Interviews | Substance use disorder


Estie de Wet – Social Worker/Case Manager of Hesketh King Treatment Centre

19 August 2019

  1. What would you say are some of the current trends of substance abuse in the Western Cape?

Since the decriminalisation of cannabis, we at Hesketh King noticed an increase in youth stating that cannabis is their drug of choice, and also that some patients don’t want to acknowledge that using cannabis is problematic. This is because they are under the impression that it’s now legal and therefore don’t understand that it is still illegal to sell it or to smoke it if you are under the age of eighteen -  even if it is in a private dwelling. Furthermore, methamphetamines remain popular among youth in vulnerable communities.  There is an overall increase in the use of various illicit substances and alcohol due to the availability of it in both affluent and poor communities.

2.    Please comment on some of the feedback we received from the public during a radio show:

a. Substance abuse should be beaten out of anyone with addiction problems because it is an individual choice:

I firmly believe that substance abuse is a family or community illness. Yes, it is up to the individual to decide to start experimenting, but if someone is exposed within their home or community, that person is at a higher risk of developing a substance use problem.

Should it be beaten out of someone? No. Substance abuse can be seen as a chronic illness. It’s slow to develop and needs life-long treatment. Much the same as diabetes, and no one would try to beat a diabetic until their sugar levels are back to normal.

b. Parents should send their kids to rehabilitation centres that use unorthodox methods such as beating, starving, and restraining young people until they no longer have an addiction problem:

It is understandable why parents would send their kids to unorthodox facilities -  out of desperation. But it’s not advised to make use of them as these facilities tend to violate the basic human rights of that person. It is highly recommended that parents try and find a suitable registered treatment facility. All registered facilities are held to very strict norms and standards in order to protect the recovering individual. During the treatment programme parents can be rest assured that the recovering individual is being treated with respect and that their human rights are protected. Also using methods such as beating, starving and restraining won’t help anybody to “come right”, it takes a multi-disciplinary team with a bio-psychosocial approach to help motivate a recovering individual to choose a life of sobriety.

  1. When someone is taken to a rehabilitation centre, they should be “fixed” when their treatment course is completed.

Recovery is a lifelong process. During the rehabilitation process the recovering individual is equipped and empowered to handle and maintain his or her own sobriety. The real hard work only starts when the person is discharged. As mentioned before, addiction is a chronic illness. In order for the recovering individual to remain sober and live a healthy life, he or she must make healthy life style changes. These changes take time and is a collective effort from both the recovering individual and their family members.     

3.    What can communities do to cope with substance abuse in the area which they stay and how can they help to assist those fighting this pandemic?

The best thing people can do is to report the merchants selling the substances to the local police station. Furthermore, they can support and encourage addicted loved ones to go for help at a registered inpatient facility or community-based organisation. The Department of Social Development has a full directory of all registered and funded organisations. Lastly, do not support unregistered facilities, and report them to the Department of Social Development.

Imelda April – Social Work Manager

12 July 2019

  1. Give a brief background of the drug addiction situation in your area (location) of work.

There is a high caseload for the Retreat Service Delivery Area. Dual diagnosis is when someone is experiencing mental health illness and substance use disorder simultaneously. In some cases we find that patients need treatment for mental health issues before rehabilitation can take place.

  1. Are there possible indicators that the public could identify or relate to when referring to mental health issues?

Aggression, overwhelming fear and hostility directed at people who are perceived as threatening or provoking to the affected person. The consequences of mental health vary from poor physical health/ hygiene, risky behaviour, poor administration of medication to difficulty with relationships.

  1. What is the best course of action in this regard?   

Disorganised speech, hallucinations, obsessive behaviour and paranoia are signs of mental disorders. Psychiatric assessment will determine if its predominantly a mental health disorder or a substance induced case. High risk behaviour should report to South African Police Service and DSD to facilitate immediate admission for assessment via a hospital. If there are moderate behaviour indicators, report to the DSD offices for an assessment.

  1. If almost 80 % of cases are drug induced mental health illnesses, can those affected make decisions independently?

Conditions vary from day to day and could be affected by environmental stimuli. The affected person is thus not always able to make sound judgement calls, depending on their conditions.

  1. What is the general understanding of substance abuse in that community?

It is not always clear that a collaborative process is necessary where not only DSD is involved, but also other departments such as Health and Education. Often there is an urgent need is to deal with the addiction immediately, but rehabilitation is multifaceted. It could be a long-term intervention and include several processes. We try to explain that addiction was a process that happened over time, therefore rehabilitation will be a process to address the various effects of substance abuse. It took time to get addicted therefore it will take time to be rehabilitated.

  1. What are the expectations of the family/loved ones? 

Families believe that once the person has attended an impatient programme, the behaviour is changed and the addiction is gone. Admission to a rehabilitation should ideally come from the user for greater success. However, should it be a forced admission, even more support from family is required.

  1. What information/message would you provide to educate the community and person affected by drug addiction?

Admission to treatment centres might entail a waiting list, but as an interim measure outpatient and community-based programmes can be accessed. The message to communities is to be supportive to family members during the process of rehabilitation. Admission to rehabilitation is a start, the reintegration with family and community is the most difficult issue, but an important one. Families can assist rehabilitation by assisting with the reintegration process back to home and back into the community.

  1. What substance abuse registered treatment programmes are available for those with problems of addiction?

Substance abuse programmes are funded by Department Social Development, the online directory is housed on the Department’s website as a reference for the public. Faith-based organisations play an important role as well as the City of Cape Town via the matrix programmes. Schools and health facilities can be utilised as point of referrals.

Ejaz Macpherson (age: 39) – success story

18 July 2019

  1. When did you first get involved with drugs and for how long were you suffering with addition?

I was introduced to alcohol at the age of 15 years old and not long after, I started using cannabis. My addiction quickly progressed to other harder drugs like mandrax, ecstasy, cocaine, rocks and methamphetamine. By the age of 20, I was completely addicted. I have a 15-year history of substance abuse and I came into recovery at the age of 30 years old.

  1. How did it affect you and your loved ones?

It affected me in every way possible; mentally, physically, spiritually and emotionally. I lost all contact with my family and I lived on the streets for 4 years. I was unemployable, degraded, broken and all of my relationships were either strained or none existent. My family was sad, powerless and suffering with me. Every attempt to get better failed and it set my family up for disappointment.

  1. Have you identified any triggers and what has helped you to cope?

I experienced various triggers in early recovery like money, people and places. But I connected myself with recovery support structures and my family.

  1. How are you managing your sobriety?

I went to a substance abuse treatment centre eight and half years ago. Today, I am still clean and living clean as a productive member of society. I am working as an Addictions Counsellor. While in treatment, I joined Narcotics Anonymous and I started attending meetings; got myself a suitable sponsor; did suitable services and built a relationship with God.

I attended a Recovery Assistant Course and went for training in the Matrix method of substance abuse treatment. In addition, I completed an Addictions Councillor Course at the University of the Western Cape and then completed a Higher Certificate in Adult Learning at the University of Cape Town.

  1. What message do you have for those battling addiction?

Today, I am almost nine years clean and living a productive, fulfilling life. It is possible to lose the desire to use drugs and alcohol, find a new way to live and be happy. The darkness of active addiction is paralysing and you feel powerless, but with support, it is possible to move from the darkness of addiction in to the light of recovery. If you are dying from the disease of addiction, the evidence is in your face that you need assistance as much as you want to deny it. Reaching out to anyone and asking for help if you really want to stop using it is possible, and treatment institutions are waiting to help with love, motivation and professional treatment.