Alcohol and Drug Abuse Research Unit

Report to Parliament 2005: Alcohol and Drug Abuse Research Unit

Outline of Research Activities
Over the past year scientists in the Alcohol & Drug Abuse Research Unit have monitored trends in the use of alcohol and other drugs and associated health/social consequences in various sentinel sites in South and Southern Africa (SACENDU and SENDU projects respectively). The SACENDU project is funded by the National Department of Health and the SENDU project by the European Union (via SADC). 2004 also saw staff undertaking a study funded by the UN Office on Drugs & Crime (UNODC) to estimate the number of heroin users in Cape Town and to assess the health and social consequences of heroin use.

In terms of research on substance use risk behaviour, we have continued to analyse data from research conducted in Gauteng between 2002 and 2004 on alcohol, tobacco and drug use among adolescents (funded by the US National Institutes of Health) and on the link between alcohol use and risky sexual behaviour among adult 'risky drinkers' (funded by WHO).

During 2004 an audit of specialist substance abuse treatment facilities in Gauteng was completed as was a national study to evaluate substance abuse treatment facilities funded by UNODC. Staff continue to be actively involved in evaluating the HIV and Alcohol Prevention in South African Schools (HAPS) project, a collaborative initiative involving the HSRC, the University of Kentucky, and the MRC (funded by the US National Institute on Alcohol Abuse and Alcoholism).

Major breakthroughs and successes
During 2004 the SACENDU project was expanded from five sites ( Cape Town, Durban, Gauteng, Mpumalanga, and Port Elizabeth) to also include East London and the regional initiative (SENDU project) was expanded to Luanda ( Angola) and Kinshasa (DRC) following technical support visits. Steps were also undertaken to expand surveillance in Tanzania beyond the two existing sites in Dar es Salaam and Zanzibar. The main sources of data used include specialist and non-specialist drug treatment facilities (now numbering over 100 in 12 countries), non-governmental organizations, and law enforcement agencies. At the 6 th regional report back meeting of the SENDU project held in November 2004, data were reported for the first time on 12 countries. In comparison with 2003, the region saw an increase in the demand for treatment for cocaine-, heroin- and methamphetamine-related problems and an increase in police seizures of heroin. In the 2004 UN World Drug Report (released in 2005) South Africa was singled out as the African country having the most systematic means of collecting data on drug abuse, largely due to the work of the SACENDU project. The findings of both the SACENDU and SENDU projects were extensively referred to in this report.

The unit was also at the forefront of efforts to highlight the increasing use of and burden of harm from methamphetamine ('tik') in Cape Town, and in the third quarter of 2004 released a Fact Sheet on methamphetamine use and promising intervention strategies. Among other things the unit noted that the number of patients at specialist drug treatment centres in Cape Town having methamphetamine as a primary or secondary drug of abuse increased from 121 to 429 between the second half of 2003 and the first half of 2004. Almost 6 out of 10 patients in treatment for methamphetamine-related problems were younger than 20 years and over 40% of these patients took methamphetamine daily. To alert health professionals an editorial was written for the South African Medical Journal (published in December 2004) and a further article is due to come out in SA Family Practice during 2005.

Preliminary data from the HAPS Project (see above) has shown that developing and delivering culturally relevant classroom interventions can attract and hold students attention, can increase the salience of HIV-related knowledge, and can lead to positive changes in HIV- and alcohol-related risk behaviors. In addition, this project found that the combined use of peer leaders and participatory methodologies is an effective means of communicating health promotion and risk reduction messages.

Capacity development achievement/research strengthening/collaboration
One of the major capacity development activities of the unit has been the provision of technical support to SADC countries to establish and expand alcohol and drug surveillance activities. This has been ongoing since 2000 and has included technical support visits to 13 countries and the provision of training at the six monthly regional report back meetings.

Mavis Moshia undertook a research training visit to New York University for three and a half months in 2004. She attended lectures in the Departments of Applied Psychology and Biostatistics, and received experiential training on tobacco and other substance use research training within the Department of Psychiatry. Her training visit was funded through a grant received from the Fogarty International Center (NIH) and the Centers for Disease Control and Prevention.

In collaboration with Zohn Rosen (a research director within the Department of Psychiatry at New York University School of Medicine), Dr Neo Morojele undertook training visits to the Universities of Venda, the North and the Witwatersand. They provided lectures to staff members and post-graduate students on research methods and advanced statistical techniques in substance use research.

Bronwyn Myers received training in the Addiction Severity Index (ASI) and Matrix Model of Outpatient Treatment for Substance Use Disorders at the Neuropsychiatric Institute, University of California, Los Angeles and at the Matrix Institute, Los Angeles. This training was funded by the Friends Research Institute, based in the USA.

During 2004/5 scientists in the unit had over one hundred radio, TV and print media contacts.

In 2004 staff in the unit initiated and ran a module for 4 th year students in psychology at Stellenbosch University on "Alcohol abuse in South Africa". The purpose of this course was to get students to critically reflect on this burden and what can be done at various levels to decrease the burden caused by the misuse of alcohol. It drew on the findings of MRC research on the topic and focused on the contribution that can be made by psychologists.

Impact of research outputs
In collaboration with the Institute for Security Studies and based on data from the SACENDU study (referred to above), the 3 Metros Study on Drugs and Crime, an analysis of police dockets in Gauteng and fieldwork on the links between drugs and sex work and drug markets, a pocket-sized handbook ("South African Drug Enforcement Handbook") was launched in Pretoria in March 2005. The handbook has been designed to assist law enforcement officials in identifying street drugs, the people that use them and the people that sell them. The purpose of this initiative, funded by the US National Institute of Justice, is to make the findings of earlier research which had been published in various reports and four journal articles (in Acta Criminologica; American Journal of Drug & Alcohol Abuse; Criminal Justice; and Drugs, Education, Prevention & Policy) more useable and accessible to law enforcement practitioners.

Research conducted by the unit was also directly fed into various policy initiatives in 2004/5 including the revision of South Africa's national drug master plan, an initiative of the Department of Health to regulate the placement of warning labels on alcohol containers, and the preparation of a Discussion Paper on cannabis by the Central Drug Authority.

Preliminary findings from the HAPS project provide evidence that a skills-based HIV and Alcohol Prevention project is more effective in changing HIV-related attitudes, intentions and behaviours than the provision of HIV-related knowledge alone. This may impact on the provision of future schools-based prevention campaigns.

Findings from an evaluation of substance abuse treatment facilities funded by the UN Office on Drugs and Crime may inform policies and practices regarding substance abuse treatment service delivery in South Africa. For example, in order to address the relative inaccessibility of substance abuse treatment services to young, impoverished, Black South Africans, this study recommended that (i) treatment facilities revise their admission criteria to ensure that services are accessible to Black clients; (ii) facilities lobby for more state-funded treatment staff (especially African-language speaking therapists) and increases in state funding for treatment-related services so that more indigent clients can be treated; (iii) facilities develop an adolescent-oriented treatment stream that includes an evidence-based treatment model for adolescents, involves the family in treatment, addresses adolescents' developmental needs, and is delivered by staff qualified to work with adolescents; (iv) research that examines the need for treatment by underserved population groups and the barriers that prevent untreated substance users from accessing treatment is conducted; and (v) interventions that target these barriers to treatment entry are designed, implemented and evaluated.

Other
Staff serve on the boards of various organizations (including the South African Central Drug Authority, the Cape Town Drug Counselling Centre, SANCA ( Western Cape), and the Western Cape Drug Forum) and on the Editorial (Advisory) Boards of various journals (African Journal of Drug & Alcohol Studies, Addiction, and the Journal of Substance Use).

Dr Neo Morojele, Deputy Director of the unit was a finalist in Category J: "Young Black Researcher in the Past 2-5 years" for a NSTF Science & Technology Forum Award in 2004 and Prof Charles Parry was presented with a Merit Award by the South African National Council on Alcoholism & Drug Dependence in 2005. Dr Neo Morojele was also an invited plenary speaker at the 31 st Annual Conference of the Global Health Council in Washington, DC.

Professor Parry continued to serve on the Alcohol Policy Strategy Advisory Committee of the World Health Organization (WHO) and also attended a WHO sponsored technical meeting on regulatory approaches to alcohol marketing and young people in Washington DC, in November 2004.

Summary of selected outputs/outcomes

Name of unit : Alcohol & Drug Abuse Research Unit