the causes of relapse amongst young african adults following in-patient treatment for drug abuse in

151 Pages·2015·3.26 MB·English

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by

ILZE SWANEPOEL

A mini-dissertation submitted in partial fulfilment of the requirements for the
degree

MASTER OF SOCIAL WORK (HEALTH CARE)

In the Department of Social Work and Criminology
at the
UNIVERSITY OF PRETORIA
FACULTY OF HUMANITIES

SUPERVISOR: DR LS GEYER

October 2014
DECLARATION OF ORIGINALITY

The Department of Social Work and Criminology places great emphasis upon integrity and ethical
conduct in the preparation of all written work submitted for academic evaluation.

While academic staff teach you about referencing techniques and how to avoid plagiarism, you too
have a responsibility in this regard. If you are at any stage uncertain as to what is required, you should
speak to your lecturer before any written work is submitted.

You are guilty of plagiarism if you copy something from another author‟s work (eg a book, an article or
a website) without acknowledging the source and pass it off as your own. In effect you are stealing
something that belongs to someone else. This is not only the case when you copy work word-for-word
(verbatim), but also when you submit someone else‟s work in a slightly altered form (paraphrase) or
use a line of argument without acknowledging it. You are not allowed to use work previously produced
by another student. You are also not allowed to let anybody copy your work with the intention of
passing if off as his/her work.

Students who commit plagiarism will not be given any credit for plagiarised work. The matter may also
be referred to the Disciplinary Committee (Students) for a ruling. Plagiarism is regarded as a serious
contravention of the University‟s rules and can lead to expulsion from the University.

The declaration which follows must accompany all written work submitted while you are a student of
the Department of Social Work and Criminology. No written work will be accepted unless the
declaration has been completed and attached.

Full names of student: ILZE SWANEPOEL

Student number: 26102766

Topic of work: The causes of relapse amongst young African adults following in-
patient treatment for drug abuse within the Gauteng Province

Declaration
1. I understand what plagiarism is and am aware of the University‟s policy in this regard.

2. I declare that this mini-dissertation (eg essay, report, project, assignment, dissertation,
thesis, etc) is my own original work. Where other people‟s work has been used (either from a
printed source, Internet or any other source), this has been properly acknowledged and
referenced in accordance with departmental requirements.

3. I have not used work previously produced by another student or any other person to hand in as
my own.

4. I have not allowed, and will not allow, anyone to copy my work with the intention of passing it
off as his or her own work.

SIGNATURE ...................................................................................................................................

DATE 31/10/2014
i
Acknowledgements
I would like to thank everyone that contributed to this study, with special thanks to:

 Firstly, I would like to express gratitude to my Heavenly Father for giving me the strength to
complete this research study.

 My supervisor, Dr LS Geyer, for his professional study guidance and mentorship throughout.

 Mrs. A Britz, my editor for her professionalism in editing this research report.

 My colleague and friend, Monique Marais, who started this journey with me and who never
allowed me to give up, her support is greatly appreciated.

 Mr A Masenga and Dr G Crafford for statistical consultation services provided during this
project.

 My parents, Flip and Marlene Swanepoel, for their love, patience, encouragement and mostly
believing in me. Especially thanking them for providing the means and support for completing
this study.

 My colleague, Adele Naudé, at Dr Fabian and Florence Ribeiro Treatment Centre for sharing
ideas.

 My friends for the on-going support and encouragement when it was needed the most.

 The treatment centres that allowed me to conduct my research at the centres – House of
Mercy, Horizon Clinic, Wedge Gardens and Dr Fabian and Florence Ribeiro Treatment Centre.

 Lastly, I would like to thank all the respondents for their participation in the research study.

“… but those who hope in the LORD will renew their strength.
They will soar on wings like eagles;
They will run and not grow weary;
They will walk and not be faint”
Isaiah 40:31

I SWANEPOEL
Pretoria, October 2014
ii
ABSTRACT
The causes of relapse amongst young African adults following in-patient treatment for drug
abuse in the Gauteng Province

RESEARCHER: Ms Ilze Swanepoel
SUPERVISOR: Dr LS Geyer
DEGREE: MSW (Health Care)
INSTITUTION: University of Pretoria

Drug abuse is not a new concept and there is no doubt that it is a public health problem as it has
reached epidemic proportions both nationally and internationally. With the increase in drug abuse,
treatment demands are also proven to be increasing. Even more so, the rate of re-admissions into
treatment centres following relapse after previous in-patient treatment for drug abuse, is also on the
increase. “Drug addiction is a chronic, relapsing disorder in which compulsive drug-taking behaviour
persists despite serious negative consequences” (Cami & Farrè, 2003:975). Relapse refers to the
return of drug use, after detoxification and in-patient treatment for at least six- to twelve weeks;
together with the marked return of behaviours associated with drug use. Relapse rates have been
found to be high both nationally and internationally. Considering South African statistics, in 2013, 22%
of admissions into treatment centres were re-admissions (SACENDU, 2014:15). The problem of
relapse is undoubtedly one of the most important challenges facing the field of addictions. In line with
literature, it has become apparent that young African adults are being re-admitted on a frequent basis
and the need for research amongst this target group was thus confirmed. The goal of this study was to
determine the causes of relapse amongst young African adults following in-patient treatment for drug
abuse in the Gauteng Province.

The theoretical frameworks that guided and informed this study was the adaptation model and the
eco-systems perspective. The importance of being able to adapt to the environment at all levels of
functioning (micro, meso and macro level) following in-patient treatment for drug abuse was regarded
as important in determining the causes of relapse amongst young African adults.

This study used a quantitative approach with a non-experimental research design. The implementation
of this study fell within the applied research category and was furthermore exploratory in nature. In this
study a survey was undertaken to collect quantitative data from the respondents. The replicated
randomised cross-sectional survey design was applicable as the survey was conducted with different
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samples randomly drawn from the population and was conducted with each sample. The study was
conducted by applying stratified random sampling in combination with purposive sampling in the
selection of respondents. The population was divided in terms of different strata, which included four
in-patient treatment centres within the Gauteng Province that was part of this study. Within each of the
strata, purposive sampling was employed to recruit prospective respondents. A total of 44
respondents took part in this study. All the respondents gave voluntary informed consent to partake in
the study and completed a group-administered questionnaire. The data were analysed by making use
of descriptive statistics, more specifically association statistics.

From the findings, the following causes of relapse amongst young African adults were identified: (1)
Environmental risk factors, which included availability and accessibility of drugs and environmental
cues; (2) interpersonal/ social risk factors including peer group influence, limited access to services in
the community, lack of recreational activities, stigmatisation by community members, lack of support
needed after treatment, conflict management, and difficulty finding employment; (3) intrapersonal risk
factors including emotions and dealing with emotions, loneliness, lack of effective coping mechanisms
and stress management, lack of assertiveness and easily influenced by others, cravings, losing
motivation and commitment towards maintaining abstinence, controlled drug use, and the decision not
to attend aftercare support services and (4) physical risk factors which included experiencing physical
pain.

The conclusions of this study reflect that young African adults‟ communities (environments) are not
conducive to recovery. This together with intrapersonal differences makes maintaining abstinence
difficult for the young African adult. Rehabilitation of people with drug abuse problems must therefore
be holistic and address both psychological developmental issues and environmental challenges as
experienced by the young African adult.

Recommendations from this study can be used by in-patient treatment centres to improve their
existing treatment programmes. By dividing service users in accordance to their gender and ages
(developmental phase) treatment can be more specific to include specific challenges faced by them. It
is recommended that a structured aftercare programme based on the causes of relapse amongst
young African adults be implemented. Professionals should be educated with regard to aftercare
services in an attempt to improve the utilisation and referral to such services. Future research that
can contribute to relapse prevention include exploring the ignorance and barriers to effective aftercare
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being rendered; the effect of including skills development in a treatment programme; and the factors
hindering efficient family support.

Keywords:
Substance abuse
Illicit drug abuse
Relapse
Young African adults
In-patient treatment
Gauteng Province

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TABLE OF CONTENTS
Page

Declaration of Originality i
Acknowledgements ii
Abstract iii

CHAPTER 1: GENERAL INTRODUCTION

1.1. INTRODUCTION AND CONTEXTUALISATION 1
1.2. THEORETICAL FRAMEWORK 2
1.2.1. Adaptation model 2
1.2.2. Eco-systems perspective 3
1.3. RATIONALE AND PROBLEM STATEMENT 4
1.4. GOAL AND OBJECTIVES OF THE RESEARCH STUDY 4
1.5. OVERVIEW OF RESEARCH METHODOLOGY 5
1.6. LIMITATIONS OF THE STUDY 9
1.7. DEFINITION OF KEY CONCEPTS 9
1.7.1. Substance abuse 9
1.7.2. Illicit drug abuse 10
1.7.3. Relapse 10
1.7.4. Young adults 10
1.7.5. African 10
1.7.6. In-patient treatment 10
1.8. CONTENTS OF THE RESEARCH REPORT 11

CHAPTER 2: CAUSES OF RELAPSE UNIQUE TO THE YOUNG AFRICAN ADULT

2.1. INTRODUCTION 12
2.2. OVERVIEW OF DRUG ABUSE AND RELAPSE IN SOUTH AFRICA 12
2.3. CONCEPTUALISING THE CAUSES OF RELAPSE 14
2.3.1. Environmental risk factors 15
2.3.1.1. Availability and accessibility of drugs 15
2.3.1.2. Other environmental cues 15
vi
2.3.2. Interpersonal/ Social risk factors 15
2.3.2.1. Peer group influence 15
2.3.2.2. Conflict 16
2.3.2.3. Employment status 16
2.3.3. Intrapersonal risk factors 17
2.3.3.1. Affect/ emotions 17
2.3.3.2. Coping skills 18
2.3.3.3. Cravings 18
2.3.3.4. Self-efficacy 18
2.3.3.5. Outcome expectancy 18
2.3.3.6. Motivation 19
2.3.3.7. Personality traits 19
2.3.3.8. Seemingly irrelevant decisions 19
2.3.4. Physical risk factors 20
2.3.4.1. Physical dependence 20
2.3.4.2. Withdrawal 20
2.3.4.3. Negative physical state 20
2.4. CHARACTERISTICS OF YOUNG AFRICAN ADULTS 21
2.4.1. Characteristic related to developmental transition 21
2.4.1.1. Social role changes 22
2.4.1.2. Adolescent initiation 23
2.4.1.3. Employment 23
2.4.1.4. Change in social groups 25
2.4.2. Position of the young African adult within society and socio-economic status 25
2.5. RELAPSE PREVENTION MODELS 27
2.5.1. Cognitive-Behavioural Model (The Relapse Prevention Model) 27
2.5.2. Cenaps Model 31
2.6. TASKS OF SOCIAL WORKER(S) IN RELAPSE PREVENTION 33
2.6.1. Provisions and mandate with regard to aftercare 34
2.6.1.1. The Prevention of and Treatment for Substance Abuse Act 70 of 2008 34
2.6.1.2. The National Drug Master Plan 2006-2011 35
2.6.2. Application of theoretical models 36
2.6.2.1. Adaptation model 36
2.6.2.2. Eco-systems perspective 37
vii
2.7. SUMMARY 39

CHAPTER 3: RESEARCH METHODOLOGY, EMPIRICAL FINDINGS AND INTERPRETATION

3.1. INTRODUCTION 41
3.2. RESEARCH APPROACH 41
3.3. TYPE OF RESEARCH 42
3.4. RESEARCH DESIGN 42
3.5. DATA COLLECTION INSTRUMENT 42
3.6. RELIABILITY AND VALIDITY IN QUANTITATIVE RESEARCH 44
3.6.1. Reliability 44
3.6.2. Validity 44
3.7. DATA ANALYSIS 45
3.8. RESEARCH POPULATION AND SAMPLING 46
3.9. PILOT STUDY 47
3.10. ETHICAL CONSIDERATIONS 48
3.10.1. Avoidance of harm 48
3.10.2. Voluntary participation 49
3.10.3. Informed consent 49
3.10.4. Deception of respondents 49
3.10.5. Violation of privacy/ confidentiality 49
3.10.6. Debriefing of respondents 50
3.10.7. Publications of findings 50
3.11. BIOGRAPHIC PROFILE OF RESPONDENTS 51
3.11.1. Gender 51
3.11.2. Age 52
3.11.3. Level of education 52
3.11.4. Employment status 53
3.11.5. Income per month 55
3.11.6. Source of income 55
3.11.7. Marital status 56
3.11.8. Number of occupants in household 56
3.12. DRUG OF CHOICE 57
3.13. PERCEPTIONS, VIEWS AND EXPERIENCES RELATED TO DRUG ABUSE 59
viii
3.13.1. Age of experimentation with drugs 59
3.13.2. Reasons for drug experimentation 60
3.13.3. Period between drug experimentation and dependency 61
3.13.4. Substance abuse in the family 61
3.14. PERCEPTIONS, VIEWS AND EXPERIENCES REGARDING DRUG ABUSE
TREATMENT 62
3.14.1. Previous drug abuse treatment 62
3.14.2. Completion of previous treatment for drug abuse 64
3.14.3. Length of previous treatment for drug abuse 65
3.14.4. Aftercare support services 65
3.15. PERCEPTIONS, VIEWS AND EXPERIENCES RELATED TO RELAPSE 68
3.15.1. Causes of relapse amongst genders 68
3.15.2. Personal accounts of relapse 70
3.15.3. Significant causes of relapse 71
3.15.3.1. Environmental risk factors 72
3.15.3.2. Interpersonal/ Social risk factors 73
3.15.3.3. Intrapersonal risk factors 78
3.15.3.4. Physical risk factors 85
3.16. CAUSES OF RELAPSE AMONGST DIFFERENT AGE GROUPS 86
3.16.1. Emerging adulthood (18 to 24 years) 89
3.16.2. Young adulthood (25 to 38 years) 91
3.17. CONFIDENCE IN MAINTAINING ABSTINENCE AFTER TREATMENT 92
3.18. SUMMARY 95

CHAPTER 4: CONCLUSIONS AND RECOMMENDATIONS

4.1. INTRODUCTION 96
4.2. RESEARCH GOAL AND OBJECTIVES 96
4.3. KEY FINDINGS 99
4.4. CONCLUSIONS 102
4.5. RECOMMENDATIONS 103
4.5.1. Recommendations for treatment centres to improve service delivery to young
African adults 104
4.5.2. Recommendations for aftercare (and reintegration) support services 106
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