Browsing by Subject "Substance use"
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- ItemOpen AccessAggressive behaviour among drug-using women from Cape Town, South Africa: ethnicity, heavy alcohol use, methamphetamine and intimate partner violence(2017) Carney, Tara; Myers, Bronwyn; Kline, Tracy L; Johnson, Kim; Wechsberg, Wendee MBACKGROUND: Women have generally been found to be the victims of violence, but scant attention has been paid to the characteristics of women who perpetrate aggression and violence. In South Africa, violence is a prevalent societal issue, especially in the Western Cape. METHOD: This study aimed at identifying factors that were associated with aggression among a sample of 720 substance-using women. We conducted multivariate logistic regression to identify factors that are significantly associated with these behaviours. RESULTS: Ethnicity (Wald Χ2 = 17.07(2), p < 0.01) and heavy drinking (Wald Χ2 = 6.60 (2), p = 0.01) were significantly related to verbal aggression, methamphetamine use was significantly related to physical (Wald Χ2 = 2.73 (2), p = 0.01) and weapon aggression (Wald Χ2 = 7.94 (2), p < 0.01) and intimate partner violence was significantly related to verbal (Wald Χ2 = 12.43 (2), p < 0.01) and physical aggression (Wald Χ2 = 25.92 (2), p < 0.01). CONCLUSIONS: The findings show high levels of aggression among this sample, and highlight the need for interventions that address methamphetamine, heavy drinking and intimate partner violence among vulnerable substance-using women.
- ItemOpen AccessBrief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study(2021-01-19) Calligaro, Gregory L; de Wit, Zani; Cirota, Jacqui; Orrell, Catherine; Myers, Bronwyn; Decker, Sebastian; Stein, Dan J; Sorsdahl, Katherine; Dawson, RodneyBackground Only 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular. Objectives To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n = 10). Results Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration South African National Clinical Trials Register ( DOH-27-0315-5007 ) on 01/04/2015 ( http://www.sanctr.gov.za )
- ItemOpen AccessEffectiveness of early interventions for substance-using adolescents: findings from a systematic review and meta-analysis(BioMed Central Ltd, 2012) Carney, Tara; Myers, BronwynBACKGROUND: Information on the impact of available interventions that address adolescent substance use and delinquency can inform investment choices. This article aims to identify and evaluate early interventions that target adolescent substance use as a primary outcome, and criminal or delinquent behaviours as a secondary outcome.METHOD:A systematic review of early interventions for adolescent substance use and behavioural outcomes was conducted. RESULTS: We identified nine studies using specific search strategies. All but one of the studies reported the use of brief intervention strategies. Only seven studies contained information which allowed for the calculation of an effect size, and were therefore included in the meta-analysis. The overall effect size for all outcomes combined was small but significant (g=0.25, p<0.001). The overall outcome for substance use was also small but significant (g=0.24, p<0.001). For studies with behavioural outcomes, the overall effect size reached significance (g=0.28, p<0.001). In general, subgroup analysis showed that individual interventions with more than one session had a stronger effect on the outcomes of interest. CONCLUSIONS: Early interventions for adolescent substance use do hold benefits for reducing substance use and associated behavioural outcomes. Interventions are most promising if delivered in an individual format and over multiple sessions. One intervention in particular had large effect sizes. As all the interventions were tested in developed countries, further testing is needed in low- and middle-income countries where there is a lack of research on evidence-based interventions for adolescent risk behaviours. Additional recommendations for policy and practice are provided in this paper.
- ItemOpen AccessExploring the Service Providers' and Former Service Users' Perceptions of the Effect and Impact of Living Hope Community Based Substance Abuse Rehabilitation of South Peninsula, Cape Town(2025) Klaas, Portia Siphokazi; Colvin, Christopher; Mokganyetji, TebogoSubstance use remains a significant global public health challenge. This growing issue has extensive consequences, impacting health, crime, exacerbating socio-economic issues, and the spread of HIV/AIDS. In South Africa, the prevalence of substance use, involving alcohol, cocaine, and dagga, is a major concern. The Western Cape, particularly in Cape Town, struggles with unique challenges, marked by prevalent usage of methamphetamine, heroin, and alcohol. Understanding the effectiveness and impact of substance use care is one of the strongest interpreters of improved results among people living with substance use disorders. This study examined providers' and former users' experiences and perspectives on the effect and impact of Living Hope substance use program. Semi-structured interviews were conducted by the researcher and a thematic analysis was used on the interview data. The interviews were conducted with 11 participants, 7 being former users and 4 service providers at Living Hope facilities. Participants shared their perceptions on the effects and impacts of the Living Hope program. Four major themes identified include: Program Effectiveness and Impact, Family and Community Involvement, Enablers/Facilitators and Barriers of the Program, as well as Challenges and Needs of the Program. All participants provided insights into the complex dynamics of addiction treatment. Successes and challenges highlight the necessity of tailored interventions, continuous support, and systemic improvements for program effectiveness. The findings emphasized the diverse nature of addiction recovery, advocating for holistic, resource- backed strategies to address individual and structural aspects for favorable outcomes. The results indicated that a key impact of Living Hope should be in helping former service users in securing jobs after overcoming substance use disorders, as they find it difficult to get employment.
- ItemOpen AccessA novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial(2021-01-07) Sorsdahl, K; Stein, D J; Pasche, S; Jacobs, Y; Kader, R; Odlaug, B; Richter, S; Myers, B; Grant, J EBackground Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD. Methods We enrolled 60 adults with a MAUD and randomly assigned them 1:1 to the IDMI intervention delivered by clinical psychologists and a control group who we referred to usual care. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, were calculated. Follow-up interviews were conducted at 6 weeks and 3 months post-enrollment. Results Over 9 months, 278 potential particiants initiated contact. Following initial screening 78 (28%) met inclusion criteria, and 60 (77%) were randomised. Thirteen of the 30 participants assigned to the treatment group completed the intervention. Both psychologists were highly adherent to the intervention, obtaining a fidelity rating of 91%. In total, 39 (65%) participants completed the 6-week follow-up and 40 (67%) completed the 3-month follow-up. The intervention shows potential effectiveness in the intention-to-treat analysis where frequency of methamphetamine use was significantly lower in the treatment than in the control group at both the 6 week and 3-month endpoints. No adverse outcomes were reported. Conclusions This feasibility trial suggests that the locally adapted IDMI intervention is an acceptable and safe intervention as a brief treatment for MAUD in South Africa. Modifications to the study design should be considered in a fully powered, definitive controlled trial to assess this potentially effective intervention. Trial registration The trial is registered with the Pan African Clinical Trials Registry (Trial ID: PACTR201310000589295)
- ItemOpen AccessPrevalence and correlates of atypical patterns of drug use progression: findings from the South African Stress and Health Study(2011) Myers, B; van Heerden, M S; Grimsrud, A T; Myer, L; Williams, D R; Stein, D JAtypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans. Method: Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. Results: Overall, 12.2% of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. Conclusion: Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common, especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research.
- ItemOpen AccessProject Khanya: a randomized, hybrid effectiveness-implementation trial of a peer-delivered behavioral intervention for ART adherence and substance use in Cape Town, South Africa(2020-03-04) Magidson, Jessica F; Joska, John A; Myers, Bronwyn; Belus, Jennifer M; Regenauer, Kristen S; Andersen, Lena S; Majokweni, Sybil; O’Cleirigh, Conall; Safren, Steven AAbstract Background Substance use is prevalent in South Africa and associated with poor HIV treatment outcomes, yet, it is largely unaddressed in HIV care. Implementing an evidence-based, task-shared intervention for antiretroviral therapy (ART) adherence and substance use integrated into HIV care may be a feasible and effective way to improve HIV treatment outcomes and reduce substance use in this population. Methods Guided by the RE-AIM framework, a randomized, hybrid type 1 effectiveness-implementation trial (n = 60) is being used to evaluate a peer-delivered intervention that integrates evidence-based intervention components, including Life-Steps (problem solving and motivational skills for HIV medication adherence), behavioral activation to increase alternative, substance-free rewarding activities in one’s environment, and relapse prevention skills, including mindfulness. The comparison condition is enhanced standard of care, which includes facilitating a referral to a local substance use treatment clinic (Matrix). Participants are followed for a period of 6 months. Implementation outcomes are defined by Proctor’s model for implementation and include mixed methods evaluations of feasibility, acceptability, and fidelity, and barriers and facilitators to implementation. Primary patient-level effectiveness outcomes are ART adherence (Wisepill) and substance use (WHO-ASSIST and urinalysis); viral load is an exploratory outcome. Discussion Results of this trial will provide important evidence as to whether peer delivery of an integrated intervention for ART adherence and substance use is feasible, acceptable, and effective. Implementation outcomes will provide important insight into using peers as an implementation strategy to extend task sharing models for behavioral health in resource-limited settings globally. Trial registration ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
- ItemOpen AccessReadiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments(BioMed Central, 2016-02-20) Myers, Bronwyn; van der Westhuizen, Claire; Naledi, Tracey; Stein, Dan J; Sorsdahl, KatherineBackground: This study examines whether readiness to change is a predictor of substance use outcomes and explores factors associated with RTC substance use among patients at South African emergency departments. Methods: We use data from participants enrolled into a randomized controlled trial of a brief substance use intervention conducted in three emergency departments in Cape Town, South Africa. Results: In adjusted analyses, the SOCRATES “Recognition” (B = 11.6; 95 % CI = 6.2–17.0) and “Taking Steps” score (B = -9.5; 95 % CI = -15.5- -3.5) as well as alcohol problems (B = 4.4; 95 % CI = 0.9–7.9) predicted change in substance use involvement at 3 month follow-up. Severity of depression (B = 0.2; 95 % CI = 0.1–0.3), methamphetamine use (B = 3.4; 95 % CI = 0.5- 6.3) and substance-related injury (B = 1.9; 95 % CI = 0.6–3.2) were associated with greater recognition of the need for change. Depression (B = 0.1; 95 % CI = 0.04 -0.1) and methamphetamine use (B = 2.3; 95 % CI = 0.1 -4.2) were also associated with more ambivalence about whether to change. Participants who presented with an injury that was preceded by substance use were less likely to be taking steps to reduce their substance use compared to individuals who did not (B = -1.7; 95 % CI = -5.0- -0.6). Conclusion: Findings suggest that brief interventions for this population should include a strong focus on building readiness to change substance use through motivational enhancement strategies. Findings also suggest that providing additional support to individuals with depression may enhance intervention outcomes.
- ItemOpen AccessSubstance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital(BioMed Central, 2018-03-06) Breet, Elsie; Bantjes, Jason; Lewis, IanAbstract Background Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources.
- ItemOpen AccessThe prevalence of psychoactive substance use amongst undergraduate students at a medical school in South Africa(2025) Nair, Devina; Dannatt, Lisa; Sibeko, NtokozoBackground: Substance use and its associated problems are a global public health concern. Factors that can influence trends in substance use include the characteristics of the substance itself as well as those related to the individual and their environment (including availability and implementation of national and local policy and service delivery). Students entering a tertiary education facility show a marked increase in substance use compared to those that live at home or seek employment following graduation from high school. Several risk factors for substance use are specific to this population, including an affiliation with fraternity or sorority life, perception of high academic pressure and peer pressure. Substance use disorders develop over time following repeated episodes of misuse. It may therefore be possible to identify emerging risky substance use and to potentially arrest the development of more problematic substance use and addiction. Aim: To determine the prevalence of substance use in a sample of undergraduate students at a medical school in South Africa. Methods: This was a descriptive cross-sectional study conducted at the University of Cape Town's (UCT) medical campus. The study population included all undergraduate medical students in years one through to six who consented to participate. As this was a descriptive study no set recommendations were given regarding appropriate sample size. Data was collected using an online version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). This tool was developed as a Web App version for this study by the UCT Department of Psychiatry and Mental Health and allowed for completion of an auto-scoring version of the ASSIST. To maintain anonymity the system assigned a random identity token which was not linked to any identifying data. Screening risk scores and brief intervention outcomes, including information for inward referral for assessment and care, were shared with the participant onscreen at the end of the screening process. The anonymized data was analysed using the R statistical software package. Descriptive statistics was used to summarize the data. Results: 444 ASSIST tools were completed with signed consent and therefore appropriate for the data analysis; this equated to a response rate of 32,2%. Across all demographics, 83.1% (369 respondents) reported substance use. Alcohol (88,1%) followed by cannabis (53,8%) and tobacco (43,1%) were the most commonly used substances by our student population. Overall, our study found that the prevalence of substance use at UCT medical school is higher in females, Caucasian individuals and students in the later years of study. The vast majority of the students, 359 out of 369 (97,3%), fall into the low-risk category for substance use. Conclusion: From this study we see that the prevalence of substance use amongst undergraduate medical students at UCT is high (83,1%). However, in this study calculated risk was shown to be low. Whilst risk might be low, we know that substance use disorders develop over time with repeated episodes of misuse. Given the devastating sequelae of substance use disorders, early identification, primary prevention and intervention is needed. Further studies building on this one would be useful particularly in exploring cause and effect of substance use. It would be interesting to see whether, as seen in international literature, difficulty in social integration as well as academic pressure from increased work load could be contributing to the high prevalence of substance use that we have seen in this population. These findings might assist in streamlining and optimising the support services that the university is able to offer this student group.