Elsevier

Drug and Alcohol Dependence

Volume 152, 1 July 2015, Pages 79-86
Drug and Alcohol Dependence

Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study

https://doi.org/10.1016/j.drugalcdep.2015.04.016Get rights and content

Highlights

  • Mixed methods were used to describe addiction experiences in methamphetamine users.

  • Most reported daily drug use and high addiction severity; few had sought treatment.

  • Both motivators for and barriers to treatment were prominent in the qualitative data.

  • Interventions must seek out users, foster motivation, and link them to treatment.

  • Community education about addiction may be important in eliminating barriers.

Abstract

Background

Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town.

Methods

Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment.

Results

Participants had used methamphetamine for an average of 7.06 years (SD = 3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD = 8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning.

Conclusion

This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.

Introduction

Methamphetamine is a highly addictive amphetamine-type stimulant (ATS) that produces increased energy, alertness, hypersexuality, and euphoria, among other physiological effects (Barr et al., 2006, Darke et al., 2008, Panenka et al., 2013). Globally, ATS is the second most widely used class of drugs, and they are generally more prevalent in high-income countries (United Nations Office on Drugs and Crime, 2014). The prevalence of ATS use remains relatively low in Africa, but notable increases have emerged in the southern and western parts of the continent (Mbwambo et al., 2012). Providing quality treatment for ATS addiction in low- and middle-income countries (LMICs) remains compromised by overstretched health care facilities and the dearth of accessible drug treatments (Coovadia et al., 2009, Mbwambo et al., 2012, Odejide, 2006).

Methamphetamine first emerged in South Africa in the late 1990s, fueled by socio-political changes following the end of apartheid (Peltzer et al., 2010, United Nations Office on Drugs and Crime, 2012). The prevalence of methamphetamine use has increased steadily since 2000, with its epicenter in Cape Town (Dada et al., 2014, Parry et al., 2008, Peltzer et al., 2010). Data from drug treatment facilities in the city indicate that the proportion of patients reporting methamphetamine as their primary drug increased from 0.3% in 2002 to 42.3% in 2006, the fastest increase in admissions for a single drug ever noted in South Africa (Pluddemann et al., 2008). In recent years, nearly half of admissions were related to methamphetamine (Dada et al., 2014). Community-based studies provide further evidence of a growing methamphetamine problem in peri-urban (“township”) communities that are characterized by high population densities, elevated poverty rates, and limited infrastructure (Meade et al., 2012, Myers et al., 2013, Simbayi et al., 2006, Wechsberg et al., 2010). Methamphetamine use in South Africa is of particular concern because of its association with risky sexual behaviors (Meade et al., 2012, Simbayi et al., 2006, Wechsberg et al., 2010), fueling fears that methamphetamine may accelerate HIV transmission in communities already burdened by high HIV prevalence. With 6.4 million HIV-infected adults (18.8% of persons 15–49 years), South Africa has the largest number of cases of any country in the world (Shisana et al., 2014).

In South Africa, methamphetamine is generally smoked using a glass pipe, and is known as “tik” due to the sound produced when heated (Peltzer et al., 2010). Smoking, like injection, increases drug availability, onset of action, and peak effects, thus increasing risk of dependence (McKetin et al., 2006, Volkow et al., 2004). Studies on amphetamine dependence have originated primarily from North America, Europe, and Australia, with limited information from LMICs (Degenhardt and Hall, 2012). While there are a few studies from China, Thailand, and South Africa (Kelly et al., 2014, Sutcliffe et al., 2009, Watt et al., 2014), none of these examined the drug use histories, symptoms of addiction, and treatment experiences of methamphetamine users in the community. Examining how addiction and drug treatment are perceived by drug users can guide the development of interventions to improve the uptake of services in LMICs that are (or may become) affected by methamphetamine. Our mixed-methods study aimed to fill this gap in the literature by assessing the addiction and treatment experiences of a community-recruited sample of methamphetamine users from a South African township.

Section snippets

Setting

This study was conducted in Delft, a township located ∼24 km from Cape Town's city center that was established in the early 1990s. The majority of Delft's 150,000 residents are Coloured (52%) and Black African (46%) (these terms originate from the Apartheid era and are still used as demographic markers referring to people of mixed versus African ancestry, respectively; City of Cape Town, 2013). The population is relatively uneducated (with only 27% of adults completing high school), largely

Sample characteristics

The sample included 201 men and 159 women, ranging in age from 18 to 66 years. As described in Table 1, the majority were Coloured, heterosexual, and unmarried. Only 2% had injected drugs in the past 3 months (6% lifetime). Women were more likely than men to be Coloured (χ(1)2 = 27.30, p = .000) and unemployed (χ(1)2 = 5.49, p = .019). The 17 men and 13 women who completed IDIs had similar demographic characteristics as the full sample.

The large majority of the sample were unemployed and had not

Discussion

There is a paucity of research describing the addiction experiences and treatment histories of out-of-treatment methamphetamine users. The few studies that have examined this vulnerable population are concentrated in high-income countries (Kenny et al., 2011, MacMaster, 2013, Quinn et al., 2013), and the extent to which findings can be extrapolated to LMICs with newer ATS problems is unknown. Our prior qualitative work in this setting has demonstrated the ubiquity of methamphetamine use and the

Role of funding sources

This study was funded by grants R03-DA033828, K23-DA028660, and T32-AI007392 from the United States National Institutes of Health (NIH). The Duke Global Health Institute (DGHI), Duke University provided Dr. Kimani with a scholarship to support travel and living expenses in South Africa and provided Dr. Kimani and Mr. Lion a research assistantship to work on the study protocol and data analyses. Neither the NIH nor the DGHI had any further role in study design; data collection, analysis, and

Contributors

Meade, Watt, and Skinner designed the original project and secured grant funding; Meade, Towe, and Watt conceptualized the current study; Watt and Kimani conducted the qualitative analyses; Meade, Towe, and Lion conducted the quantitative analyses; Meade drafted the initial manuscript; Towe, Watt, Lion, and Myers wrote sections of the final manuscript; Pieterse provided oversight of data collection and management; and all authors contributed to and approved the final manuscript.

Conflict of interest

We wish to confirm that there are no known conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced its outcome.

Acknowledgements

We are grateful to all of the men and women who participated in this study and our study staff in South Africa (Albert Africa, Tembie Mafikizolo, and Mariana Bolumbe), without whom this study would not have been possible.

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