Substance abuse has a severe impact on the South African population. Various organizations, governmental and non-governmental, take on the challenge to assist in the treatment of substance abuse. Several gaps have been identified in dealing with substance abuse in South Africa. One of these gaps includes regular audits of treatment services and prevention programmes. One of the major concerns is that most primary prevention programmes appear to be implemented in the absence of evidence on their effectiveness and are mostly implemented on an ad hoc basis. The respondent organizations appear to display a poor understanding of evaluation. It was evident that there is a need for a systematic review of what works in the context of substance abuse prevention among the South African population as well as the development of an effective regulatory regime regarding primary prevention activities. Evaluation can be an important tool to provide monitoring, as well as a tool to identify strengths and weaknesses in treatment programmes. In light of the above, the South Coast Recovery Centre, a substance abuse treatment centre that operates in the private sector, was approached to evaluate the effectiveness of its treatment programme. The research focused on gaining insight into and exploring the strengths and weakness of the programme based on how patients experienced the programme and how satisfied they were with it. The use of multimethod approach which included positivist and interpretative approaches to evaluation was viewed as an appropriate method to use for the study in facilitating an understanding of the patient’s experience of the programme and how satisfied they were with the intervention they received. The study is both qualitative and quantitative in nature and used questionnaires and focus group interviews as data sources. All participants in the study were inpatients at the South Coast Recovery Centre. Frequency distributions, chi square analysis, as well as a thematic analysis were used to analyze the data of the study. The study concluded that patients were in general satisfied with the treatment programme. The programme provided opportunity for behavior changes and introspective learning. They were satisfied with professionals’ skills and behaviours, 6 types of interventions provided, efficacy and accessibility. Areas that patients were not satisfied with included: the facilitated involvement of relatives, the provision of information, and the large amount of residents in the programme. Recommendations were made with regards to programme improvement. The recommendations included the following: a. A coherent programme with clear links between outcome objectives and programme activities should be created. b. The number of counsellors in the programme should be reconsidered. c. The number of patients that should be allowed in the programme should be reconsidered. d. A platform for counsellors to deal with their personal emotions and counter transference should be created. e. Counsellors’ emotional involvement with patients should be addressed and exposed. f. More structured leisure activities that use interactive learning styles could be implemented in order to facilitate the learning of social skills. g. An awareness of possible comorbid mental disorders should be developed. h. Patients can be more involved with the cost aspect of the programme in order to facilitate more ownership of their treatment process. i. Provision should be made in the programme to allow for more involvement of relatives. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

THIS STUDY EXAMINES SUBSTANCE ABUSE IN SOUTH AFRICA WHICH POSES MAJOR CHALLENGES IN THE AREAS OF ASSESSMENT, TREATMENT, REHABILITATION AND AFTER-CARE. THIS HAS A DIRECT IMPACT ON A NUMBER OF POLICIES DEALING DIRECTLY WITH RESOURCES, BUDGETS, NORMS AND STANDARDS OF / FOR SERVICE DELIVERY. THIS STUDY FOCUSSES ON THE AGENCIES AND THE INDIVIDUALS BECAUSE BOTH ARE CRUCIAL IN THE INTERVENTION, PLANNING OF TREATMENT AND REHABILITATION PROGRAMMES AS WELL AS IMPLEMENTING POLICY. THIS RESEARCH INVESTIGATED THE TYPES OF TREATMENT AVAILABLE, THE MULTI-DISCIPLINARY TEAM, ITS FUNCTIONS, AREAS OF NEED AND CONCERNS REGARDING THE CURRENT POLICIES. THE ASSESSMENT OF THE SERVICE DELIVERY ORGANISATIONS REVEALED, DEDICATION BUT ALSO A NUMBER OF ISSUES THAT NEEDED TO BE DEBATED UPON. FEW AGENCIES CHANGED OR USED MORE UP TO DATE INTERVENTION MODELS, WHICH GIVES THE CLIENT FREEDOM OF CHOICE AND ALLOWED HIM/HER TO BE THE MAJOR CHANGE AGENT IN HISIHER BEHAVIOUR CHANGES. A LACK OF KNOWLEDGE OF CHEMICAL SUBSTANCES AND SUBSTANCE ABUSE LEADS TO INAPPROPRIATE TREATMENT PLANS WHICH IN MANY INSTANCES LEADS TO THE RELAPSE RATES REMAINING HIGH. A STUDY OF THE MULTI DISCIPLINARY AND INDIVIDUAL TEAM MEMBERS OF GOVERNMENTAL, NON-GOVERNMENTAL AND PRIVATE REHABILITATION AND TREATMENT CENTRES WAS CONDUCTED TO ASSESS THEIR KNOWLEDGE BASE AND ISSUES THEY FACED. AN EXAMPLE WOULD BE THE DUAL DIAGNOSED CLIENTS, WHO HAVE FALLEN THROUGH THE NET BECAUSE OF LACK OF TRAINING THEORY AND PRACTICE 0N THE PART OF THE MULTI-DISCIPLINARY TEAM. THE STUDY REVEALED THAT THE GAP BETWEEN POLICY AND PRACTICE NEEDS TO BE MORE INTEGRATED TO ACHIEVE THE DESIRED DRUG FREE INDIVIDUALS. AGENCIES DO NOT HAVE THE TIME OR THE ENERGY TO DEAL WITH AND IMPLEMENT NEW AND OTHER POLICY CHANGES. THIS RESULTS BECAUSE OF OVERLOAD, LACK OF FUNDS AND LACK OF HUMAN RESOURCES. THROUGH THE LITERATURE STUDY A COMPREHENSIVE PROGRAMME FOR TREATMENT AND REHABILITATION IS RESEARCHED TO MEET THE UNIQUE INDIVIDUAL NEEDS OF THE SUBSTANCE ABUSER AND ALSO THE TEAM /INDIVIDUALS WHO PLAN THE TREATMENT. A LARGE NUMBER OF MODELS ARE DISCUSSED SO THAT THE PLANNING TEAM CAN CHOOSE APPROPRIATE ONES TO MEET THE NEEDS OF CLIENTS. ANOTHER AREA OF ASSESSMENT WAS THE INDIVIDUAL TEAM MEMBERS OPINIONS ON TREATMENT TIME FRAMES AND TREATMENT STRATEGIES. THIS THESIS RESEARCHED EVERY COMPONENT TREATMENT PROGRAMMES AND STRATEGIES AND SHOULD BE USED AS A REFERENCE AND TRAINING GUIDE BY ALL THOSE INVOLVED IN SERVICE DELIVERY IN THE FIELD OF SUBSTANCE ABUSE IN SOUTH AFRICA AND GLOBALLY. OF SPECIAL EMPHASIS WOULD BE THE UNDERSTANDING OF DUAL DIAGNOSIS AND THE PROVISION OF A SUITABLE TREATMENT PROGRAMME. THE INVESTIGATION INTO SOCIAL POLICIES PROVIDES FOR A MORE COMPREHENSIVE PARTNERSHIP BETWEEN AGENCIES AND GOVERNMENT TO MEET THE NEEDS FO SUBSTANCE ABUSERS IN SOUTH AFRICA AND WORLD WIDE. / Thesis (Ph.D)-University of KwaZulu-Natal, 2005.

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Arts in Clinical Psychology. Johannesburg, 2016 / Substance dependence is a global issue that is becoming significantly more problematic. This is due to the fact that it does not just have a devastating effect on the individual but results in profound spin-off effects, which impact society as a whole. Much research has been conducted within this area and contemporary research has seemed to focus on the link between attachment styles and substance abuse. Since its conception by John Bowlby, attachment theory has achieved an empirical authority that has contributed to its popularity in modern times. However, despite this renewed interest there still exists a gap in the literature around the role that relationships, throughout the lifespan, play in areas such as pathology and recovery. Consequently, this research embarked on an interpretive phenomenological exploration of the way relationships impact the lives of individuals suffering from substance dependence. Adults in recovery from substance dependence were individually interviewed about their experiences of their relationships during and after their years of abusing substances. Hermeneutical phenomenological analysis was used to analyse this data and it revealed a typical model of pathology where a negative childhood experience had cascading effects that culminated in the later dependence on substances. Participants all highlighted relationships with themselves or others as pivotal to either seeking substances or to going into recovery. These themes were then located within Bowlby’s (1976, 1980) developmental pathways framework in order to make sense of the progression of substance dependence along the lifespan as it manifested in these participants. / MT2017

Submitted in partial fulfillment of the requirements for the Degree of Master of Human Resources, Durban University of Technology, Durban, South Africa, 2017. / The aim of this study was to assess the employee assistance programme related to substance abuse within a selected private hospital in KwaZulu Natal. A paucity of information within the South African context on how employees with substance abuse problems were being managed within the workplace provided the motivation for this study. The objective of this study was to evaluate existing employee assistance programmes, the line manager model and existing human resource policies and procedures within the selected private hospital. The research design adopted a mixed method approach using a questionnaire, followed by an interview based on findings of the questionnaires. The intended sample size was 185 out of 460 staff and the final return of questionnaires was 219. Of significance is the response rate of over a 40% which implies a margin error of 5%. The data was analysed using the computerised Statistical Program for Social Sciences (SPSS version 22.0 for Windows). This study concluded with the findings that emerged from the research. The findings suggest that employees with substance abuse problems are not being effectively managed and that there are no awareness models apart from the employee wellness provider. The limit of the employee wellness provider is that it markets “employee wellness” rather than an emphasis on substance abuse. A suggestion is that the human resource department and the wellness provider partner in inspiring a substance abuse prevention and assistance campaign. Another recommendation highlights the training of all line managers in identification of recognising employees with substance abuse problems prior to work performance being affected. The study concluded with suggestions for future research in this field. / M

Thesis (MA(MW))--University of Stellenbosch,2004. / ENGLISH ABSTRACT: An exploratory study was done on prevention programmes of substance abuse by high school learners. This was done in order to: explore the factors leading to substance abuse by high school learners; explore the conditions for successful substance abuse programmes and compare it with existing programmes; and to determine how prevention programmes for high school learners can be used in South-African schools. The motivation for this study emerged as a result of the researcher’s involvement in prevention programmes for adolescents in schools and on farms at the South-African Council for Alcohol and Drug Dependency (SANCA) in the Paarl area. The objective of this study is to provide guidelines to social workers for the effective implementation of substance abuse prevention programmes for high school learners. The literature study confirmed the need for effective prevention programmes and highlighted the focus om the factors which leads to substance abuse. Emphasis is placed on risk and protection factors involved with substance abuse. SANCA in Paarl’s adolescent community’s risk and protective factors was investigated, because of the necessity to identify these factors before a prevention programme can be designed. The universum is the grade 10 learners of six schools in the Paarl area. One learner out of each class represented the sample of 48 respondents. The study was done trough a structured questionnaire. A combination of qualitative and quantitative information, through the use of open and close-ended questions, was gathered. The results of this study confirmed the results of the literature study, namely that the most important factor leading to substance abuse, is peer group influence. However, a combination of strategies and programmes are needed to develope a suitable programme for the specific community. The recommendations focus on four areas. Firstly the conditions are described for an effective prevention programme regarding the role of social workers, the use of assessment, evaluation, models, theories and approaches. Secondly, recommendations are made for techniques and general approaches. The third area gives directions for programme content. The last area recommends a possibility for future research: the process, roles and type of training needed to implement an effective and sustainable support group system in schools, must be tested. / AFRIKAANSE OPSOMMING: ’n Verkennende studie vir voorkomingsprogramme vir middelmisbruik deur ho¨erskoolleerders is gedoen ten einde: die faktore wat tot middele-misbruik deur ho¨erskoolleerders aanleiding gee, te ondersoek; die voorwaardes vir suksesvolle middele-misbruikvoorkomingsprogramme te verken en met bestaande programme in verband te bring; en te bepaal hoe voorkomingsprogramme aan ho¨erskoolleerders in Suid-Afrikaanse skole benut kan word. Die motivering vir die studie het gespruit uit die navorser se betrokkenheid by die Suid- Afrikaanse Raad vir Alkohol- en Dwelmafhanklikes (SANRA) met die aanbied van voorkomingsprogramme vir adolessente, op plase en in skole in die Paarl-omgwing. Die doel van hierdie studie is dus om riglyne vir maatskaplike werkers daar te stel vir die effektiewe implementering van voorkomingsprogramme vir middelmisbruik deur ho¨erskoolleerders. Die literatuurstudie het die behoefte aan effektiewe voorkomingsprogramme bevestig en die faktore wat lei tot middelmisbruik is ook uitgelig. Daar is veral gefokus op die risikoen beskermingsfaktore hierby betrokke. Die studie is ingelei deur ’n ondersoek na die risiko- en beskermingsfaktore wat ’n rol speel in die adolessente gemeenskap van SANRA (Paarl), aangesien dit noodsaaklik is om hierdie faktore te identifiseer voordat ’n voorkomingsprogram ontwerp word. Die universum is graad-10 leerders van ses skole in die gebied. Een leerder uit elke klas het die steekproef, van 48 respondente, verteenwoordig. Die ondersoek is aan die hand van ’n gestruktureerde vraelys gerig. Kwalitatiewe en kwantitatiewe inligting is deur middel van ’n kombinasie van oop en geslote vrae ingesamel. Die resultate van hierdie ondersoek het die literatuurstudie bevestig, naamlik dat die hoof faktor wat aanleiding gee tot middelmisbruik, portuurgroepinvloede is. ’n Kombinasie van verskeie strategie¨e is nodig om geskikte programme vir spesifieke gemeenskappe te ontwerp. Die aanbevelings fokus op vier areas, naamlik die voorwaardes vir ’n effektiewe voorkomingsprogram rakende die rol van die maatskaplike werker, die gebruik van assessering, evaluering, modelle, teorie¨e en/of benaderings en aanbevelings ten opsigte van tegnieke, programvoorstelle en programinhoud. Die vierde en laaste area maak ’n aanbeveling vir verdere navorsing: ’n Ondersoek na die proses, rol van en tipe opleiding nodig om ’n effektiewe en volhoubare ondersteuningsgroepstelsel in skole te implementeer.

Text in English / Against the background of high prevalence of substance abuse in the globe generally and South Africa in particular, research has shown an association between substance abuse and other mental disorders or vice-versa. With most rehabilitation centres offering separate diagnosis and treatment for the two disorders, the problem of relapse has been significant. The purpose of this study is to explore the perceived effectiveness of CBT as a treatment model for substance use disorders with co-occurring disorders. Subsequently, the research will add to the already existing research evidence. The study was conducted in five rehabilitation centres in Gauteng Province. The qualitative descriptive research approach was used to conduct the study. Both purposive and snowball sampling were used to recruit participants in this study. The sample consisted of CBT specialist participants from diverse race, gender, ethnicity, and age ranging from 30 to 65 years, with at least a minimum of five years’ experience. A pilot study with two specialist participants was conducted, and this enhanced trustworthiness and authenticity of the study. The primary method of qualitative data collection employed in this study was semi-structured individual interviews for specialist participants. Grounded theory analysis was employed to analyse data. The findings of the study emphasised a need to not separate treatment of substance use disorders and psychiatric pathologies. More importantly, the effectiveness of CBT in treating both disorders was established by the study. The study further encourages more time in therapy as the way to increase effective results accompanied by less relapse rate. Accordingly, the findings of this study encourage more research and use of CBT treatment for substance use disorders with co-occurring disorders in South Africa. This study found that the most used substances are both legal and illegal, and they are further classified as depressants, stimulants, opioids, and new psychoactive substances. A vulnerable population to abuse substances includes adolescent and young adults, individuals with co-occurring disorders, and low socio-economic status. The disorders that normally co-exist with substance use disorder ranges from depression, bipolar disorder, schizophrenia, sleeping disorder, impulsivity, antisocial behaviour, borderline disorder, paranoia, panic disorder, and suicide behaviour. The study found that genetic predisposition, depression, parental neglect and financial problems, experimentation with substances for relaxation, peer group pressure, and co-occurring disorders are high risk causes for substance abuse. The experience of participants in treating substance use disorder with co-occurring disorders involves which disorders get treated first, and the mental state of patients for effective treatment. The various substance abuse treatment models includes person centred approach, bio-psychosocial approach, holistic approach, eclectic therapy, integrated approach, resilient approach, rational emotive behavioural therapy, family therapy, motivational interviewing, 12-step programme, and cognitive behavioural therapy. The participants’ experience with CBT entails its usability in both individual and group therapy, the use of CBT skills after therapy, and CBT effectiveness in relapse prevention. Accessibility and affordability of CBT treatment is influenced by access to rehabilitation centres and cost of rehabilitation centres. Lastly, individual factors, family factors, and environmental factors are part of the contributing factors towards high relapse rates. / Psychology / M.A. (Psychology)

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))

Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed. / Psychology / (M.A.(Psychology))

Substance abuse is a significant challenge facing the World and in particular South Africa. In this study, various Western and African traditional perspectives were considered to gain an understanding of the substance abuse problem among adolescents. The study was conducted in one of the rural villages of the Ramotshere Moiloa Local Municipality in the North West Province of South Africa. Participants included 24 African male and female adolescents between 13 and 19 years of age, as well as 2 parents and 9 professionals. The 9 professionals are educators, a social worker, a clinical psychologist, a mental health worker, a traditional leader and a traditional healer, between 37 to 53 years of age. A qualitative, explorative research design was employed. Data sources included individual face-to-face interviews, focus group discussions, and a document review. Thematic analysis was employed to analyse data. The findings were based on the perceptions of participants and revealed that adolescents are socially entrapped to substances such as alcohol, tobacco, cannabis, cocaine, glue, nyaope, and segonyamahlo. Reasons for their use of substances included individual, family, and environmental factors. The findings revealed the severe impact of substance abuse on adolescents and their families. There was evidence of primary, secondary, and tertiary levels of substance abuse prevention programmes targeting adolescents and other community members. In addition, stakeholders such as parents, peers, professionals, traditional leaders, traditional healers, government, and non-government organisations were recommended to implement substance abuse prevention programmes to address the substance abuse problem among adolescents. Furthermore, the study highlighted efforts made to reflect on the implemented substance abuse prevention programmes. / Psychology / D. Phil. (Psychology)

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))