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

Abstract

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. 44-44d