Let’s talk ‘people’ and not ‘addicts’

There is no silver bullet in dealing with drug problems in our society. If we want solutions, we need a co-operative effort that has realistic, implementable and sustainable plans. More than that, these plans need to use a multipronged approach based on reason, research, knowledge and compassion.

Tony Ehrenreich’s suggestion (Friday Grill, October 14) that we need a “leader” in the “battle on drugs” looks at the drug problem, and more especially the solution, in a one-dimensional way.

Second, there is no “battle on drugs”. That is so last century. Unfortunately it is often the media that perpetuate such emotive terminology. The entire world has discovered that the “war on drugs” has been an enormous mistake. It has not only wasted financial and human resources, but has actually exacerbated some of the problems.

One “unintended consequence” of the drug war is that people can’t distinguish between the drug and the users. It makes it more difficult for people to access treatment because of the stigma – they feel the “war” is against them.

The worst unintended consequence was in Mexico, where it turned into a gang/drug war that has cost 25 000 Mexicans their lives. Some were even killed while they were in residential treatment or rehab.

Methamphetamine (tik) is the most widely used illicit drug in the world, except for cannabis. Forty million people worldwide regularly use tik, according to the UN World Drug Report, about 10 million use cocaine and 15 million use heroin.

We need to understand that it’s not only South Africa that has drug problems, nor indeed only the Western Cape – it’s global.

Our illegal drug problems came later than more developed countries, and they came rapidly. Seventeen years ago our only illegal drugs were dagga, mandrax and Welcanol. We were underprepared for the flood of drugs like tik, heroin, cocaine and crack through our borders.

Research tells us that alcohol and drug use underpins most of our family and community challenges – crime, violence, risky sexual behaviour, unemployment, abuse and poverty. Alcohol misuse alone is going to cost the Western Cape more than R3 billion in the next year

We need to learn from those who have gone before us; countries that have been dealing with tik for more than 20 years and with heroin for 40. Some of these countries are years ahead of us in skills, resources and systems, and have found many solutions, but still have drug problems.

It is worth noting that rather than dragging their feet over the past five years, as Ehrenreich implies, the City of Cape Town and the Western Cape government have developed free interventions that are being complimented by professionals around the world.

The Matrix Institute on Addictions at UCLA has been successfully treating people with tik problems for the past two and a half decades.

The institute’s executive director, Jeanne Obert, recently wrote about Tafelsig Clinic in Mitchells Plain, the first of the city’s four free drug and alcohol treatment programmes: “Let me say that the Tafelsig Clinic is one I talk about all the time with people all over the world. The most amazing thing about that clinic is that you established it within a primary health care setting where it is just one of a number of services offered to surrounding residents.

“Countries like the US are struggling to emulate such a model. Giving patients access to such a wide array of services without sending them to many different locations is a wonderful and very futuristic model.”

The same model has been used in the Cares (Community Awareness, Rehabilitation and Education Services) project in Hout Bay. This is a prime example of everyone working together – civil society and the provincial departments of social development and health are partners in the project.

There is a wealth of local and international research that tells us what works, and there’s even more that tells us what doesn’t.

Drugs are a great leveller. It doesn’t matter what faith, nationality, colour, gender or social status, individuals, families and communities all have the same feelings of hopelessness and helplessness. A drug- or alcohol-affected family suffers the same anguish whether they live in Bishop Lavis or Bishopscourt. The difference is that one suffers in more comfort. But suffer they do.

All spheres of government have realised that drug problems are complex medical and social issues and there is no quick fix. There have to be inclusive plans with clear and measurable objectives; everyone needs to know what the plan is, what their roles and responsibilities are, and have enough knowledge to make informed decisions.

If all structures develop multi-pronged interventions, we’ll be making huge strides forward.

All spheres of government understand that the solutions lie in two separate, yet parallel, strategies: supply reduction and demand reduction.

Supply reduction includes police, customs and other law enforcement agencies, the criminal justice system and projects such as Ceasefire and Violence Prevention through Urban Upgrading.

Demand reduction is all about a range of services, from prevention, treatment and after-care, to education, skills development and job creation. If we are successful with demand reduction it has a huge impact on supply reduction, and vice versa.

We need to intervene on every level and not wait until someone has become dependent. But we must ensure our interventions are practical, research-based and effective, not simplistic one-line messages or one-off talks at schools.

One key component is building knowledge, capacity and skills among our service providers. However, we need to ensure public money is well spent by the government on effective “training” programmes. In the past this sometimes wasn’t the case. Training was often eclectic, unmonitored and hardly ever sustainable.

An example would be the extensive (and expensive) “training” the previous provincial administration gave to religious leaders, Cosatu, the Siyavulela campaign (1 000 random community members) and others. Had this “training” been effective, Ehrenreich would be more informed.

The current provincial administration has recognised this as a problem, and so has provided bursaries at all three universities in the Western Cape for specific courses on addictions – a first in South Africa. It might also be a good idea for them to make sure city councillors and provincial MECs also receive reliable information so they can engage in informed debate.

The city has had a measurable strategic plan between 2007 and last year. It has achieved much of this, and in the new strategy moving forward to 2015, this will help communities to develop strategies for managing their specific drug problems and challenges.

It will also be an effective way of identifying referral routes and gaps in services, and planning community-based prevention and education campaigns and interventions.

As we learn more about what does and doesn’t work globally, we need to make changes. Language is one of the more subtle components needed to create change.

I would argue that for a newspaper to ask if “Cosatu (sic) and the ANC in Cape Town view drugs as a scourge akin to apartheid” is at best naive, at worst irresponsible and uninformed.

Newspaper reports, no matter how positive, often refer to “addicts”.

Often people refer to themselves as addicts but this is generally after they have stopped using drugs – and they are talking about themselves.

Let’s start talking about “people” with alcohol and drug problems rather than the stigmatising word “addict”, or worse still, “tikmonster”.

People with alcohol and drug problems, and their families, suffer. Let’s start to restore the individuals, their families and our communities, and let’s do it in a spirit of unity.

We need to start living in the solution and not dwelling in the problem, and we need to make sure everything we do is based on reason, research and compassion.

* Fisher is the executive director of Smart (Substance Misuse: Advocacy, Research, Training)

Sauce

Drinking is dangerous

The alcohol and advertising industries have recently circulated a petition aimed at pressuring government to abandon its intended ban on advertising alcohol.

Their view is that while alcohol as a product has disastrous effects on individual users, families and communities, government should not focus on advertising or other strategies to reduce the demand and supply of alcohol. Instead, we should focus on the underlying factors driving alcohol abuse.

To them, the driving factors are solely the high levels of poverty, joblessness and the more vague notions of family issues.

We welcome their acknowledgement that alcohol has significant negative impacts, but we are committed to using evidence-based strategies to reduce the harm caused by alcohol use and abuse.

Before looking into strategies to reduce alcohol-related harm, it is useful to discuss the product itself.

Beneath the fancy bottling, packaging and slick advertising linking alcoholic products to sporting prowess, business savvy and overwhelming sexiness, lies a drug called ethanol.

Ethanol is the drug found in beer, wines and spirits similar to the active ingredient Tetrahydrocannabinol (THC) that is found in the plant marijuana.

Like THC, ethanol when ingested – as a cold beer, in wine and in a shot of even the most expensive whisky – impacts negatively on the physiology of the drinker and impairs his or her senses.

The drinking of ethanol in its fancy packaging has been identified as a leading risk factor for death and disability globally. In an article due to be published in the journal Addiction, entitled “Alcohol Consumption and Non-Communicable Diseases: Epidemiology and Policy Implications” by Charles Parry, Jayadeep Patra and Jurgen Rehm, the role of alcohol as a risk factor in the spread of Non-Communicable Diseases (NCDs) is outlined clearly.

They found that alcohol accounted for 3.8 percent of deaths globally and 4.6 percent of Disability Adjusted Life Years in 2004. Alcohol was found to be the fifth highest risk factor for deaths in middle income countries. In terms of Disability Adjusted Life Years lost in 2004, alcohol ranked first in middle income countries. With South Africa being a middle income country, the scale of the problem is clearly a cause for alarm.

Parry et al also cite the International Agency for Research and Cancer which asserted that there was significant evidence for a causal link between alcohol and cancer of the oral cavity, pharynx, larynx oesophagus, liver, colon, rectum and female breast. These cancers showed evidence of what is known as dose-response relationship.

That is, the more people drink ethanol through their brand of choice, the higher the risk of getting any of these life-threatening illnesses. This research is backed up by similar evidence garnered by the World Health Organisation and medical research done here and abroad. Alcohol is not just another consumer product, but impacts negatively on the health of those who consume it and places an enormous strain on the health system.

The relationship between alcohol and social disorder may be worse. The South African Health Information network, using research by the Medical Research Council, indicates that alcohol intoxication is associated with morbidities arising from intentional and non-intentional injuries, with increased risk of contracting sexually transmitted diseases. It impacts negatively on the criminal justice system as the evidence indicates a significant association between drinking and committing or being a victim of a crime.

Mortuary statistics for 2002 indicate that alcohol played a role on average of up to 46 percent of transport-related deaths and homicides. The picture was more alarming in the metro areas where for example, in Port Elizabeth, alcohol accounted for 63 percent of transport-related deaths and 69 percent of homicides. The figures for the other major cities were equally startling.

In addition, research conducted by the Crime Research and Statistics component of Crime Intelligence over the past decade, has confirmed that about 70 percent to 80 percent of murders, 60 percent of attempted murders, 75 percent of rapes and 90 percent of all assaults involve victims and perpetrators who know one another.

The analysis indicates that alcohol, and to a lesser extent other drug abuse, frequently played a role in these crimes. This is why the five crimes in question are referred to as social contact crimes. The latest research indicates that roughly 65 percent of murders are associated with social behaviour fuelled by alcohol abuse.

The evidence related to the negative impact of alcohol on the health of South Africans and the social fabric shows that we have to be robust in reducing the harm caused by alcohol. This means we have to implement measures that will reduce exposure of young people and the general population to advertising that falsely portrays carefully packaged ethanol as being cool and successful.

We have to ensure that we raise the price of alcohol to make it less accessible. We have to ensure that we regulate the number of licensed outlets so that we limit access. We have to put in place measures that will raise the legal age for buying alcohol so that we can protect our youth and become very strict with regard to drink driving.

These strategies are regarded as common sense and serve as guidelines for good policy by the World Health Organisation.

The alcohol and advertising industries on the other hand would want us to ignore best practice and evidence garnered from local and international experts and have us focus on the one area that has been shown in research to be the least effective, that is, public education.

Public education and awareness campaigns are only successful if accompanied by legislative measures such as the restriction of advertising and increasing the price of alcohol. We intend to implement all these measures and not just one or two.

We are aware that alcohol consumption has occurred for thousands of years and is seen as part of “our culture”. However, many of its varied health effects have been discovered fairly recently. Notwithstanding this relatively new evidence of the link between alcohol consumption and its negative health and social consequences, we have to battle a well-resourced industry tasked with saving its bottom lines and preserving alcohol as part of a cultural identity that makes it an acceptable drug.

We hope that the public sees the difference between our attempts to promote public health and social integrity and the attempts of the industry to maintain the unhealthy status quo.

I would like to re-tell a story published by James Siddall, on his struggle with addiction. He tackles the myth related to drugs that asserts that “if it’s legal, it can’t be that bad”. He quotes William L White, author of the book Pathways From the Culture of Addiction to the Culture of Recovery: A Travel Guide for Addiction Professionals, who writes that society celebrates alcohol, tolerates nicotine and prohibits other drugs such as marijuana and cocaine.

White suggests that what separates legal from illegal substances is, to a huge degree, society’s perception (culture).

White further writes that anyone using prohibited drugs is painted as bad and worse. Alcohol, on the other hand, is part of the warp and weft of Western society. Never mind that, more than any other drug, it attacks every single organ and tissue in the body and has incalculable social costs.

He emphasises the dangers of alcohol by pointing out that alcohol is one of the few substances whose withdrawal can kill. Not even heroin shares that dubious quality.

Dlamini is Minister of Social Development

- Sunday Independant