What’s in a name?

‘Substance use disorder’ is the correct medical term for what many people call drug addiction or substance abuse. These terms refer to a situation when someone uses alcohol or another substance (drug) in a way that leads to health problems and badly affects their lives at home, work or school.
Alcohol is the most widely available legal drug in the world, followed by nicotine (cigarettes) and cannabis (dagga).

Other common ‘hard’ drugs include crystal meth (tik), Mandrax, cocaine and heroin. Children who live on the street are likely to drink cough syrup or sniff glue. Whoonga or nyaope (a mixture of low-grade heroin, cannabis and other substances) is also widely used on the streets, because it is cheap and easy to get.
Many drugs that are used to treat medical conditions, such as Ritalin (used for attention deficit disorder) are also addictive unless they are carefully controlled.

Substance use disorder in numbers

According to the Central Drug Authority (CDA), at least 15% of South Africans have a drug problem. That’s 15 out of every 100 people! The CDA lists cannabis as the main drug of choice, followed by alcohol.
The second South African National Youth Risk Behaviour Survey (NYRBS) in 2008 found that 30% of learners at school had smoked tobacco; 13% had smoked dagga, 12% had used inhalants, 7% had used cocaine, 7% had used tik, and 7% had used Mandrax.

The South African Anxiety and Depression Group (SADAG), says that the average age for drug dependency in South Africa is 12 years, and half of the country’s teenagers use alcohol. Children as young as 10 have easy access to alcohol and drugs.
What happens when you use drugs?
Drugs act on your body in different ways. They all:
• affect your senses (how you see, hear and taste), brain, heart-rate and behaviour;
• can lead to addiction (inability to do without the drug); and
• damage your health.
Alcohol is a depressant. This means that it makes you feel relaxed and sleepy. Over time, heavy drinking can damage your heart, liver and pancreas.

Dagga makes you feel unusually happy (‘high’) and changes your senses. Sometimes it makes you feel very anxious. Over time, dagga can affect the development of your brain, and reduce your ability to learn and remember. If you start using marijuana before you are 18, you are more likely to develop substance use disorder than if you start as an adult. And if you are in your early teens when you start using it, you are more likely to develop schizophrenia, a serious mental illness.

Tik (crystal meth) and cocaine are very addictive stimulants. They make you feel better about your circumstances; you feel alert, confident and invincible – too powerful to be defeated. You may feel restless, speak very fast, and become easily angry and aggressive. As the drug wears off, you will feel depressed, and over time you will need to take bigger amounts to get the same high.

Mandrax is often smoked with dagga and called ‘witpyp’. It helps you feel relaxed and happy, but it is very addictive.

Heroin (or ‘smack’) is an opiate, which means it is a powerful painkiller and highly addictive. It can make you feel extremely happy and excited, and you forget about your problems. You may have problems speaking or paying attention, move in an uncoordinated way and seem confused. Heroin is more likely to result in death than other drugs.

Inhalants, such as glue, paint thinners, petrol and cleaning fluids all produce a sense of excitement. If you have inhaled one of these substances, you act drunk and may be aggressive. Because the substances are toxic, you may feel dizzy or nauseous, and have difficulty speaking. Using inhalants can also result in brain damage or even death.

Why is substance use disorder a serious problem?

In addition to the physical harm substance use disorder causes, it will affect your whole life in many other negative and destructive ways. It can devastate your relationships with loved ones, lose you your job and career or make you drop out of school. You might take decisions that you deeply regret, or behave in ways that have lasting negative consequences – even cost your life. For example, according to the CDA and the World Health Organisation (WHO), about half the car accidents in South Africa are linked to alcohol use disorder. It is estimated that tobacco kills over 40 000 people in South Africa every year. And if you take an overdose (too much) of some drugs, it can be fatal.

Why do some people suffer from substance use disorder?

People suffer from substance use disorder for various, complicated reasons. In South Africa, alcohol and tobacco are freely available and many communities regard drinking and smoking as normal behaviour. Unemployment and poverty make people anxious, stressed and bored – and they turn to the short-term relief they experience when using a substance. Many young people feel hopeless, with no prospect of employment or little to do outside of school hours, and a culture of substance use develops.

Many who develop a substance use problem have low self-esteem, depression or another mental problem. Children who grow up seeing their parents using drugs may have a higher risk of developing substance use disorder later in life.

There are several stages of substance use leading to addiction. Young people seem to move more quickly through the stages. First, they experiment, with friends – then the need for the drug starts impacting their choices, until the need for another fix becomes the most important thing in their lives, and they are physically addicted.

How can we prevent it?

Of course, the best way to prevent substance use disorder is not to take a drug at all, and to follow instructions when you are prescribed medication for an illness.

Some argue that alcohol and tobacco are the ‘gateway’ to other drugs, and that government regulations around these substances should be increased. Others say that spazas and liquor outlets should make it more difficult for young people to obtain these substances, and that society should not make smoking and drinking seem glamourous.

How can we get help?

Treatment begins with recognising the problem. Someone who has substance use disorder is more likely to admit there is a problem if they are given empathy and respect, rather than confronted and told what to do.
Medication-assisted treatment (MAT) is the most effective. This involves the combination of the correct medications and behavioural counselling or therapy. Medication allows a patient to manage withdrawal symptoms such as sleeplessness, mood changes, depression, anxiety, pain and nausea. Behavioural interventions range from talking to a trained therapist about how to change the way you think and behave, to learning how to relax your body and mind and reduce stress.

If you have depression or another mental health disorder, it should be treated. In many cases, a person starts using drugs to try to self-treat mental illness.

SAHARA, an organisation that provides free care for people with substance use disorder, believe that treatment should be available at clinics throughout the country. They say that, although it’s hard for people to treat drug addicts with compassion when they commit crimes, people suffering from substance use disorder should not be seen as criminal or immoral.

Where can we get help?

If you’re not ready to approach a health care provider or mental health professional, help lines or hotlines may be a good place to learn about treatment.
• South African Depression & Anxiety Group (SADAG) – 0800 121 314 / 011 234 4837
SADAG also has a WhatsApp chat where you can get information and help.
• Kemoja WhatsApp Chat Platform – 087 163 2025
You can find out more about getting help at these websites:
• Drug and alcohol abuse hotlines
• Find a helpline
• getting free help
• SANCA national