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

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.

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

“…The recall period of 30 days was selected based on previous substance use evaluations in the region. 57–60 The recall period was also piloted for acceptability.…”

Intersecting motivations for leaving abusive relationships, substance abuse, and transactional sex among HIV high-risk women

“…Prior studies evaluating motivators reasons for leaving abusive relationships, substance abuse, and transactional sex independently have noted similar findings. For example, studies evaluating triggers for leaving abuse have identified ‘inability to endure the violence anymore’ as a key factor in leaving; for transactional sex, ‘deep hatred for the profession,’ ‘being tired of sex work,’ and ‘feeling disgraced by the nature of the work itself’ have been described (Manopaiboon et al 2003; Haj-Yahia and Eldar-Avidan, 2001); and for substance abuse, not wanting ‘lives of addiction,’ perceiving self as ‘being dirt,’ and ‘wanting a better future’ (Meade et al 2015; Sobell et al 2001). …”

HIV Risk Behavior Among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

“…Our results suggest that offering HIV testing as part of substance abuse treatment may be an effective strategy for increasing uptake of HIV testing, and it was encouraging that participants overwhelmingly had positive attitudes toward HIV testing. However, the vast majority of methamphetamine users in South Africa do not seek substance abuse treatment services (20), and attitudes toward HIV testing in community-based samples have been less favorable (47). On a positive note, participants who were sexually active and engaged in risky sexual behaviors were more likely to have been HIV tested in the past year, suggesting that the riskiest sub-group is receiving regular testing.…”

“…In this region, methamphetamine is generally smoked, which carries a high risk of dependence (16, 17). The number of methamphetamine users in the Western Cape has increased rapidly since 2000 (18, 19), and a recent community-based study of methamphetamine users found a very high prevalence of dependence on the drug (20). Among persons entering substance abuse treatment, the proportion reporting methamphetamine as their primary drug increased from 0.3% in 2002 to 42.3% in 2006; since then, methamphetamine has accounted for 40-50% of admissions (21, 22).…”