Moving beyond access: Towards a quality-orientated substance abuse treatment system in South Africa

There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes

Special Issue: Alcohol Policy and Public Health-Contributing to the Global Debate on Accelerating Action on Alcohol

First paragraph: In July 2018, under our guidance, IJERPH put out a call for papers to be considered for publication in a Special Issue on “Alcohol and Public Health”. This was motivated by the reports of mixed success regarding the achievements by member states on the objectives of the Global Strategy to Reduce the Harmful Use of Alcohol

Legalising medical use of cannabis in South Africa: Is the empirical evidence sufficient to support policy shifts in this direction?

Inkatha Freedom Party MP Mario Oriani-Ambrosini’s impassioned plea to legalise the medical use of cannabis must be understood in the context of his own condition as well as legislative changes in at least ten countries. This article argues that any decisions to shift policy must be based on a consideration of the evidence on the risks and benefits associated with the medical use of cannabis for the individual and broader society. It concludes that there are important gaps in the evidence base, particularly in human trials supporting the efficacy of cannabis use for treating and preventing medical conditions and alleviating negative symptoms associated with these conditions. South African researchers should be enabled actively to support development of the necessary evidence base actively by conducting preclinical and clinical research in this area. Human trials to establish the efficacy of the use of cannabis/cannabinoids in addressing AIDS wasting syndrome and other negative sequelae of HIV and AIDS are especially needed

The socioeconomic profile of alcohol-attributable mortality in South Africa : a modelling study

CITATION: Probst, C. et al. 2018. The socioeconomic profile of alcohol-attributable mortality in South Africa : a modelling study. BMC Medicine, 16:97, doi:10.1186/s12916-018-1080-0.The original publication is available at https://bmcmedicine.biomedcentral.comBackground: Globally, illness and life expectancy follow a social gradient that puts people of lower socioeconomic status (SES) at higher risk of dying prematurely. Alcohol consumption has been shown to be a factor contributing to socioeconomic differences in mortality. However, little evidence is available from low- and middle-income countries. The objective of this study was to quantify mortality attributable to alcohol consumption in the adult (15+ years) general population of South Africa in 2015 by SES, age, and sex. Methods : A comparative risk assessment was performed using individual and aggregate data from South Africa and risk relations reported in the literature. Alcohol-attributable fractions (AAFs) and alcohol-attributable mortality rates were estimated for cause-specific mortality by SES, sex, and age. Monte Carlo simulation techniques were used to calculate 95% uncertainty intervals (UI). Results: Overall, approximately 62,300 (95% UI 27,000–103,000) adults died from alcohol-attributable causes in South Africa in 2015, with 60% of deaths occurring in people in the low and 15% in the high SES groups. Age-standardized, alcohol-attributable mortality rates per 100,000 adults were highest for the low SES group (727 deaths, 95% UI 354–1208 deaths) followed by the middle (377 deaths, 95% UI 165–687 deaths) and high SES groups (163 deaths, 95% UI 71–289 deaths). The socioeconomic differences were highest for mortality from infectious diseases. People of low SES had a lower prevalence of current alcohol use but heavier drinking patterns among current drinkers. Among men, AAFs were elevated at low and middle SES, particularly for the middle and higher age groups (35+). Among women, AAFs differed less across SES groups and, in the youngest age group (15–34), women of high SES had elevated AAFs. Conclusions: Alcohol use contributed to vast socioeconomic differences in mortality. Where observed, elevated AAFs for people of low and middle SES arose from higher levels of consumption among current drinkers and not from the prevalence of current alcohol use per se. The findings can direct preventive measures and interventions on those at highest risk. Future research is needed to investigate socioeconomic differences in the risk functions relating alcohol use to cause-specific mortality.https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1080-0Publisher's versio

Tobacco use and nicotine dependence among people living with HIV who drink heavily in South Africa: a cross-sectional baseline study

Abstract

“Knowledge I seek because culture doesn’t work anymore … It doesn’t work, death comes”: the experiences of third-generation female caregivers (gogos) in South Africa discussing sex, sexuality and HIV and AIDS with children in their care

Background Sexual reproductive health communication between parents and children has been shown to promote safer sexual choices. In many South African households, third-generation female caregivers, often grandmothers or other older females, locally known as gogos, are primary caregivers of children due to parents being deceased or absent. Subsequently, the responsibility of talking about sex and related issues has shifted to these gogos. This study explored the experiences of gogos living in Alexandra, Johannesburg on talking about sex, sexuality and HIV and AIDS with children aged 10–18 years that are in their care. Methods Ten primary caregivers were purposively selected. Data were collected through in-depth individual interviews. Thematic analysis was performed and inductive codes and themes identified. Results All gogos selected found it difficult to discuss sex, sexuality and HIV and AIDS due to culture and traditional values impacting on personal experiences as well as generation and gender barriers. Perceived low self-efficacy due to low levels of knowledge and limited skills in speaking about sex, sexuality and HIV and AIDS also contributed to low levels of sexual reproductive health communication. Conclusions This study highlights the need for interventions that focus on improving gogos’ knowledge about sexual reproductive health in addition to providing them with the skills to talk about sex, sexuality and HIV and AIDS with children in their care

Codeine misuse and dependence in South Africa: Perspectives of addiction treatment providers

Background. General practitioners are referring patients with codeine-related problems to specialist treatment facilities, but little is known about the addiction treatment providers, the kinds of treatment they provide, and whether training or other interventions are needed to strengthen this sector.Objectives. To investigate the perspectives of addiction treatment providers regarding treatment for codeine misuse or dependence.Method. Twenty addiction treatment providers linked to the South African Community Epidemiology Network on Drug Use and the South African Addiction Medicine Society were contacted telephonically and asked 20 questions.Results. While many participants had received training in pharmacological management of individuals with opioid dependence, only two had received specific training on codeine management. Between half and two-thirds of the treatment settings they worked in provided detoxification, pharmacotherapy, psychosocial treatment and aftercare. Very few treatment settings offered long-term treatment for codeine misuse and dependence. Participants indicated that over half of their codeine patients entered treatment for intentional misuse for intoxication, and dependence resulting from excessive or long-term use. The main barriers to patients entering treatment were seen as denial of having a problem, not being ready for change, mental health problems, stigma, and affordability of treatment. Participants identified a need for further training in how to manage withdrawal and detoxification, treatment modalities including motivational interviewing, and relapse prevention.Conclusions. Gaps in training among treatment providers need to centre on how to manage withdrawal from codeine use and detoxification, motivational interviewing and relapse prevention. Interventions are needed to address barriers to entering treatment, including user denial.

Characteristics and predictors of Heavy Episodic Drinking (HED) among young people aged 16–25 : the International Alcohol Control Study (IAC), Tshwane, South Africa

CITATION: Harker, N. et al. Characteristics and predictors of Heavy Episodic Drinking (HED) among young people aged 16–25: The International Alcohol Control Study (IAC), Tshwane, South Africa. International Journal of Environmental Research and Public Health, 17(10). doi:10.3390/ijerph17103537The original publication is available at https://www.mdpi.com/journal/ijerphIn South Africa, little is known about alcohol consumption patterns, such as drinks consumed, container size, salience of alcohol price, affordability and availability, and perceptions of alcohol policies as potential predictors of heavy episodic alcohol (HED) use among young people. This paper examines predictors of HED among young people with specific consideration given to these alcohol consumption patterns. This study conducted in the Tshwane Metropole in 2014 employed multi-stage stratified cluster random sampling. Participants were between the ages 16–25 years. A structured questionnaire was used to collect data. Of the 287 (n = 678) participants who had used alcohol in the past six months and for whom we had complete consumption data, almost half were identified as heavy episodic drinkers (HEDs) and were significantly more likely to consume alcohol on a daily basis (p = 0.001). Having nightclub as the primary drinking location (p = 0.023) and drinking from a container size bigger than one standard drink (p = 0.014) were significant predictors for HED. HEDs were also more likely to have a perception that most people consume alcohol (p = 0.047). The results point to HED of alcohol among young people who drink in South Africa, highlighting the need for multicomponent interventions.https://www.mdpi.com/1660-4601/17/10/3537Publishers versio