accordance with the multi-faceted and multi-layered complexities of substance abuse. In keeping with this finding was the call for in-depth interventions to make the transition from being an addict and substance dependent to a person who is empowered and free from dependence. Users must not be viewed as victims of their circumstances, but be encouraged to reclaim an inner locus of control. South African Family Practice Vol. 50 (6) 2008: pp. 44-44

Treatment for substance abuse in residential centres in the 21st century.

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.The aim of this exploratory study was to examine and compare three traditional models of substance abuse treatment interventions at various rehabilitation treatment centres in South Africa. Three treatment centers were chosen each representing a particular treatment model, namely the Disease/Minnesota Model at Careline Crisis Centre (Hillcrest, Durban), the Therapeutic Community Model at Horizon Halfway House (Cape Town) and the Narconon Model at Narconon Rehab (Johannesburg). Data was obtained by means of two research instruments, namely structured interview schedules and focus group. The study was qualitative entailing critical analysis of data yielded by the research instruments. In the structured interview, the researcher asked the staff members at each centre questions and recorded their answers while the focus group methodology was used with the clients or patients (referred to as "students" in the Narconon Model) at each of the centres. The groups were comprised of three or four members. The study was conducted in two phases where phase one comprised. 13 themes and phase two comprised three themes. Based on the structured interviews with the staff members at the three treatment centres and the data yielded from the focus groups of the clients, strengths, weaknesses, differing conceptualizations of chemical addiction and the foci of intervention to treat the addictions of clients were evaluated with the purpose of integrating the best from each of these models of treatment to propose the development of what the researcher has chosen to call The Empowerment Model. Drawing from the conception of human consciousness in the philosophical tradition of existentialism where human consciousness is viewed as Nothingness, a void that is filled or engaged with Being-inthe- World, Being-with-Others and being-with-Oneself. Failure in the engagement of consciousness leads to a frustrating painful void. Given the existence of addictive chemicals, the human in the course of the history of humankind developed the ingestion of such chemicals to seek to fill the void with pleasurable sense experiences. The Empowerment Model aims to create an awareness of this human weakness and advocates filling or engaging this void with purpose in life comprising most notably Spirituality, Sociability, Vocation and Recreation to grow and evolve to a point of going beyond being human

Outcomes after percutaneous coronary artery revascularization procedures for cardiac allograft vasculopathy in pediatric heart transplant recipients: A multi-institutional study

© 2015 International Society for Heart and Lung Transplantation.Background Cardiac allograft vasculopathy is an important cause of long-term graft loss. In adults, percutaneous revascularization procedures (PRPs) have variable success with high restenosis rates and little impact on graft survival. Limited data exist in pediatric recipients of transplants. Methods Data from the Pediatric Heart Transplant Study (PHTS) were used to explore associations between PRPs and outcomes after heart transplant in patients listed ≤18 years old who received a first heart transplant between 1993 and 2009. Results Revascularization procedures were done in 28 of 3,156 (0.9%) patients; 13 patients had multiple PRPs giving a total of 51 PRPs performed across 15 centers. Mean recipient age at time of transplant was 7.7 ± 6.7 years; mean donor age was 15.9 ± 15.4 years. The mean time to first PRP was 5.7 ± 3.2 years. Vessels involved were left anterior descending artery (41%), right coronary artery (25%), circumflex artery (18%), other coronary branches/unknown (16%). PRPs consisted of 38 (75%) stent implantations and 13 (25%) balloon angioplasties with an overall procedural success rate of 73%. Freedom from graft loss after PRPs was 89%, 75%, and 61% at 1, 3, and 12 months. In addition, patients with transplants from donors >30 years old were found to have less freedom from the need for a revascularization procedure than patients with transplants from younger donors (p < 0.0001). Conclusions In this large pediatric heart transplant cohort, use of PRPs for cardiac allograft vasculopathy was rare, likely related to procedural feasibility of the interventions. Despite technically successful interventions, graft loss occurred in 39% within 1 year post-procedure; relisting for heart transplant should be considered

Interview Guide: Clinician discussion guide on heart failure management and use of technology for care.

Interview Guide: Clinician discussion guide on heart failure management and use of technology for care.</p

Pediatric ventricular assist device use as a bridge to transplantation does not affect long-term quality of life

ObjectiveThe present study sought to determine the long-term quality of life (QOL) of children who required long-term ventricular assist device (VAD) support as a bridge to transplantation (BTT) compared with children who underwent heart transplantation without VAD support. Currently, 20% of children undergoing heart transplantation have required a VAD as a BTT. Few data have been published assessing how children requiring a VAD as a BTT will fair in terms of their long-term QOL.MethodsThe present study used a cross-sectional design, using the Core and Cardiac modules of the Pediatric Quality of Life Inventory survey. In a secondary analysis, the factors associated with worse QOL outcomes among the VAD patients were also investigated.ResultsAt follow-up (median, 4.2 years), between the 21 children who required a VAD as a BTT and 42 who went straight to transplantation, no significant differences were found in the QOL as measured using the Psychosocial Health Summary Score, Physical Health Summary Score, or Total Score in the survey's Core Module, nor were any differences found in the outcomes assessed using the survey's Cardiac Module. Of the patients who required a VAD, only the presence of a neurologic complication was associated with worse QOL, which was demonstrated by decreased Physical Health Summary and Cardiac Communication scores.ConclusionsOver the long term, surviving children who required a long-term VAD as a BTT experience a similar QOL as those who went straight to transplantation