Notes for Northern Cape MEC for Social Development Mr Alvin Botes on the Summit for Substance Abuse, Kimberley
16 Nov 2010
Programme Director and Head of Department: Mr Kholekile Nogwili
Father Tefo Motaung
Deputy Chairperson of Central Drug Authority: Dr Bayever
Representative from SANCA: Ms S van Tonder
Representative from the South African Police Service (SAPS): Director Myburg
National Office Representative (Senior Manager): Mr Pierre Vivier
Executive and senior managers from the Department
Delegates to the Summit
Ladies and Gentlemen
Programme Director, we were the very first province to launch Community Mobilisation and Mass Media Campaign Launch Against Substance, Drugs and Alcohol Abuse, under the theme: “No place for drugs in my community” on the 14th October in Rosedale, Upington. We feel very honoured as province as we had the then Deputy Minister and current Minister Ms. Bathabile Dlamini to facilitate that particular launch.
That particular launch was an important step by our government in addressing the serious the impact of substance abuse in our society. It provided an opportunity to renew government’s commitment to taking action against substance abuse and the harms they cause to individuals, families and their communities.
She emphasis that the launch an integral part of the implementation of the National Drug Master Plan, and said that the Prevention of and Treatment of Substance Abuse Act places more emphasis on prevention as it proved to be a more cost effective intervention.
Programme Director, the far-reaching implications of substance abuse in our society should not be underestimated. It is touching the roots of our society—it ruins the lives of our young children, influences gangsterism and other criminal activities, contributes to the spread of sexually transmitted infections including HIV and AIDS, poverty, domestic violence and other forms of abuse, and in fact, every facet of our social fabric. Substance abuse has thus become a threat to the future of our society and it necessitates our urgent attention.
In view of the aforementioned, a need was identified at National ministerial level as part of outcome three which calls for communities to be mobilised in order to voice their concerns and possible solutions to successfully addressing substance abuse problems in the country.
The inputs by communities will inform the Biennial Substance summit scheduled for 8-10 December 2010 which will be hosted by Central Drug Authority in collaboration with the national Department of Social Development.
Drugs, alcohol and substance abuse are in essence a counter-revolutionary feature, which if not curbed in society, could reverse the gains of our democratic dispensation and progress.
Experience has shown that successfully combating the drug problem requires the application of three elements harmoniously, in an integrated and balanced manner.
These are supply reduction through law enforcement, demand reduction through prevention strategies amongst others, and harm reduction through treatment and social support. These three elements form the key pillars of the Prevention of and Treatment of Substance Abuse Act.
The act provides hope as it will substantially improve the manner in which the country responds to drug and substance abuse. We remain optimistic that with cooperation from all communities and sectors, we can begin to stem the tide of substance abuse.
I would like to emphasise that our government has made sure that the issue of substance abuse and illicit drugs receives priority. We have established the Central Drug Authority, which in partnership with the civil society and other structures of our society is responsible for developing programmes and strategies to deal effectively with this problem.
We need to augment on these initiatives.
Recent advances in psychosocial research and neurosciences have provided new avenues for prevention of substance abuse at the individual and community level. A series of risk and protective factors affecting the likelihood of using and abusing substances have been identified. The scope of prevention has been broadened, allowing the prescription of different interventions for individuals according to their varying degrees of vulnerability to substance experimentation, continuous use and dependence.
An increased awareness of comorbidity between mental and substance use disorders provides an arena for prevention within psychiatry and related disciplines. Emphasis on programme evaluation has helped identify cost effective programmes and policies. The integration of prevention within healthy life style policies and programmes, including interventions at the school, family and community levels, is more likely to produce the desired outcomes.
The overwhelming effects of substance abuse on individuals, families and societies demand effective mechanisms of deterrence. While there is consensus about the importance of prevention, there is a lack of agreement over the best way to achieve it.
Prevention is understood as any activity designed to avoid substance abuse and reduce its health and social consequences. This broad term can include actions aimed to reduce supply - based on the principle that the decreased availability of substances reduces the opportunities for abuse and dependence) and actions aimed to reduce demand- including health promotion and disease prevention. Evidence from epidemiology suggests continuous shifts between periods of increasing and decreasing abuse of substances; prevention can modify the trend, generate or reinforce the downward shift, or help diminish the rising trend.
Reducing the supply of illegal substances has included efforts aimed at destroying crops, crop substitution, prosecution of big scale traffickers and substance dealers, and reduction of substance availability on the streets. Abuse of psychotropic and narcotic medicines with a dependence potential has been controlled through medical prescription and the application of specific regulations for the production and distribution of medical drugs and their precursors. Medical education has a crucial role to play in reducing the availability of prescribed substances for abuse.
Demand reduction can be accomplished through special programmes aimed to modify those factors which make individuals vulnerable to substance experimentation, continuous use and dependence, as well as to promote protective factors in the individual and the environment.
The need for an integrated strategy of supply and demand reduction was recognised during the 20th Special Session of the United Nations. In the continued relevant political declaration, member states recognised that action against the substance problem was a shared responsibility requiring an integrated, balanced approach.
The term "demand reduction" was used to describe policies and programmes aimed at reducing consumer demand for narcotic and psychotropic substances covered by the international substance control conventions. The Declaration of Demand Reduction recognised the need t a) assess the problem, in order to base prevention on a regular evaluation of the nature and magnitude of substance abuse and related consequences; b) tackle the problem, from discouraging initial use to reducing the negative health and social consequences, education, public awareness, early intervention, aftercare and social reintegration, early assistance and access to services for those in need; c) forge partnerships, through the promotion of a community-wide participatory and partnership approach as the basis for the accurate assessment of the problem and the formulation and implementation of appropriate programmes, integrated into broader social welfare and health promotion policies and preventive education programmes; d) focus on special needs of the population in general and of specific subgroups, with emphasis on youth; e) send the right message (the information utilised in educational and prevention programmes should be clear, scientifically accurate and reliable, culturally valid, timely and, where possible, tested on a target population).
In the past, there was a tendency to regard primary prevention, i.e. interventions before the onset of symptoms, as the only true form of prevention. It is now recognised that effective prevention approaches are required before and after symptoms become apparent, since substance abuse disorders are chronic and relapsing or recurring in nature. Moreover, personal and financial costs can be largely attributed to episodes that follow a first onset, meaning that the prevention of recurrence and relapse - including relapse after successful treatment - is an essential aspect of a public health strategy to reduce prevalence.
Moreover, primary prevention has been classified into universal, selective and indicated, according to the level of risk of using substances. Universal preventive interventions are those targeting the general public or a whole population group.
Selective preventive interventions are those aimed at subgroups of the population whose risk of developing the disorder is significantly higher than average, i.e. persons who may be at imminent risk or have a lifetime risk. Indicated preventive interventions were defined as those targeting high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing the disorder, or biological markers indicating a predisposition for the disorder, but who do not meet diagnostic levels at the present.
The scope of prevention also includes early intervention with individuals that have experimented with substances but are not severely dependent and may therefore be "re-educated" through learning interventions, as well as treatment of dependence, relapse prevention and social reintegration. It is now recognised that interventions within the whole spectrum reduce the burden of the problem for society.
The burden of substance abuse can be divided into two areas: intoxication and dependence. Limiting the damage to the individual and society from intoxication, i.e. driving under the effects of psychoactive substances and reducing the risk of exposure to substances and thus of developing dependence, are essential components of prevention.
Reduction of harm is a somewhat different approach of prevention. This type of measures has been shown to reduce major health and social consequences. Examples of risk reduction measures include making clean syringes available, which has proved to reduce the risk for human immunodeficiency virus (HIV) infection and hepatitis B, or substitution treatment, which reduces crime levels in the streets.
A broad definition of prevention includes health promotion and prevention of disorders. The former aims to increase well-being by, for example, reducing inequities and building social capital, while the latter seeks to reduce incidence, prevalence, recurrence and time spent with symptoms, prevent relapses, delay recurrence and reduce the severity of symptoms. Decreasing the impact of illness on the person, the family and society is also considered part of prevention. Prevention also includes reduction of stigma, and consequently of barriers to treatment.
Variations in personal characteristics and in the socio-cultural environment create differences in the degree of vulnerability to substance experimentation, continuous use and dependence, meaning that prevention also needs to vary both in content and intensity.
Risk factors can be found in different domains: a) at the individual level, e.g., some mental disorders or a sensation- seeking personality; b) in the family, e.g., living with a depressed or substance dependent parent) c) at school, e.g., poor academic performance; d) among peers, e.g., friends that use substances, e) in the community, e.g., easy availability of substances, social tolerance. These factors interact with the individual process of receiving, elaborating, interpreting and responding to stimuli.
The change in scope from prevention of substance use to the prevention of risk factors opened up new possibilities, particularly since it was expanded to include interventions at the early developmental stages. Nonetheless, it has also been observed that exposure to risk factors, even if these are extremely numerous, does not inevitably lead to substance use or escalation to dependence. In fact, children raised in problematic family environments, even if they live in environments where substances are easily available, may reach adulthood without having experimented with substances, due to the presence of protective factors that offset existing risk factors.
Protective factors can also be found in different domains: a) at the individual level, e.g., high self-esteem or a risk avoidance personality trait; b) in the family, e.g., living with parents able to meet their children's affective needs; c) at school, e.g., school adherence; d) among peers, e.g., close peers with a low tolerance of drug use ; e) in the community, e.g., strong social networks. Although these factors can protect the individual from risk, they should not be regarded as the absence of risk. Risk factors indicate where it is necessary to intervene and protective factors show how to do so.
Preventive interventions should encompass disease-specific as well as more generic risk and protective factors. The latter are those common to several disorders and may create a wide spectrum of preventive effects such as poverty and child abuse. Disease- specific risk and protective factors are those that are mainly related to the development of a particular disorder: for example, social tolerance toward alcoholic inebriation and the lack of regulations concerning drunk driving are specifically linked to the likelihood of alcohol-related traffic accidents.
Broad contextual factors - such as inequity, poverty, neighbourhood disorganisation, lack of health and social services, availability of substances - are important determinants of the level of use and problems. It has been shown that, although the population with higher income levels consumes more substances, substance abuse has a greater impact on the poor, since it compounds their numerous everyday problems. Societies can reduce this burden by integrating social minorities, providing services and facilitating community networks.
Improved understanding of the neurobiological mechanisms underlying substance dependence can lead to better strategies to prevent substance involvement and dependence. AWorld Health Organisation (WHO) publication on the neurosciences of substance use and dependence summarises recent findings in this field. Substances differ with respect to the specific receptors in the brain that they influence, but there are also considerable commonalities. Substance dependence is a disorder that involves the motivational systems of the brain, and despite the fact that each substance has unique mechanisms of action, all substances which cause dependence activate the mesolimbic dopamine system.
The neural pathways that substances affect are the same as those involved in many other human behaviours, including eating, having sex or gambling. Dependence-producing substances differ, however, from conventional reinforcers in that their stimulant effects on dopamine release in the nucleus accumbens are significantly greater than natural reinforcers such as food.
Dependence-producing substances have the potential to produce positive effects on the individuals using them, that vary from minor effects such as reduction of stress to major effects such as the "high" or "rush" associated with the use of amphetamines, heroin or crack cocaine. The presence of the reinforcing mechanism explains why individuals use substances and establishes the basis for continuous use that is a necessary but not a sufficient condition for the onset of dependence.
Repeated exposure increases the reinforcing effects. This process is associated with marked changes in the dopamine mesolimbic system. There are both presynaptic changes, increased dopamine release and postsynaptic changes, i.e. changes in receptor sensitivity. In addition, structural changes in output neurons in the nucleus accumbens and prefrontal cortex have also been seen following sensitisation to amphetamines and cocaine. The final step in this process is substance dependence. This enduring process of sensitisation can explain relapses after considerable periods of substance abstinence.
There seems to be no linear relationship between the amount of a substance used and the severity of dependence, and no single relationship between pattern of use and onset of dependence. On the basis of available knowledge, it is not possible to predict who will lose control and become dependent.
As an MEC of your government, I recognised that the absence of concrete infrastructure investment in the field of substance abuse, raise more questions than answers.It is for this reason that government will partner with private sector service providers, to build a multiple rehabilitation centre in the Northern Cape province.
The recent interest in documenting the outcomes of prevention programmes has provided some general principles for substance prevention. In general, multiple-component programmes (school, family, community) have proved to be the most effective, particularly if they are incorporated into a wider perspective of healthy life styles rather than emphasising what is forbidden or dangerous. Information in itself has proved to be insufficient: the most commonly used school programmes have proved successful in modifying knowledge and attitudes, but sustained change is more difficult to achieve. Better results have been observed when programmes include skills training components and when they can intervene in more than one of the steps in the chain from substance availability to having the opportunity to use substances, experimenting, continuous use, different levels of dependence and abstinence.
The legal status of alcohol poses different challenges and raises the possibility of prevention mainly in the form of introducing measures to regulate availability and maintain it at reasonably acceptable levels. Alcohol control measures are often unpopular and therefore difficult to incorporate into public policy. Our NorthernCape provincial governmentmust amongst other things, conduct a study on the relationship between the visibility of taverns in a particular community, and alcohol abuse prevalency in the community.
Establishing a minimum legal age for drinking and server liability, restrictions on hours and days of sale, and different availability by alcohol strength have shown to achieve positive results if adequately enforced.
Regulations on drinking and driving have also proved to be efficient. Measures such as lowered legal blood alcohol limits, that might include zero tolerance for young drivers, random breath testing and sobriety check points are also supported by evidence. Server intervention programmes, that might include training staff and managers to identify and stop service for intoxicated patrons and handle aggression more effectively, have shown a moderate impact where implemented. Early treatment interventions, including mandatory treatment for recurrent drinking drivers, have also proved to be effective measures in the decrease of alcohol-related consequences, reducing costs for the individual, the family and the society as a whole. Regulation of promotion most common in the mass media, such as advertising bands or control of content in the advertisement, have shown to have some effect if enforced and monitored. Education and persuasion, including alcohol education in schools or universities and warning labels, have shown to change knowledge and attitudes but have no sustained effect on drinking. The best results are achieved through integrated policies.
The Northern Cape’s department of Social Development, with its social partners has achieved the following over the last past year:-
- 18 389 persons were reached through substance abuse prevention. 212 Departmental officials and NGO officials trained in substance abuse prevention and treatment services.
- 358 persons received community based or in-patient treatment services
- 10 tavern owners entered into partnership with the Department on the responsible trading campaign
- 996 women reached through Fetal Alcohol Syndrome (FAS) prevention services in Upington.
- 18 local drug action committees operational in the province.
The above-mentioned interventions have in its own way, contributed to a level of stabilisation of rampant alcohol and drug abuse in the Northern Cape.
We must all be very worried if the ANC get concern about the levels of alcohol and substance abuse in the province, and allow me to quote from the ANC 1st National General Council report, “Amongst the challenges facing the Province are: the province needs to develop a programme of addressing the rampant social ills of alcoholism and inter-personal violence amongst our people”.
We need to without fail remind the youth as leaders of the future, that they must do everything to assist us in our endeavours to building a social cohesion and leading the Moral Regeneration Campaign, we need youth that has respect for self and is patriotic towards this country.
And indeed finally—the singular purpose of today’s summit is to present the Northern Cape’s people with a provincial substance abuse strategy.
Issued by: Northern Cape Social Development
16 Nov 2010
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