A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa.

BACKGROUND: Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town. METHODS: Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted. RESULTS: Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital. DISCUSSION: The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers. CONCLUSIONS: Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

The association between psychopathology and substance use in young people: a review of the literature.

This article reviews the recent literature on the association between psychopathology and substance use in young people. An electronic literature search, using PSYCINFO/PSYCLIT and PUBMED/MEDLINE, yielded 93 English-language articles for the period 1990-2008. Of these articles, 89 (95.7%) reported studies conducted in developed countries, 57 (61.3%) had community or population samples, 38 (40.9%) had sample sizes ranging from 500 to 2000 subjects, and 33 (36.7%) had sample sizes of between 50 and 500. The most commonly-used assessment tool (n = 29, 31.2%) was the Diagnostic Interview Schedule. Evidence exists for associations between depression and cigarette smoking, between anxiety and cigarette smoking, and between anxiety and alcohol use. The strength of the associations is increased with greater frequency and quantity of substance use, and is influenced by the nature of the psychopathology, the specific substances of use, and demographic factors such as gender, age or developmental stage. The need for more longitudinal studies on community populations, and increased access to funds and resources for researchers in developing countries is highlighted.

Association between psychopathology and substance use among school-going adolescents in Cape Town, South Africa.

Limited information exists regarding the association between psychopathology and specific substance use in young people both globally and locally. We examined the association between psychopathology and substance use in high school students to determine the nature of the associations and the role of demographic factors in these associations. Grade 8 (N=480) and Grade 11 (N=459) students from 39 high schools in Cape Town, South Africa, completed a self-administered questionnaire. Psychopathology information was obtained from total scores on the Harvard Trauma Questionnaire, Beck Depression Inventory and the Zung Self-Rating Anxiety Scale. Lifetime prevalence rates were calculated for tobacco, alcohol, cannabis and inhalant use. Associations between psychopathology and substance use were determined using regression analyses and structural equation modeling. On adjusting for demographic characteristics, significant associations were found between PTSD and all substance use, between depression, alcohol, cannabis and inhalant use, and between anxiety and cannabis use. The associations of PTSD and depression with alcohol and cannabis use, and between anxiety and cannabis use, were moderated by grade. Although psychopathology and substance use were associated with each other, these associations occurred in accordance with substance and grade. Roles for gender, age and ethnicity emerged in the associations, but further investigation is recommended to examine these.

Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey.

OBJECTIVES: The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic. METHODS: A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted. RESULTS: Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs. CONCLUSIONS: Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs.

The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa.

INTRODUCTION: Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use. METHODS: Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients' sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders. RESULTS: The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use. CONCLUSION: The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users.

The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey.

INTRODUCTION: Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use of specific substances, and iii) to determine whether specific psychiatric disorders were associated with use of specific substances in the South African population. METHODS: Data were drawn from the South African Stress and Health (SASH) study, a nationally-representative, cross-sectional survey of South African households that forms part of a World Health Organisation (WHO) World Mental Health (WMH) initiative to standardise information on the global burden of mental illness and its correlates. Data from a subset (n = 1766; aged 18 to 30 years) of the SASH sample of 4351 individuals were analysed. The Composite International Diagnostic Interview Version 3 (CIDI 3.0) was used to elicit basic demographic details and information regarding mental illness and substance use. Multiple regression analyses, adjusted for age and gender, were used to identify associations between mental disorders and substance use. RESULTS: Significant associations were found between substance use and mood and anxiety disorders, with a particularly strong relationship between cannabis use and mental disorder. CONCLUSION: The results are consistent with those from previous studies, and reinforce the argument that comorbid substance use and mental disorders constitute a major public health burden.

Clinical presentations and diagnostic issues in dual diagnosis disorders.

PURPOSE OF REVIEW: The co-occurrence of mental disorders and substance use disorders (SUDs) is very common, and associated with substantial psychiatric morbidity, functional and quality of life impairments, and societal costs. However, dual disorders are often underdetected, misdiagnosed and inadequately treated in both substance abuse and mental health settings. RECENT FINDINGS: Individuals with dual or multiple disorders generally have worse clinical features and long-term outcomes than those with single disorders. However, findings can vary depending on factors such as type(s) of psychiatric disorder(s) and substance(s) involved, and whether the mental disorder is primary or secondary, or substance-induced or independent. Underdiagnosis or misdiagnosis of dual disorders may occur due, in part, to the use of measurement instruments and diagnostic approaches that have uncertain clinical utility. SUMMARY: Routine, thorough, and integrated screening and diagnosis of dual disorders are needed to facilitate implementation of appropriate treatment. Results suggest that forthcoming revisions to the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases should categorize and define mental and SUDs such that clinicians can more readily detect and diagnose all types of substance use and mental health comorbid conditions. Adoption and widespread use of appropriate screening, assessment and diagnostic instruments, and more thorough diagnostic (clinimetric) approaches are recommended.

Brief report: Social and neighbourhood correlates of adolescent drunkenness: a pilot study in Cape Town, South Africa.

AIM: To identify social and neighbourhood correlates of drunkenness among adolescents. DESIGN: A cross-sectional, community study. PARTICIPANTS: A multi-stage cluster sampling strategy was used to select 90 adolescents aged 11-17 years from nine distinct communities in Cape Town, South Africa. The sample was stratified by race, income, and gender. Randomly selected adolescents from each household were interviewed by trained interviewers. INSTRUMENT: A questionnaire that included questions on substance use behaviour, peers, neighbourhood factors and recreational activities. RESULTS: A third of the sample indicated having been drunk at least once in their lifetime. Older adolescents and adolescents whose friends drink were significantly more likely to have been drunk. The risk of having been drunk was also associated with being white and with being exposed to public drunkenness on a daily or at least weekly basis. Gender was not associated with reporting of lifetime drunkenness. Attendance at religious services (at least weekly) was found to be a significant protective factor against drunkenness. CONCLUSION: The study highlights a number of environmental factors that should be considered in tackling adolescent drunkenness.