In response to claims that drug use is not harmful, David Bayever, a volunteer for emergency services and lecturer at the Wits Medical School Pharmacy Department (in an interview with the Saturday Star, June 9) asks the question: "How many old addicts do you know?" He states "Although no-one sets out to become a drug addict, the sad reality is that the drug is more powerful than any person."
According to research carried out between July - December 2000 by the South African Community Epidemiology Network on Drug Use (SACENDU), an alcohol and other drug sentinel surveillance system operational in Cape Town, Durban, Port Elizabeth, Mpumalanga, and Gauteng (Johannesburg/Pretoria), substance abuse is on the increase in South Africa. Greater numbers are seeking treatment, with accident and mortality rates linked to substance use soaring. The decreasing age of people seeking treatment is also of concern.
Alcohol is still the dominant substance of abuse and has a major impact on individuals and society, particularly in the area of violence and traffic-related trauma. Between 4% and 25% of psychiatric patients in selected psychiatric hospitals in Cape Town, Gauteng and PE had alcohol related psychiatric discharge diagnoses. In PE 92% of trauma patients had positive breath alcohol (up from 79% in the first half of 2000). In Cape Town 56% of mortuary cases in 2000 had blood alcohol concentrations in excess of 0.05g/100ml.
Other drug use has also been escalating, with 11.5 tons of hashish seized in Durban, over 2 million mandrax tablets and over 2 900 units of LSD seized nationally in the 2nd half of 2000, 38kg of cocaine powder seized nationally between June and December - up from 32kg seized in the 1st half of 2000. Nationally there was also a substantial increase in the amount of heroin seized, from 1.2kg in the 1st half of 2000 to over 14kg in the 2nd half of the year. With availability increasing, the problem threatens to become rampant.
Substance abuse tends to co-occur with other mental illnesses, for example, schizophrenia, panic disorder, social phobia or depression. In many of these cases people attempt to cope with their emotional pain through "self- medication", using alcohol and illegal drugs. This can lead to the abuse of these substances, whereupon the person is given a "dual diagnosis".
If untreated, the disorder worsens, and then the person may resort to using alcohol and other drugs to relieve their stress, loneliness or sadness. Some people use it to feel more "normal" and to feel more at ease around other people. Over time the person may develop a "need" for the substance to cope with life. They may also begin to need more and more of the drug to achieve the same feeling. Johannesburg psychologist, Wendy Sinclair, states: "Unfortunately, many users of alcohol are depressed to begin with, and experience a kind of 'self-medication' relief while drinking. This however, is short-lived, and always leads to even deeper depression when the user is not drinking. Prolonged use and abuse will lead to prolonged periods of depression."
Conversely, the person could also have had the substance disorder first. Over time they may have begun to act differently, and their brains and other organs may have been affected. This then led to the development of a mental illness. Alternatively, one may not have caused the other and both could have developed simultaneously, but in these cases the two disorders still affect each other.
Once diagnosed, a treatment plan can be formulated, in which both the original illness and the co-occurring depression are treated. It will include being educated about your condition and how you can work to improve it. It may also include medication and/or psychotherapy. Often taking part in a self-help group is encouraged, where it is possible to talk to people who share the same types of problems. The Depression and Anxiety Support Group offers telephone counselling by trained counsellors, and referrals to appropriate mental health professionals and to various support groups throughout South Africa. A new toll-free line has recently been established with the help of one of the group's pharmaceutical company sponsors, Sanofi-Synthelabo, dedicated to substance abuse disorders. The number to call is 0800 11 8392, Monday to Friday, 8am to 7pm, and on Saturday, 8am to 5pm.
The important thing to remember though, is that no matter what the cause, the problem can be treated. Warning signs to look for include:
§ The use of substances to control feelings and to avoid problems
§ An increased frequency and need for the substance
§ Continual unsuccessful attempts to control the use of the substance
§ Extreme mood swings
§ Long periods of sadness or depressed mood
§ A lack of interest in activities formerly found enjoyable
§ Excessive anger
§ Talking about suicide