Codeine misuse and dependence in South Africa – learning from substance abuse treatment admissions

Background. Misuse of prescription and over-the-counter codeine-containing products is a global public health issue.Objectives. To investigate the extent of treatment demand related to the misuse of codeine or codeine dependence in South Africa (SA) and the profile of patients seeking treatment, so as to understand the nature and extent of the problem.Method. Data were collected from centres participating in the South African Community Epidemiology Network on Drug Use in 2014. A total of 17 260 admissions were recorded.Results. There were 435 recorded treatment admissions for codeine misuse or dependence as a primary or secondary substance of abuse (2.5% of all admissions). Of treatment admissions, 137 (0.8%)  involved codeine as the primary substance of abuse; 74.9% of patients were males, with an even spread across population groups. Ages ranged from 11 to 70 years, with the highest proportion aged 20 - 29  years; >40% were referred by self, family and/or friends, and 26.7% by health professionals; and 36.8% had received treatment previously. The majority reported misuse of tablets/capsules, with 17.6% reporting misuse of syrups. Oral use comprised 96.6% and daily use 63.1%.Conclusions. Data from treatment admissions related to codeine misuse and dependence are  informative, but provide an incomplete picture of the nature and extent of codeine-related problems in SA. Other data sources must be considered before further regulatory/policy changes regarding codeine are implemented

Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

Background. Hazardous alcohol consumption presents a serious threat to the health and wellbeing of all people and is linked to chronic and acute health problems.Objectives. To: (i) estimate the prevalence of alcohol use disorders and remission from alcohol abuse and dependence in the South African (SA) population; and (ii) determine whether age of onset, education, sex and level of cohort alcohol use are associated with commencement of use, regularity of use, and transitions to and remission from more harmful levels of use.Methods. The study was a nationally representative sample of 4 315  individuals aged ≥18 years. In a multistage, area probability sample of adults, data were collected from 4 311 alcohol users using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview version 3.0. All analyses were carried out using SAS version 9.4.Results. Of the respondents, 40.6% indicated lifetime use of alcohol,  35.3% reported regular use, and 8.8% met diagnostic criteria for alcohol abuse and 2.7% for alcohol dependence. The prevalence of remission from lifetime abuse without dependence was 55.9%. The median age of onset of alcohol use was 20 years, with transition from use to regular use occurring within ~1 - 3 years. The results suggest that males, students (compared with those who had completed a high level of education) and greater  alcohol use in the respondent’s birth cohort were all associated with increased odds of commencing alcohol use. For transitions from use to regular use, increased odds were associated with males, greater birth cohort alcohol use, low education and later (>21 years) onset of first alcohol use.Conclusions. Our findings suggest that cohort alcohol use is associated with transition to commencement of use and from use to regular use in the general SA population. The study further highlighted the need for  interventions among males and university students, given that hazardous alcohol consumption seems to be the most prevalent public health issue encountered by university students and males

Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

Background. Hazardous alcohol consumption presents a serious threat to the health and wellbeing of all people and is linked to chronic and acute health problems.Objectives. To: (i) estimate the prevalence of alcohol use disorders and remission from alcohol abuse and dependence in the South African (SA) population; and (ii) determine whether age of onset, education, sex and level of cohort alcohol use are associated with commencement of use, regularity of use, and transitions to and remission from more harmful levels of use.Methods. The study was a nationally representative sample of 4 315 individuals aged ≥18 years. In a multistage, area probability sample of adults, data were collected from 4 311 alcohol users using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview version 3.0. All analyses were carried out using SAS version 9.4.Results. Of the respondents, 40.6% indicated lifetime use of alcohol, 35.3% reported regular use, and 8.8% met diagnostic criteria for alcohol abuse and 2.7% for alcohol dependence. The prevalence of remission from lifetime abuse without dependence was 55.9%. The median age of onset of alcohol use was 20 years, with transition from use to regular use occurring within ~1 - 3 years. The results suggest that males, students (compared with those who had completed a high level of education) and greater alcohol use in the respondent’s birth cohort were all associated with increased odds of commencing alcohol use. For transitions from use to regular use, increased odds were associated with males, greater birth cohort alcohol use, low education and later (>21 years) onset of first alcohol use.Conclusions. Our findings suggest that cohort alcohol use is associated with transition to commencement of use and from use to regular use in the general SA population. The study further highlighted the need for interventions among males and university students, given that hazardous alcohol consumption seems to be the most prevalent public health issue encountered by university students and males.

Alcohol marketing and adolescent alcohol consumption: Results from the International Alcohol Control study South Africa

Background. A complete ban on alcohol advertisements has been proposed for South Africa (SA), but there has been limited local research on the association between exposure to alcohol advertisements and alcohol consumption.Objectives. To examine the role of demographic factors, exposure to alcohol marketing and liking of alcohol advertisements in predicting use of alcohol in the past 6 months among older adolescents in Tshwane, Gauteng Province, SA.Methods. Participants comprised the adolescent sub-sample (N=869) of the International Alcohol Control study survey that was conducted in SA. They consisted of 408 males and 461 females aged 16 and 17 years who took part in structured interviews on their alcohol consumption and various alcohol-related attitudes and behaviours. A multiple survey logistic regression analysis of the dependent variable alcohol use in the past 6 months on the independent variables age, gender, educational status, socioeconomic status, exposure to alcohol brand marketing and liking of alcohol advertisements was used. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.Results. The prevalence of drinking in the past 6 months was 10.6% (95% CI 5.9 - 18.3). The number of modes of alcohol brand/product advertising to which the adolescents were exposed was positively associated with alcohol use in the past 6 months. An additional mode of alcohol brand/product advertising exposure led to a relative increase of 1.13 (95% CI 1.01 - 1.28) in the odds of alcohol use in the past 6 months (e.g. a participant who was exposed to advertisements via seven different channels was 2.08 times more likely to have used alcohol in the past 6 months than a participant with exposure via a single channel). Having a strong dislike of alcohol advertisements was associated negatively (protective) with alcohol use in the past 6 months, with the odds ratio being 0.35 (95% CI 0.19 - 0.64). Having only a moderate dislike or a liking of alcohol advertisements was positively associated with alcohol use in the past 6 months among the study participants (OR 2.90 and 2.84, respectively). Age, gender, educational status and socioeconomic status were not independently associated with alcohol consumption.Conclusions. Exposure to alcohol marketing and not being strongly averse to advertisements of alcohol brands and products were associated with alcohol use among adolescents. The results have implications for policies on alcohol marketing in SA.Â

Alcohol marketing and adolescent alcohol consumption: Results from the International Alcohol Control study (South Africa)

Background. A complete ban on alcohol advertisements has been proposed for South Africa (SA), but there has been limited local research on the association between exposure to alcohol advertisements and alcohol consumption.Objectives. To examine the role of demographic factors, exposure to alcohol marketing and liking of alcohol advertisements in predicting use of alcohol in the past 6 months among older adolescents in Tshwane, Gauteng Province, SA.Methods. Participants comprised the adolescent sub-sample (N=869) of the International Alcohol Control study survey that was conducted in SA. They consisted of 408 males and 461 females aged 16 and 17 years who took part in structured interviews on their alcohol consumption and various alcohol-related attitudes and behaviours. A multiple survey logistic regression analysis of the dependent variable alcohol use in the past 6 months on the independent variables age, gender, educational status, socioeconomic status, exposure to alcohol brand marketing and liking of alcohol advertisements was used. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.Results. The prevalence of drinking in the past 6 months was 10.6% (95% CI 5.9 - 18.3). The number of modes of alcohol brand/product advertising to which the adolescents were exposed was positively associated with alcohol use in the past 6 months. An additional mode of alcohol brand/product advertising exposure led to a relative increase of 1.13 (95% CI 1.01 - 1.28) in the odds of alcohol use in the past 6 months (e.g. a participant who was exposed to advertisements via seven different channels was 2.08 times more likely to have used alcohol in the past 6 months than a participant with exposure via a single channel). Having a strong dislike of alcohol advertisements was associated negatively (protective) with alcohol use in the past 6 months, with the odds ratio being 0.35 (95% CI 0.19 - 0.64). Having only a moderate dislike or a liking of alcohol advertisements was positively associated with alcohol use in the past 6 months among the study participants (OR 2.90 and 2.84, respectively). Age, gender, educational status and socioeconomic status were not independently associated with alcohol consumption.Conclusions. Exposure to alcohol marketing and not being strongly averse to advertisements of alcohol brands and products were associated with alcohol use among adolescents. The results have implications for policies on alcohol marketing in SA.

Monitoring alcohol and drug abuse treatment admissions in South Africa: January- June 2013: Phase 34: SACENDU report back meetings

This report contains detailed data from specialist substance abuse treatment centres in six sites that now comprise the South African Community Epidemiology Network on Drug Use in the Western Cape, KwaZulu-Natal (mostly Durban and Pietermaritzburg), Eastern Cape (Port Elizabeth, East London), Gauteng province, Mpumalanga and Limpopo provinces (now termed the Northern Region), and the so-called Central Region (comprising of the Free State, Northern Cape and North West provinces). Data collection in Limpopo province began in July 2007 from one centre in Polokwane.

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

AimsTo disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio‐demographic correlates for the opportunity to drink and transitions into life‐time alcohol use, regular use and alcohol use disorder.DesignA retrospective, cross‐sectional population survey within a family panel study.SettingChitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol.ParticipantsA total of 10 714 individuals aged 15–59 years (response rate = 93%).MeasurementsThe Nepal‐specific Composite International Diagnostic Interview assessed life‐time alcohol use opportunity, any use, regular use, disorder and socio‐demographic characteristics.FindingsSeventy per cent [95% confidence interval (CI) = 69.08–70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14–38.99%) had life‐time alcohol use, 32.37% (95% CI = 31.48–33.27%) had regular alcohol use and 6.04% (95% CI = 5.60–6.50%) developed an alcohol use disorder. Compared with high‐caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16–1.47 to 1.98, 95% CI = 1.81–2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41–6.03) to development of disorder (OR = 1.95, 95% CI = 1.35–2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47–5.29) to development of disorder (OR = 9.34, 95% CI = 6.88–12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71–0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59–0.89)].ConclusionsThe prevalence of life‐time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio‐demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life‐time use, regular use), but not later transitions (use and regular use to disorder).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167024/1/add15221_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167024/2/add15221.pd