Photo: Dr Amanda Saunders and Sibabalwe Goqwana , mental health counsellor, with a patient during enrollment consultation.
In our community, as in many others across South Africa, the misuse of alcohol and tobacco presents significant social, physical, and emotional challenges. These substances, while widely consumed, are often used as coping mechanisms for underlying issues such as trauma, stress, and economic hardship. Over the years, we have seen first-hand how the resulting harm from substance misuse affects individual lives and ripples out to impact families, relationships, and our broader community.
Given the pressing need for effective interventions, we are excited to announce the expansion of our Alcohol and Tobacco Harm Reduction Programme. This month, we have introduced a pharmacotherapy and group therapy component overseen by a medical doctor, Dr Amanda Saunders, and a licensed mental health counsellor, Sibabalwe Goqwana, to provide comprehensive support to those struggling with substance misuse in our community.
Substance misuse, particularly alcohol and tobacco, is a pervasive issue in our community. However, despite the clear need for intervention, there are no formal programmes available through public healthcare to assist individuals in overcoming addiction. Those who rely on public healthcare often face a lack of viable options for stopping substance use, even if they or their families are committed to making a change. Private programmes, where they exist, can be prohibitively expensive, leaving many without the support they need.
Recognising this gap, our expanded programme aims to provide accessible and effective treatment options tailored to the severity of substance use. By offering a combination of medical treatment and psychosocial support, we hope to make a lasting impact on individuals, their families, and our community.
Before launching this expanded programme, our Nomakhayas screened and identified 18 individuals who would benefit from focused alcohol harm reduction interventions. However, recognising the interconnected nature of alcohol and tobacco use, we broadened our scope to include both substances. The response has been overwhelmingly positive, with 57 participants enrolling voluntarily. This level of interest is encouraging, and we look forward to seeing how participants progress over the coming weeks.
Our Alcohol and Tobacco Harm Reduction Programme begins with a thorough assessment of each participant’s substance use. We use various tools, such as the ASSIST score and the AUDIT for alcohol, as well as the Fagerström Test for Nicotine Dependence, to classify the severity of use—ranging from low risk to harmful use and dependence. This classification helps us determine the most appropriate treatment and support for each individual.
- For Alcohol: Participants identified as having harmful use or alcohol dependence may qualify for pharmacological treatment. We use Naltrexone, an opioid antagonist that decreases the euphoria associated with alcohol consumption, thereby reducing the desire to drink. By diminishing the rewarding effects of alcohol, Naltrexone helps individuals cut down on their intake and avoid relapse.
- For Nicotine: For those with moderate nicotine dependence, we provide nicotine replacement therapy in the form of patches or gum, which can help manage cravings and gradually reduce use. For severe nicotine dependence, Bupropion is prescribed. This medication works by reducing withdrawal symptoms and cravings, making it easier for participants to quit smoking.
In addition to pharmacotherapy, our programme includes group therapy sessions and individual counselling. These sessions are designed to help participants explore the underlying reasons for their substance use, gain insight into their behaviours, and develop healthier coping mechanisms. The group therapy component strengthens a sense of community and mutual support, crucial for sustained recovery.
Programme Aims and Objectives
Our programme is designed to achieve several key aims and objectives:
Aims:
- Positive Impact on Individual Health: By reducing substance use, we aim to improve participants’ physical and mental health and enhance their overall quality of life.
- Positive Impact on Families: Reducing substance misuse can improve economic stability and healthier family dynamics, benefiting the individual and their loved ones.
- Positive Impact on Community Well-being: As individuals and families heal, the broader community will experience less violence, greater cohesion, and improved public health.
Objectives:
- Raise Awareness: We are working to increase awareness of the programme through communication with traditional leaders, direct outreach to individuals, and radio advertisements.
- Identify and Recruit Participants: We are actively identifying and recruiting individuals who can benefit from the programme to ensure that those in need receive the necessary support.
- Establish a Sustainable Programme: Our goal is to establish ongoing harm reduction medical treatment with a psychosocial support provision to harm reduction programme to provide a comprehensive and sustainable solution to substance misuse.
- Educate the Youth: We are committed to educating young people about the harms of substance misuse to aim to prevent future cases of addiction and the associated adverse outcomes.
As we expand this programme, we are aware that the definition of success may vary based on individual circumstances and community needs. Ideally, we hope to see harm reduction in all participants, but we recognise that each person’s journey is unique.
We will measure success by tracking the number of participants who remain engaged with the programme after 12 weeks and conducting follow-up assessments at six months using the initial screening tools. These evaluations will help us understand the long-term impact of our interventions and guide any necessary adjustments to our approach.
The expansion of our Alcohol and Tobacco Harm Reduction Programme marks a significant step forward in our efforts to address substance misuse in our community. By offering tailored treatment options and comprehensive support, we can enable individuals to make positive changes in their lives, ultimately benefiting their families and our community. We look forward to sharing more updates on our progress and the positive outcomes we hope to achieve together.