The Scourge of Drugs and Alcohol Addiction in South Africa

"All sins tend to be addictive, and the terminal point of addiction is damnation"
W.H. Auden

FACTS ABOUT DRUGS

The more you know about how drugs work and the effect they can have on your body and mind, the more you will be able to protect yourself against them.

FACT 1: Different Drugs cause Different feelings and physical responses

Caffeine, alcohol, dagga, heroin, ecstasy, mandrax and cocaine are all drugs but they have little else in common. Whereas caffeine and alcohol are legal drugs, drugs such as dagga, heroin, ecstasy, mandrax, and cocaine are illegal. Further, you could experience a very pleasant response to one drug, yet another drug could have a very frightening response – it could even kill you.

Drugs such as dagga and heroin are derived from plants. Others drugs such as ecstasy and mandrax are and man-made. Pure drugs are far more expensive than drugs mixed or “cut” with less expensive substances. Like any business the illicit drug industry is profit-driven. Therefore drug dealers use a variety of substances to cut drugs. Some of these substances may be more harmful than the drug itself. The drug you are offered tomorrow may look the same as the drug you were offered yesterday, but you can never be sure of what it contains. The only way to be sure that you don’t ingest it is to avoid taking drugs!

Drugs can be swallowed (pills), smoked, inhaled or injected. You can never anticipate the effect that drugs will have on you. It is a mistake to think that experience increases your tolerance levels or that nothing will happen to you if you take a drug that you have used before. It is a well-known fact that seasoned drug addicts often die of overdoses. 

Drug addiction seduces you into wanting more and different and stronger drugs, against your will and the natural tolerance of your body. No matter how good you may feel when using drugs, your body suffers. Drugs are dangerous. If you take drugs, you are at great risk of becoming addicted.

 

Uppers (cocaine, ecstasy, speed, crack-cocaine) 

Uppers are designed to make you feel great. You make you feel alive, dynamic, and energized. Depending on your personal response to the drug, you could, however, also feel anxious, nervous and paranoid. You could even die. Uppers put a terrible strain on the heart. Long-term use destroys your nerves, takes away your appetite and causes sleeplessness. You will end up taking a downer as your body suffers withdrawal symptoms when the drug wears off. You will feel depressed and, sometimes, suicidal.

 

Downer (alcohol, dagga, heroin, mandrax) 

Downers make you feel relaxed or laid back. Unfortunately, you cannot control just how relaxed you will be. Long-term use of downers causes lethargy and makes it harder for you to do the things you need to do as a functional member of society. Schoolchildren and students who use these drugs find it hard study or complete assignments, and relationships inevitably suffer. Too much of a powerful downer like heroin causes the systems of the body to shut down, eventually leading to death.

 

Hullucinogens (LSD, mescaline)

These drugs cause powerful hallucinations or dreams in which your reality is changed. You cannot predict whether the dream will be enjoyable or be a hideous nightmare. A “bad trip” can haunt you for the rest of your life, with flashbacks occurring at any time. 

 

FACT 2: Different People respond differently to the same drugs

Drugs cause different reactions in different people. Never take a drug based on someone else’s reported experience of using that drug. Never persuade someone else to take a drug based on your own experience of using it. 

FACT 3: The more drugs you take, the more you need

The first time you take a drug, you will probably experience and exhilarating high. As your body gets used to the drug, you will need more and more of it to experience the same intense reaction. This increasing tolerance to a drug is actually a growing addiction. Addiction comes with a big price tag. The more drugs you want, the more money you need to “feed the habit”. Drugs are expensive and their effect on you makes it unlikely that you will be able to earn enough money to afford them. Some drug addicts turn to crime and other high-risk behaviour. Many are arrested and go to prison. Others turn to prostitution and live tragic and tainted lives, almost inevitably die young.

Some people take drugs for a while and then manage to escape before they become addicts or before irreparable harm is done. Do not rely on being one of those people – being strong is not enough to withstand the horrors of drug addiction. It is not weak people who become drug addicts, its drug addicts who become weak people. No addict takes that first drug believing that he or she will be addicted. All addicts start out believing that they could give up drugs any time they wanted to. Every addict is sad proof of how wrong that belief is.

 

FACT 4: Life is Tough Enough - Drugs only make it Tougher

When you feel that you cannot cope with life’s challenges, you may feel tempted to take a drug to make you feel vibrant and confident, or to change your sense of reality – even if only for a short while. Instant gratification, a sense of peace, a wonderful trip, or a feeling of power – all these things you are promised by those who offer you drugs. Such persons often describe the effects of drugs in glowing terms.

But they do not tell you:

·         that you cannot control your response to a drug;

·         what a drug contains;

·         the more you like a drug, the more you will want it and that you will eventually become addicted; 

·         when the drug wears off, reality will still be there with all the problems from which you were trying to escape;

·         uppers make you need downers and a combination of the two can kill you; and

·         drugs let you lose control, which, in turn, makes you -

o    lose the ability to do certain things (for instance, to drive your car); and

o    more vulnerable to sexual or physical assault.

However tempting it may be, using drugs to take a break from reality will not make your problems disappear or make life better. If you feel that things are spiralling out of control and you are overwhelmed by problems, seek real help from someone who cares. People who try to sell you drugs are not interested in your well-being. 

FACTS ABOUT ALCOHOL

Effects of acute alcohol intoxication in South Africa

• Alcohol misuse is causally implicated in a range of chronic health problems (e.g. cirrhosis of the liver). However, many of the primary effects of alcohol misuse occur from episodes of acute alcohol intoxication.
• Acute alcohol intoxication is associated with increased mortality and morbidity arising from intentional and non-intentional injuries.
• Acute alcohol intoxication is also associated with unsafe sexual practices and increased risk of contracting a sexually transmitted disease.
• Alcohol misuse, combined with poor nutritional status, increases susceptibility to opportunistic diseases by compromising the immune system.
• The misuse of alcohol during pregnancy has been linked to fetal alcohol syndrome in infants.
• Alcohol misuse also impacts on the criminal justice system, with evidence of associations between drinking at risky levels, committing crime, or being a victim of crime.
• Alcohol slows down your reaction time. 
• Alcohol distorts your vision.
• Alcohol gives you false courage.  
• A cold shower or cup of coffee won’t sober you up.
• Don’t party the night before you drive.
• Fatigue combined with a hangover makes you an unsafe driver!
• Do not use alcohol to deal with stress, depression or loneliness.
• Don’t feel ashamed to ask for help if you think you may have a drinking problem.
• Don’t be influenced by friends – say no to “one for the road”

Answer the following questions honestly to determine whether you may have a drinking problem:

• Have you ever tried to stop drinking for a week or two but could only manage for a few days without having a drink? 
• Do you get angry when others tell you that you drink too much and that you should cut down?
• Has alcohol abuse affected your relationships with your family, friends and fellow workers?
• During the past year, have you missed days of work because of your use of alcohol?
• Do you sometimes go on drinking sprees or alcohol binges?
• Do you sometimes struggle to remember things that happened while you under the influence of alcohol like where you were, who you were talking to and what you were saying?

Every year, more money is spent promoting the use of alcohol than any other product. Perhaps through its elaborate and creative marketing, the most basic, yet important fact about alcohol is often overlooked — alcohol is a drug — the most commonly used and widely abused psychoactive drug in the world.

One concept that many people find difficult to accept is that alcoholism and alcohol problems are a disease. Research has shown that alcohol interacts with the body’s systems in predictable ways to lead to physiological addiction.

Alcoholism is a disease — a chronic, progressive, fatal disease if not treated.

Short Term Effects
Even at low doses, alcohol significantly impairs the judgment and coordination required to drive a car or operate machinery safely. Low to moderate doses of alcohol can also increase the incidence of a variety of aggressive acts, including domestic violence and child abuse.

Effects of moderate alcohol intake include dizziness and talkativeness. The immediate effects of a larger amount of alcohol include slurred speech, disturbed sleep, nausea, and vomiting. “Hangovers” are another effect after large amounts of alcohol are consumed — symptoms including headache, nausea, thirst, dizziness, and fatigue.

Long Term Effects
Prolonged, heavy use of alcohol can lead to addiction (alcoholism). Sudden cessation of long term, extensive alcohol intake is likely to produce withdrawal symptoms, including severe anxiety, tremors, hallucinations, and convulsions.

Long-term effects of consuming large quantities of alcohol can lead to:
      • permanent damage to vital organs
      • several different types of cancer
      • gastrointestinal irritations, such as nausea, diarrhea, and ulcers 
      • malnutrition and nutritional deficiencies
      • sexual dysfunctions
      • high blood pressure
      • lowered resistance to disease

Mothers who drink alcohol during pregnancy may give birth to infants with fetal alcohol syndrome. These infants may suffer from mental retardation and other irreversible physical abnormalities. In addition, research indicates that children of alcoholic parents are at greater risk than other children of becoming alcoholics.

Below are a few statistics that highlight the particular burden experienced by South Africa from alcohol abuse:

• Mortuary statistics (2002) – MRC/UNISA
  In Cape Town, Durban, Gauteng, and Port Elizabeth (PE), 45% of all non-natural deaths had blood alcohol concentrations (BACs) greater than or equal to 0.05g/100ml (Durban: 37%, Gauteng: 40%, Cape Town 53%, PE: 61%). The national figure was 46%. Levels of alcohol were particularly high for transport-related deaths and homicides, with 63% of transport-related deaths and 69% of homicides in PE, for example, having levels above the legal limit for driving (0.05g/100ml).

• Trauma unit statistics (2001) – MRC
  In Cape Town, Durban and PE, 39% of trauma patients had breath alcohol concentrations (BrACs) greater than or equal to 0.05g/100ml (Durban: 22%, Cape Town 36%, PE: 57%). Levels of alcohol were particularly high for transport- and violence-related injuries with, for example, 73% of patients with violence-related injuries in PE and 46% of patients with transport-related injuries in Cape Town having levels above the legal limit for driving (0.05g/100ml).

• Demand for specialist treatment services (2003) – MRC
  Of 5886 persons treated at 52 specialist substance abuse treatment centres in Cape Town, Durban, Gauteng, Mpumalanga, and PE in the first half of 2003, 52% reported having alcohol as their primary drug of abuse, with a further 13% having alcohol as a secondary drug of abuse.

• Fetal alcohol syndrome – FARR/Wits (1997-2003)
  In research conducted in the Western Cape (Wellington), the prevalence of FAS among Grade 1 learners was found to be 46 per 1000 in 1997 and 75 per 1000 in 1999. Similar research conducted in Gauteng and De Aar in 2001, and Upington in 2003 found FAS prevalence rates of 19, 103 and 75 (estimate) per 1000 respectively.

• Alcohol and risky sex (2003) - MRC
  Research conducted in Atteridgeville among persons aged 25-44 years found a significant positive association between various measures of alcohol use (past month use, frequency and problem use) and having multiple sexual partners or sexual relations that are regretted in the past 3 months. For example, the correlation between quantity of alcohol consumed and the number of sexual partners (lifetime) was 0.436 (p<0 .001="" span="">

• Alcohol and family violence (2000) – MRC
  Between one-third to a half of arrestees in Cape Town, Durban, and Johannesburg charged with offences categorised as “family violence” reported being under the influence of alcohol at the time of the alleged offence.

• Academic failure and absenteeism (1997) – MRC/UCT
  Among grade 8 and 11 learners in Cape Town a significant association was found between past month use of alcohol and the number of days absent from school and repeating a grade. For example, the odds of repeating a grade at school was found to be 60% higher for learners who consumed alcohol.

STRATEGIES TO ADDRESS ALCOHOL ABUSE IN SOUTH AFRICA

Based on international experience (e.g. Babor et al. 2003) the following strategies to address alcohol abuse are likely to be most effective:

• Regulating physical availability
  Implementing a coherent and enforceable policy regarding liquor outlets, with:
• Effective restrictions or controls on access (limits on days and hours of business and addressing public drunkenness; restrictions on (i) sale of alcohol to drunk persons, (ii) the supply of liquor to employees, (iii) the sale/supply of harmful alcohol or packaging, and (iv) restrictions on outlet locations (especially at/near educational institutions, petrol stations, residences, multi-dwelling housing units, places of worship); regulating the types of liquor sold in supermarkets and grocery and convenience stores; preventing the purchasing by minors or supply to minors; regulating the use of alcohol in motor vehicles; and prohibiting the sale of alcohol through vending machines).
• Adequate education and training of the public at large and persons who own or manage liquor outlets or who serve alcohol.
• Strengthening community input in the process of allocating liquor licenses and dealing with complaints, requiring stricter regulations on those liquor outlets in residential areas not in business nodes or along corridors, implementing a programme for encouraging existing unlicensed outlets to become licenced and to move to business nodes or corridors.
• Ensuring improved enforcement and handling of complaints.
• Providing increased access to information and improved accountability.

• Increasing levels of taxation on different alcohol products towards to international levels
• In particular, malt beer should be raised to the international average total tax burden of 37 per cent and commercial sorghum beer and sorghum powder should be increased to approximately 50 per cent of that of malt beer (as a percentage of retail sales price).

• Implement more effective drink-driving counter-measures
• Random-breath testing of drivers (both professional and ordinary drivers) needs to be increased as a matter of urgency.
• Allowance should also be made for automatic administrative license suspension in cases where drivers are caught with alcohol levels above the allowable limits (0.05 g/100 ml for ordinary drivers and 0.02g/100 ml for professional drivers).
• Implement a policy of graduated licenses for novice drivers, whereby persons who receive a driver’s license for the first time are not allowed any alcohol in their systems while driving for a period of 3 years.
• Allow traffic police to test alcohol levels of pedestrians.

• Implement brief interventions for high-risk drinkers
• Such interventions typically consist of one to two sessions of counseling and education. The intention is to motivate high-risk drinkers to moderate their alcohol consumptions. This is generally done in primary care settings.

• Implement effective treatment programmes for drinkers dependent on alcohol
• Treatment for alcohol dependence can occur in an outpatient or an inpatient setting
• Three models of treatment have been shown to be effective in treating alcohol dependence: Twelve Step Facilitation (based on the Minnesota model and AA principles); Motivational Enhancement Therapy (also known as Motivational Interviewing); and Cognitive Behavioural approaches that include relapse prevention training.
• After treatment, treatment gains tend to be better maintained if the person becomes actively involved in AA or other recovery support groups and develops family and peer relationships that are supportive of recovery.

In addition, serious consideration should be given to bring labeling on alcohol containers up to the standard of other products. Labels should include:

Alcohol content and standard servings ( list (i) the number of standard drinks per container and the amount of alcohol in a standard serving, and (ii) the South African Food Based Dietary Guidelines on sensible drinking alcohol: no more than two standard drinks per day for women or three drinks per day for men).

Calorie information and ingredients. Labels should list calories per serving so consumers concerned about excess weight could put alcoholic beverages in the context of their diet, and labels should list ingredients so that consumers can compare beverages in terms of food allergies.

ALCOHOL IMPAIRMENT CHARTS

Despite the tireless efforts of thousands of advocates, impaired drivers continue to kill someone every 30 minutes, nearly 50 people a day, and almost 18,000 citizens a year. Remember — impairment begins with the first drink.

Alcohol affects individuals differently. Your blood alcohol level is affected by your age, weight, gender, time of day, physical condition, prior amount of food consumed, other drugs or medication taken, and a multitude of other factors. In addition, different drinks may contain different amounts of alcohol, so it’s important to know how much and the concentration of alcohol you consume.

The body metabolizes alcohol at the rate of about one drink per hour. Does drinking strong coffee or taking a cold shower have an effect on the person who is drunk? The answer is yes — the result being an alert, cold, and wet drunk. Time, and only time can sober a person up.

 A woman of equivalent weight drinking an equal amount of alcohol in the same time period of time as a man may have a higher blood alcohol concentration than that man. Therefore, women should refer to the BAC chart for women below.

The blood alcohol limit for driver is 0.02 % - one beer puts you over the limit!

Blood Alcohol Concentration Estimate for Men

DrinksA	Body Weight In Pounds								InfluenceB
	100	120	140	160	180	200	220	240
1	.04	.03	.02	.02	.02	.02	.02	.02	Possibly
2	.08	.06	.05	.05	.04	.04	.03	.03
3	.11	.09	.08	.07	.06	.06	.05	.05	Impaired
4	.15	.12	.11	.09	.08	.08	.07	.06
5	.19	.16	.13	.12	.11	.09	.09	.09	DUI
6	.23	.19	.16	.14	.13	.11	.10	.09
7	.26	.22	.19	.16	.15	.13	.12	.11
8	.30	.25	.21	.19	.17	.15	.14	.13
9	.34	.28	.24	.21	.19	.17	.15	.14
10	.38	.31	.27	.23	.21	.19	.17	.16
A One drink is 1.25 oz. of 80 proof liquor, 12 oz. beer, or 5 oz. of wine B Subtract .01 for each hour of drinking

Blood Alcohol Concentration Estimate for Women

DrinksA	Body Weight In Pounds								InfluenceB
	90	100	120	140	160	180	200	220
1	.05	.05	.04	.03	.03	.03	.02	.02	Possibly
2	.10	.09	.08	.07	.06	.05	.05	.04
3	.15	.14	.11	.10	.09	.08	.07	.06	Impaired
4	.20	.18	.15	.13	.11	.10	.09	.08
5	.25	.23	.19	.16	.14	.13	.11	.10	DUI
6	.30	.27	.23	.19	.17	.15	.14	.12
7	.35	.32	.27	.23	.20	.18	.16	.14
8	.40	.36	.30	.26	.23	.20	.18	.17
9	.45	.41	.34	.29	.26	.23	.20	.19
10	.51	.45	.38	.32	.28	.25	.23	.21
A One drink is 1.25 oz. of 80 proof liquor, 12 oz. beer, or 5 oz. of wine B Subtract .01 for each hour of drinking

ISSUES TO CONSIDER IN OUR PROGRAMMING

• Is there exaggerated advertising of alcohol during programming?
• Do we show alcohol and drugs in a fun way?
• When children are watching
• Are we informing and educating the public on the dangers of alcohol and drugs
• Are we inspiring and encouraging young people to partake in fun, safe and healthy activities as opposed to drinking and drugging??
• What sort of role models and mentors are on our screens?