Drug and alcohol problems seem to be increasing in Africa but treatment is often scarce and steep.
Brian Muhumuza, a recovering alcoholic who has been sober for more than three years, is a refugee living in Johannesburg, because there are no rehabilitation centers in his home country of Uganda.
“When I wanted to stop drinking at around 25, the only option I had for help was the church. I thought then that if my only option was religion, I would rather just drink through my problem.”
Fortunately, Muhumuza’s mother worked at a medical facility and was able to provide medication while he attempted to stop drinking.
Muhumuza is fortunate. He is one of the few who managed to get treatment. For most, treating an addiction is either inaccessible or unaffordable.
Around 5% of the world’s adults, or nearly 250 million people between the ages of 15 and 64, used at least one drug in 2014, according to the latest World Drug Report released last year by the United Nations Office on Drugs and Crime (UNODC).
It reported that the number of people classified as suffering from drug use disorders has increased disproportionally for the first time in six years. There are now over 29 million people within this category (compared to the previous figure of 27 million). Additionally, around 12 million people inject drugs, with 14% of these living with HIV, according to the report which was released in June 2016.
The report highlights a strong link between poverty and drug problems. Indeed, the brunt of the drug use problem is borne by people who are poor in relation to the societies in which they live, as can be seen in stark terms in wealthier countries.
“The strong association between social and economic disadvantage and drug use disorders can be seen when analysing different aspects of marginalization and social exclusion, such as unemployment and low levels of education.”
The overall impact of drug use, in terms of health, continues to be devastating. We are constantly told that substance abuse is a major problem in society, and statistics are often rolled out to prove the point. But trying to track these down is extremely difficult.
South Africa is one of the few African countries to have a national drug policy and this is also reflected in the number of treatment centers in the country. The South African Community Epidemiology Network on Drug Use (SACENDU) tracks admission numbers at government and private rehabilitation centers in South Africa. The SACENDU Project is an alcohol and other drug (AOD) sentinel surveillance system in South Africa.
The system, operational since 1996, monitors trends in AOD use and associated consequences on a six-month basis from specialist AOD treatment programs. The first half of 2016 saw 10,540 patients across 82 centers/programs – up from 9,679 in the second half of 2015. At an average of 21,000 recorded patients a year, at a rough estimate of $1,800 per patient, the annual income earned by these centers is around $39,000. However, Johannesburg alone probably has about 50 treatment centers of various categories and these are always at capacity with around 20 to 40 clients per three-week treatment period. Additionally, patients are often admitted to hospitals and do not go on to enter rehabs, so estimates are largely irrelevant.
The latest research from the Medical Research Council (MRC), which has been published in the SA Medical Journal, indicated South Africa lost about $23 billion in 2009 as a result of alcohol abuse.
It said that about $3 billion of that was used to deal with the socials ills associated with alcohol. These include death, illness, disability, unintentional injury, including road traffic accidents, as well as crime. Healthcare services received the second biggest bill ($930 million), followed by social welfare, at $30 million, according to the MRC study.
South Africa has taken a strong stand on the issue. Nelson Mandela highlighted the problem during his inauguration speech as far back as 1994. South Africa at least continually revisits the issue through its Drug Master Plan. The last one covered the period 2012-2017, meaning that it is currently over five years out of date.
Unfortunately, no such reports or policy have been found from the African Union, meaning that one has to rely on international stats when reviewing the issues in Africa. Even in South Africa, the widely published figures have been challenged by Africa Check, the NGO that reviews widely quoted statistics or reports. It found that many of the figures used by government or research organizations could not be proven.
The organization referred to a June 2016 newsletter, that goes out to over 700,000 principal medical aid members of Tiger Brands, CompCare Wellness and the Government Employees Medical Scheme (GEMS), which alerted them to “shocking South African drug statistics”.
In the Heartbeat newsletter, South African medical insurance schemes administrator, Universal Healthcare, suggests that rampant crime and 15% of South Africans having a drug problem are related. It also stated that the country is home to “one of the world’s drug capitals” and that drug abuse costs the country R20 billion ($1.5 billion) a year. Universal Healthcare was asked for its sources but did not respond at the time of publication.
Africa Check says that the claim of 15% cannot be proven. It reports that South Africa has no regular representative surveys on substance abuse. There has only been one nationally representative epidemiological study of alcohol, drug and psychiatric disorders, carried out between 2002 and 2004, mainly to diagnose mental disorders in adults.
The study provided figures of lifetime prevalence for any substance use disorders, including alcohol. It showed that 13.3% of adult South Africans met the criteria for a substance use disorder, including alcohol, at some time in their life.
“Without alcohol, that figure dropped to around 4.5%,” Shaun Shelley, a research expert in the addiction division of the department of mental health and psychiatry at the University of Cape Town, told Africa Check. “Over a 12-month period, the figure was 5.8% (including alcohol disorders) and about 1.5% for drugs alone.”
Relying on anecdotal evidence of the issue also threw scant light on the problem. Drug treatment centers in South Africa, particularly Johannesburg, report a steady intake of addicts and alcoholics from across Africa, for those who can afford it as residential treatment facilities charge anywhere from $1,500 upwards for a 21-day stay. But no statistics are available.
Patients from Zimbabwe, Uganda and Mozambique, all explained that the only treatment facilities in their home countries were generally small, with a maximum of 10 to 80 beds, attached to the largest state psychiatric hospitals. Space is at a premium and facilities are harsh, although many report to have met caring and professional medical staff willing to provide help and support.
A Zimbabwean in treatment in South Africa said that, for the first time, a private rehab facility had opened in Harare in March this year. Zimbabweans, Angolans and Mozambicans most often seek treatment in South Africa but one person who has extensive knowledge of rehab facilities said that out of 40 to 80 patients – or clients as they are now known – only about one to three would come from elsewhere in Africa. It is also true that many foreigners travel to South Africa for treatment, given the favorable exchange rate, familiar languages and family connections. They are able to tell employers and friends that they are on holiday in Africa while receiving first-world treatment. Some luxury rehabs, mostly in popular tourist areas like Cape Town, charge up to $8,000 for a three-week stay.
Stepping Stones lists itself as a “luxury rehab” and quotes a figure of $5,500 per month on its website. White River Manor is quoted as charging $4,900 to $12,000 per month.
For most addicts, these prices, and recovery, are difficult to reach. – Written by Les Tilley