Substance Abuse research & 2011 Summit Resolutions: briefing by Central Drug Authority & Department of Social Development

Social Development

07 November 2011
Chairperson: Ms Y Botha (ANC)
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Meeting Summary

The Central Drug Authority briefed the Committee on substance use and abuse in South Africa. The presentation focused on a survey carried out together with the Department of Social Development. The aim of this study was to survey community members’ knowledge of substance use and abuse, identify the types of drugs used in communities, and establish awareness of substance abuse prevention and treatment services in their communities. One of the key findings of the study was that only 40% of those surveyed knew that there were services available to help with substance abuse, meaning that 60% were unaware. The Central Drug Authority provided a three-pronged solution to drug and alcohol use: demand reduction, supply reduction, and harm reduction.

The Central Drug Authority analyzed the drug and alcohol problem in South Africa. For most major drugs, South Africa was well above the average usage worldwide. Drugs were a problem area for vulnerable groups such as children and women. The rate of child drug use had been increasing and should be addressed. The way that women's substance abuse was treated should take into consideration factors that affect women specifically.

Alcoholism was also a major focus of the presentation and showed that there were currently 1.97 million problem drinkers in South Africa. The approximate cost to the country for alcoholism was R78 billion per year.

The Department of Social Development emphasized that legal substances that were abused were a particular problem and one need a mechanism to make these substances illegal.

The Committee questioned the Central Drug Authority about methods and models that could be implemented to target alcohol and drug use. The Committee were particularly interested in the current status of treatment centres across South Africa and what could be done to make treatment more accessible for those that did not have the financial resources. The issue of parenting was also addressed. The Committee expressed concern about the Central Drug Authority's inclusion of harm reduction as a key component of the solution, expressing that the solution should be more preventative and not reactive.

The Department of Social Development spoke about the 2nd Biennial Anti Substance Abuse Summit. It highlighted the need for government to take an active role in addressing “the problems with alcohol advertising” and increasing education about substance abuse and alcohol across the country.

The Committee again focused on the need for more treatment centres. There needed to be a common treatment centre model that all centres adhered to. The Committee stressed that partnerships should be created with other departments and civil society.

Meeting report

The Chairperson welcomed the Director General from the Department of Social Development (DSD) and the Acting Chairperson from the Central Drug Authority (CDA). The items on the agenda included a briefing on substance use and abuse in South Africa and a report on the 2nd Biennial Anti-Substance Abuse Summit. The Committee needed to look at the new substances that were on the market and threats associated with these substances.

Mr Vusi Madonsela Director General for the Department of Social Development thanked the Committee and introduced the CDA who would lead the main presentation. The DSD and CDA were ready to speak about the Anti-Abuse Summit that took place in March.

Presentation on Substance Use and Abuse in South Africa by the Central Drug Authority

Mr Ron Eberlein, Acting Chairperson for the Central Drug Authority, said he would on substance use and abuse in South Africa and link that to the Summit in Durban as well as the National Drug Master Plan (NDMP). The presentation would focus on national statistics and research on substance abuse, nature and type of substance abuse, effects of substance abuse on women and children, and touch on the National Drug Master Plan.

Mr Eberlein stated that the study on substance use and abuse was executed in conjunction with the DSD. The study aimed to access community members’ knowledge of substance use and abuse, identify the types of drugs used in communities, and establish awareness of substance abuse prevention and treatment services in their communities. It was important to raise awareness because often community members think that substance use and abuse was not their problem, but the problem of the government. In addition to the above objectives, the study also looked to assess community member awareness regarding the law and to establish from community members what the government and others should do to prevent alcohol and drug abuse.

Mr Eberlein discussed the survey method used for the study. The study used triangulation to incorporate both quantitative and qualitative methods. All nine provinces participated with samples from selected localities. Issues of guidance and ethics were taken into account. Training was also offered by CDA members to the research assistants on request.

Mr Elberlein spoke about data collection and analysis stating that a pilot study was conducted in Gauteng in June 2010. A mobilization campaign was launched in the Northern Cape in October 2010. In both studies, questionnaires were administrated by trained volunteers and staff. The data from the questionnaires were analysed quantitatively and qualitatively.

Mr Elberlein talked about the composition of the population that participated in the study. The population was mostly female, 55% African, 33% coloured, 33% lived in rural areas, 42% in urban areas, and 20% in peri urban areas. Over 65% of the population was unemployed. This large unemployment rate had critical consequences considering that drug habits were incredibly costly. How was a family with no formal employment able to sustain such a drug habit? For the majority of the individuals surveyed, the annual income was less than R1000 a month. Again, this was important because drug habits were more expensive than this annual income.

Mr Elberlein touched on other issues addressed in the snapshot survey and summit. These issues included: the role of policy and legislative prescripts, substance abuse as an issue that affects everyone, the South African Harm Reduction perspective, empowerment as the key to supply reduction, and the question of adequate abuse treatment and aftercare.

Mr Elberlein went on to analyze the population’s knowledge of substance abuse: 56% of participants stated that they did know what substance abuse was, 38% stated that they did know; 6% were unsure; 65% of participants responded that they had a user of drugs in their homes and that this was a problem.

Mr Elberlein presented a graph showing the concerns of the community. The top three concerns were poverty, crime, and drugs, followed by unemployment, HIV/AIDS, teen pregnancy, and domestic violence. Another graph revealed that the most frequently used drugs in the community were firstly alcohol and secondly dagga (also known as cannabis). Dagga was used as a baseline for many different variations for other drugs. For example, dagga could be mixed with cocaine, heroin, and tobacco. An important point was that people would change drugs to meet their current economic situation. People would take whatever was available to them. Currently in Limpopo, there was an unidentifiable drug that was nicotine based. There was also a weed known as khat that was plucked and chewed, coming down to Cape Town in refrigerated trucks from Somalia. After alcohol and dagga, the rate of use was followed by tobacco, glue, cocaine, medication, heroin, tik, and mandrax. The use of medication referred to prescription drugs.

Mr Elberlein noted that 60% of those surveyed stated that they did not know that there were support services available to them. This was a huge problem that must be addressed.

Mr Elberlein showed a graph of substance abuse and associated social ills. Those surveyed associated crime, violence, abnormal behavior, HIV/AIDS, death, damage to body, financial problems, ill health, and family problems with substance abuse, in that order. Abnormal behavior was particularly interesting to look at. For example, those that take dagga had an increased chance of becoming bipolar. Though not as extreme, massive mood swings were also common. Despite these side effects, abuse was increasing. Why? Availability was the largest factor. The second largest factor was family history. The chances of using and abusing substances were greater for the child if the parent was a user. This was a point substantiated in research. However, there was no demonstrated genetic link as of yet. There were other factors that increased abuse, including influence, poverty, unemployment, lack of parenting, no knowledge, and mental illness. When the community surveyed was asked what factors should be addressed to alleviate the problem, the answers were: better parenting, recreation, shutting down taverns, attending rehabilitation, reducing availability, engaging in spiritual practices, increasing law enforcement, having a healthy mind, and addressing poverty.

Mr Elberlein analyzed the nature of the drug problem in South Africa: Four per cent of the world population used cannabis, but 8½ per cent of the South African population used cannabis. The percentage of users of opium was lower than the world norm. However, South Africa was expecting a large influx of opium from Afghanistan in the coming year. South Africa’s use of cocaine was double that of the world norm. Likewise, South Africa’s use of Amphetamine-type Stimulants (ATS) was double that of the world norm. There were 2.2 million cannabis users, 0.079 million opiate users, 0.21 million cocaine users, and 0.21 ATS users in South Africa. Overall, there were 235,777 problem users in South Africa. The direct costs of this drug problem to South Africa were R10 billion.

Mr Elberlein said there were 19.2 million people in South Africa that were not currently drinking. There were 4.9 million people in South Africa that had a drink sometimes. There were 3.2 million people in South Africa that could be classified as “risky drinkers” meaning that they had three to five drinks a day. There were 1.97 million problem drinkers in South Africa; this group of individuals would be classified as alcoholics. The approximate cost the country for alcoholism was R78 billion per year. It was also important to look at the percentage and type of alcohol recorded. The statistics were as follows: beer 43.3%, sorghum 24.7%, wine 12.3%, brandy 6.5%, other spirits 4.4%, alco fruit 3.4%, whisky 2.7%, fortified wine 2.4%, and sparking wine 0.3%. However, these statistics did not account for home brews. To illustrate the total consumption alcohol in South Africa, consider the following: South Africa’s 10.1 million drinkers each drink per year: 196 six-packs of beer or 62 bottles of spirits, or 220 bottles of wine, or 666 cartons of sorghum beer. This was one of the top ten drinking statistics in the world.

Mr Elberlein focused on drug problems for adults stating there were 37% or more binge drinkers, 10% drunk Monday drivers, and 7,000 Driving Under the Influence (DUI) deaths per annum. There was a link between drug use, HIV/AIDS, TB, violence and crime. For heroin dependents, there was only a 2% recovery rate. For all dependents, there was a rate of 47% or more for bipolar disorder.

Mr Elberlein presented a graph on alcohol consumption amongst adolescents. For boys in the eighth grade, around 40% had tried alcohol in their lifetime, around 25% had alcohol in the past year and around 20% had alcohol in the past month. For boys in the eleventh grade, around 65% had alcohol in their lifetime, around 50% had alcohol in the past year, and around 47 had alcohol in the past month. For girls in the eighth grade, around 32% had alcohol in their lifetime, 21% had alcohol in the past year, and 18% had alcohol in the past month. For girls in the eleventh grade, around 50% had alcohol in their lives, 38% had alcohol in the past year, and 33% had alcohol in the past month. There was also the problem of lifetime substance use by learners. Around 20% of males and 6% of female learners used cannabis. Around 6% of males and 4% of females use Mandrax. Around 6% of males and 5% of females use cocaine. Around 11% of males and 10% of females use heroin. For youth that use, there was an increased rate of crime and violence, accidents and injuries, risky sexual behavior/unplanned pregnancies/STIs and HIV and AIDS, learning problems, mental and physical health problems.

Mr Elberlein showed a graph showing the percentage of user and non-user learners reporting being stabbed. For those using alcohol, 9% reported being stabbed, compared to 4% of non-users. For those smoking, 6% reported being stabbed versus 5% of non-users. For those using cannabis, 15% reported being stabbed, versus 4% of non-users. The percentage of users and non-users reporting sexual intercourse was also reported. For those using alcohol, 29% reported having sexual intercourse, versus 3% of non-users. For those smoking, 17% of users reported having sexual intercourse, compared with 3% of nonusers. For those using cannabis, 41% reported having sexual intercourse, versus 5% for non-users. The percentage of users and non-users reporting expulsion was reported: 27% of alcohol users reported expulsion versus 11% of nonusers. 22% of smokers reported expulsion versus 16% of non-users. 44% of cannabis users reported expulsion versus 11% of non-users. The age of dependence for youth was on average twelve years and this number was reducing. For school children, one in two had experimented. Drug dealers strategically target schools and disguised drugs in peanuts, tattoos, sweets, cakes, and lollipops. There had been an increase in injection drug use (IDU) and HIV/AIDS in prisons linked to IDU. Levels of Tik use ranged from 42% to 98% in Cape treatment centres.

On women’s substance abuse, he noted that addiction occurred more rapidly in women and frequently involved more than one mood-altering substance. This produced serious medical consequences over a briefer period of time. Women were more likely to have co-morbid psychiatric disorders. Women responded differently to treatment than men, particularly to programmes designed initially for men (like the Twelve Step programme). Women were more likely to be victims of violence, physical abuse, domestic violence and rape. According to Mondanaro et al (1982), 46% of all drug-dependent women had been victims of rape. 28% to 44% had been victims of incest. Studies indicate these percentages were significantly higher for incarcerated women, 80% had experienced some form of abuse. Gender responsiveness requires programmes specifically geared to meet the needs of women, who experience substance abuse differently than men on many levels. These programmes must also be culturally sensitive. The intersection of gender expectations within culture were important to consider when adapting treatment programmes to different populations. These programmes must also take into account family and children. There were many risk factors and co-occurring disorders (e.g. a history of traumatic exposure) and consequences (interference with parenting) of substance abuse that were unique for women, giving rise to special treatment needs of substance-abusing women with children. Service barriers existed for women differently than for men. Substance abusing mothers also experience unique barriers to receiving the services they need to recover, such as abuse of child care and lack of gender-specific treatment in their communities.

Mr Elberlein said CDA’s strategy for combating addiction was three pronged: demand reduction, supply reduction, and harm reduction. Demand reductive aimed to fulfill objectives like poverty reduction. Supply reduction was concerned with production, prices, purity, consumption, trafficking, control, legal action, and trends. Harm reduction outcomes were focused on detox and rehab, after care and reintegration, medical treatment, education and communication, substitution therapy, control of distribution and access, and limiting the spread of IDU diseases.

In conclusion, Mr Elberlein said that the 2nd Biennial Anti-substance Abuse Summit had developed 34 resolutions. The CDA had been mandated to review and revise the National Drug Master Plan to meet new requirements including community needs and resolutions to combat substance use, abuse, and dependence. The CDA was currently busy consulting with the provinces about the NDMP.

Discussion
The Chairperson thanked the Acting Chairperson and asked if there was anything that DSD would like to add. If not, could the CDA talk a bit more about the appearance of new substances on the market.

Mr Elberlein stated that in the Eastern Cape and Kwazulu-Natal there was a nicotine rich drug, sold in little shops that was traditionally bought by small children, who then arrive at school on a high. This drug went by the name of Kuber and was sold as a breath freshener. There was also Khat, a weed that was originally imported from Somalia. Khat was pervasive in Limpopo. Khat was cut, cold-packed, and brought to Cape Town. Its chemical composition was illegal, but the weed was not, which made things very difficult. In Free State, dagga was used often with other drugs mixed in. Tik was used across the Western Cape, but was beginning to appear in the Northern Cape, however in lesser quantities. There was a Vaseline lip balm that was mixed with either cannabis or cocaine and was either sniffed or put on the lips, which produces a high. As economic circumstances changed, so did the drugs.

The Chairperson thanked Mr Elberlein for the elaboration.

Ms Maria Mabetoa, DSD Deputy Director General: Welfare Services, stated that she had made copies of the action plan for the members. There were no comments from the DSD on the CDA presentation.

Mr Vusi Madonsela, DSD Director General, said there was one point that he wanted to emphasize. There was particular problem with substances that were legal. Many of the substances that the Acting Chairperson for CDA referenced were legal. Alcohol was probably the biggest problem in the country. Dealing with legal drugs was very challenging. It had become socially acceptable in our homes to drink alcohol. Parents drank freely in front of their kids. The fact that alcohol had been legal for so long, it was unlikely to be reclassified as illegal. Society would need to think how best respond to a substance such as alcohol, recognizing that it was easily abused and could cause harm to other people. The process of reducing alcoholism within South Africa was going to be a long journey, as the alcohol industry invested a lot of money in advertising and would make attempts to lobby politicians and Members of Parliament to stop those that were trying to challenge the use of alcohol. The alcohol industry would claim that there was nothing wrong with alcohol use. He wanted Members of Parliament to be aware of this.

Ms C Dudley (ACDP) stated that harm reduction was a problematic phrase. Alcohol use had become socially acceptable. The harm reduction aspect furthers the element of social acceptability. Could the CDA please elaborate on the harm reduction piece of the strategy?

Ms J Masilo (ANC) said the Committee should have been invited to the Summit.

The Chairperson stated that the Committee had been invited, but only three members were selected to attend.

Ms H Lamoela (DA) stated that she was extremely worried about the country and the way that things were going. It was like a tsunami. Were there any specific models or methods that could be looked into and implemented to reduce substance abuse? There was a national increase in drug usage that was correlated to crime. The Narcotics Bureau was terminated in 2004. The core of the substance problem needed to be reached. Did the CDA think that reopening the Narcotics Bureau would help address the current situation?

Ms T Kenye (ANC) asserted that substance abuse affected everyone and needs to be prevented. What were the specific programmes and mechanisms that were in place to help address the problem? What else could be done from the parental perspective to reduce substance abuse?

The Chairperson stated that there was a list of treatment centres that had been circulated.

Ms M Mafolo (ANC) stated that she recognized that lack of parental engagement was a big issue, but there were many times where parents were speaking to their children and the children were still engaging in substance use. There was problem with the difference between public and private treatment centres. Unemployment was clearly related to substance abuse and individuals did not always have enough money to attend a treatment centre. Did the CDA have a plan to increase the number of treatment centres?

Ms S Kopane (DA) asked how long Mr Elberlein had been the Acting Chairperson?

The Chairperson stated that the current Chairperson was out of the country.

Ms Kopane inquired about the status of the delayed CDA Annual Report to Parliament. The government was promoting legislation on the reduction of tobacco use, but there seems to be no law enforcement. People did not comply, for example, there was often no separation between those that smoke and those that did not.

Ms Dudley stated that the point on tobacco was interesting. Was the CDA looking at implementing a model related to alcohol? Was there some type of model that could be implemented? Other models used for other countries had been looked at. There was concern about the link between drug use and violence. How was this issue being addressed?

Mr R Bhoola (MF) said that this was a mammoth task. There was much more that could be done within the institutions. What was the exact nature of the relationship between the Summit and the CDA? Were some of the key policies and proposals that came out of the summit being implemented? With regard to the policy and legislation that was deliberated at the summit extensively, specifically on the supply, demand, and harm reduction, what was the evaluation of this policy? What were the current challenges in implementation?

The Chairperson reminded the Committee that there was a second presentation to come that might answer some of the questions being asked. The presentation would also talk about integration with other partners and institutions.

The Chairperson stated that she had a few issues. Khat had been in her hometown for over ten years available from Somalis. The issue of parenting was very important. How did we as parents and family members engage with our children? What were the signs that we should look out for when a child was using a substance? When the analysis of the nicotine-rich drug being used as a breath freshener came out, this should be made available to the Committee. At the Summit, alcohol advertising had been discussed. She requested a list of all the harmful legal substances and the newest ones.

Mr Madonsela asked for the indulgence of the Committee to hold off on questions until the end of the second presentation to see if it answered the questions.

Mr Madonsela stated that issues about parenting would not be part of the presentation. The Committee should be aware of a green paper that would be published very soon and would cover a broad range of issues and contribute positively to the strengthening of families. Parents played a huge role and need to be good models. Families need to be viewed as institutions that could become the first line of defence before the state intervened. The CDA relied on various departments in order to complete its Annual Report. Most of the questions that had been raised would be covered by the second presentation.

Mr Elberlein replied that the CDA Annual Report had been completed.

The Chairperson said that the Committee needed to know what departments contributed to the delay of the Annual Report. This was an annual occurrence and it impacted the Committee’s ability to report.

The Chairperson was replaced by Ms Kenye as the Acting Chairperson.

Presentation on the 2nd Biennial Anti Substance Abuse Summit
Ms Maria Mabetoa, DSD Deputy Director General: Welfare Services, stated that she would merely touch on the key points. The theme of the summit was ‘An Integrated Approach: Towards a drug free society.” 34 resolutions were adopted, based on the plenary presentations and discussions that took place in the five commissions: Policy framework and legislation, demand reduction, supply reduction, harm reduction, and the role of civil society. The resolutions acknowledged that the South African approach to the fight against use and abuse of alcohol and other substances was one of prevention, treatment and after care.

Ms Mabetoa stated that the summit focused on five focus areas.
▪ The first focus area was: Developing policy, reviewing, and aligning liquor legislation. This focus area advocated for the harmonization of laws and policies for effective governance of liquor as well as the reduction of accessibility of liquor, restrictions on trading hours, raising legal age of drinking and purchase from eighteen to 21. This focus area aimed to reduce the number of liquor outlets, raising duties and taxes on alcohol products, warning labels, increasing criminal and administrative liability of individuals and institutions that sell liquor to underage drinkers, intoxicated patrons. There should be a regulation and control of home brews and concoctions, restriction of time, location and content of advertising, banning of sponsorship by the alcohol industry, mandatory contribution by liquor industry, reduction of legal alcohol content, and disallowing novice drivers from consuming alcohol before driving.

▪ The second focus area: Education and awareness on substance abuse. There should be an implementation of protocols on prevention of crime and violence in all schools. Provision of Grounding Programmes for first year students within institutions of higher learning to include substance abuse issues and the strengthening of orientation programmes within institutions of higher learning should be implemented. There should also be prevention programmes amongst women on dangers of drinking during pregnancy. Campaigns against substance abuse should be intensified. Prevention should be utilized through multiple approaches. Public service functions should be alcohol free.

▪ The third focus area: Equal access of services and resources to civil society and organizations across South Africa. Aftercare for children and learners should be strengthened. There should be an increasing provision of rehabilitation and aftercare and an implementation of a continuum of care. Multidisciplinary protocols and should be developed and implemented. Protocols for harm reduction should be developed. An abuse policy in the public service should be adopted. Furthermore, there should be an update and maintenance of the National Clearing House, the development of a treatment model, and development of guidelines for detoxification. Screen and brief interventions for alcohol should be provided. Research on TB efficacy outcomes should be conducted.

▪ The fourth focus area: Reviewing institutional mechanisms to prevent and manage substance abuse in the country. Accomplishing this would require a review of the CDA structure and setting up cross departmental operational units in government.

▪ The final focus area: Reviewing policies and legislation with regards to drugs and organized crime. There should be harsher punishment of drug related offences, speedy finalization of trafficking legislation, and a legislative response relating to smuggling of migrants. Extraterritorial jurisdiction should be considered. Obtainment of preservation order to seize proceeds of crime should be allowed. Lastly, there should be a review of the International Assistance in Criminal Matters.

Discussion
The Chairperson thanked the DSD for the presentation.

Mr Madonsela stated that the programme of action was a five-year programme, and what was just presented was only the plan of action for the next two years. The programmes that the DSD was doing now require focused attention including capacities that would best enable change to be made.

Ms Masilo stated that she wanted more clarification on the drug known as snuff.

Ms Lamoela asked what were the challenges that the DSD experienced during the first two years of implementation of the plan of action? Drug-related crimes were on the rise. What was South Africa doing wrong? There was a shortage of social workers. Was there a solution to this problem and how was this shortage affecting the programmes that were currently underway? Could a programme that provided short-term training periods for social workers be implemented?

Ms Kopane stated that her previous questions were not answered. What was the extent of the involvement of other departments when it came to substance abuse? Secondly, there seemed to not be enough money for treatment centres. Treatment centres were also not doing what they were supposed to be doing. Some of the fees for the treatment centres were so high that people could not attend. What measures were being taken to address this problem?

Chairperson Botha returned to her position.

Mr Bhoola stated that this was a tremendous challenge, but the fact that there was legislation and there had been some type of positive outcome from the first two years marked success. The problem of substance abuse needed to be addressed from the correct perspective. This perspective should include that of the addict. Those that had been rehabilitated added a unique viewpoint to the process. The cooperation of all other departments on combating substance abuse would be difficult. On the issue of treatment centres, more should be developed in rural areas. The solution to substance abuse must be found in the heart of the problem, which in many cases was in rural areas. Could the DSD give the Committee some insight into agreements between NGOs as well as other partnerships that were assisting above and beyond what was required. Clarification on the issue of courts and the programmes of the CDA and DSD would also be appreciated. It was sometimes the case that people were charged and then convicted, sent to a treatment centre on a committal basis. What was the relationship between the rehab centres and the courts?

The Chairperson clarified that if one had a criminal case, one could not be sent to rehabilitation.

Ms Dudley asked about the research done by the Human Sciences Research Council (HSRC) and what effect it was having on the work of the CDA and the DSD? Also, how were people going to be reassured around the issue of harm reduction? Again, harm reduction was a problematic concept. On the issue of terminating investigations, was this because they were actually finished, or just terminated? The presentation referenced harsher sentences; the issue of the Mental Health Care Act. Drug dealers knew how to manipulate the legislation. It was possible that one could comply for a couple of weeks and then could be back on the streets.

Ms Lameola stated that displaying all different types of drugs for educational purposes was an excellent idea for students. What could the Committee do to get a unit that displayed drugs and their associated threats to visit schools in different areas of South Africa? There should be an educational unit in each province. Children were exploring all avenues of pleasure and schools need to have a greater substance abuse education programme.

Ms Mafolo stated that public treatment centres were an incredibly important thing. Often, they were full and could not accept any more people. What could be done to help those that need to be admitted?

The Chairperson asked if there were any new treatment centres. Limpopo, the Eastern Cape, and Free State had treatment centres. However, there was nothing for the Northern Cape. Was there any plan to increase initiatives for treatment centres in other provinces? He had a list of questions that he would like to ask the Department of Justice. Again, the schools need to be addressed. There was not one school in South Africa that was not affected by the issue of substance abuse.

The Chairperson stated that the issue of alcohol advertising needed to be taken seriously. As a Committee, a definite policy position should be taken. South Africa had one of the highest incidences of Fetal Alcohol Syndrome (FAS) in the world. Looking at the statistics revealed that the rates were quite bad in the Western and Northern Cape. What were the targets to reduce FAS? Perhaps DSD would be able to speak to this as well.

The Chairperson asserted that community based services were important There should be community based services for those that abuse alcohol. The percentage of services that were offered were very small. South Africa had a variety of holidays, which people used to over indulge. With Christmas coming up, these were particularly important issues to address. South African culture viewed drinking as a rite of passage to adulthood. What role was the CDA playing in changing these perceptions? What was the CDA doing with the Department of Transport to discourage drink driving?

Ms Lamoela noted that on the first presentation, 60% of those surveyed stated that they did not know about services offered. Why was this statistic so high if there were so many projects going on? On page 24 of the report, it stated that R78 billion was the costs of dealing with alcohol issues every year. Could the Committee had more clarity on treatment centres in rural areas? Also, there should be a focus on prevention instead of treatment. This approach was more beneficial to society and was more cost effective.

Mr Madonsela addressed the issue of alcohol advertising. Alcohol advertising was associated with entrepreneurial success. There was a good image that surrounded this advertising. The alcohol industry spent billions of rand on advertising. When it was stated recently that alcohol advertising should be banned, the industry said that alcohol did not affect people’s behaviour. Then why was the industry spending so much money? It was an area of keen interest for them to deal with. Of course, advertising was linked to sponsorships. Many South African sporting programmes were associated with alcohol sponsorships.

Mr Madonsela talked about visiting schools for drug exhibition purposes. There should be an opportunity for kids to learn about the effects and know about substances. Sometimes, young people try drugs before they know what they are. Some of these drugs were so addictive that they were hooked before they realized it. The biggest challenge would be to keep up with the new substances coming into the picture. There should be an effort to keep the children educated.

Mr Madonsela spoke about the issue of partnerships. Government alone could not succeed. There were currently partnerships with various organizations. However, there were more partnerships to be had. The minister had already organized with a variety of organizations.

Mr Madonsela said there needed to be a mechanism so that the offender appreciated the process and knew that there would be consequences. The Department of Justice needs to have a larger stake in this issue.

Mr Madonsela asserted that the CDA and DSD had a unique relationship. This relationship needed to be repositioned. The CDA was associated with the DSD. The CDA was also required to have oversight of the DSD. Each provided oversight for the other. The future of the relationship between the CDA and the DSD should be considered.

Mr Mogotsi Kalaeamodimo, DSD Director: Substance Abuse, stated that the DSD had created a model and hoped to finish it within the financial year. The greatest challenge was lack of information.

Mr Kalaeamodimo stated that for treatment centres, there was a lack of capacity, and that there should be a greater degree of monitoring and evaluation.

Mr Kalaeamdimo talked about the partnerships and said that the DSD did engage with many stakeholders. The DSD also funded many of its stakeholders programmes to make sure that they were able to do their work. The DSD should look to partner with more organizations.

Mr Kalaeamodimo addressed Mr Bhoola’s question of working with people that had had a drug problem. The experiences and advice of previous attendees of treatment centres were utilized, but this was done carefully, because there was always the issue of relapse.

Mr Eberlein stated that he would answer the questions targeted at the CDA. On the issue of advertising, South African culture had accepted drunkenness and using drugs. This needed to change. In order to sort out this problem, what South Africans need to do was change the culture to one of non-acceptance. This was a long-term process. The NDMP addressed this culture change for 2012-2016. The alcohol industry was the second largest industry in the world. Advertising was there to make money.

Mr Eberlein addressed Ms Masilo’s question stating that snuff was finely ground tobacco. It was illegal to those under eighteen and was mainly consumed by young people.

Mr Eberlein talked about creating partnerships. The CDA had twelve experts, fourteen departments, nine provincial substance abuse forums, and 238 local action groups. Sometimes, CDA staff did not devote the time that it should to the NDMP. The CDA needed people there for at least two hours a day.

Mr Eberlein addressed the issue of prevention. In the past, the main viewpoint was that of supply reduction. The strategy had now shifted to focus on primary prevention. An element of prevention must be integrated into all 34 resolutions.

Mr Eberlein talked about harm reduction. If one went back to the original Act on the CDA, one would see that the goals were to reduce the harms caused by substance abuse. The CDA had looked at the 160 countries that had accepted harm reduction and realized that it did not always fit the South Africa model. There was a debate on the applicability of harm reduction. This debate was ongoing. The CDA had consulted with six provinces and would work with local drug action committees in the future.

Mr Eberlein spoke about education, stating that South Africa spent millions of dollars on drug education, but there was a weak system for monitoring and evaluation. This had led to change in the NDMP. In order to get the monitoring process going, the next CDA would be informed to form a monitoring evaluation team. The tool for evaluation was called the Quick Analysis of Substance Abuse Reporting. An experimental drug court had been set up in Khayelitsha. This concept would most likely be extended across the country.

The Chairperson thanked Mr Eberlein for answering the questions.

Ms Dudley asked with whom the CDA was consulting and how the communities were being involved in this consulting process?

Ms Lameola referenced the packets that were distributed and asked what the mechanism for delivering these was?

The Chairperson clarified Ms Lameola’s question and asked about the distribution of the pamphlets.

Mr Kalaeamodimo stated that the hope was that by 2012/13 there would be a presence in all provinces. In most cases, the pamphlets were distributed at various schools because that was where the functions occurred. They were also distributed at other events.

Ms Mabetoa commented that there was not a treatment model that should be implemented at all treatment centres. Each treatment centre used its own model.

The Chairperson asked when the DSD intended to amend these regulations? It had been almost ten years.

Ms Mabetoa replied DSD had to wait until the regulations were finalized by the end of this financial year.

The Chairperson stated that the process had been very slow moving. This was disappointing.

Ms Lamoela said there needed to be a definite time frame set for the change in regulations.

Ms Mabetoa said that the model was finalized now and that the DSD was hoping to complete it by the end of this year.

Mr Madonsela apologized and stated that he hated to disappoint the Committee. There were more complexities than had been highlighted. On the regulation side, since the passing of the new Act, the question had been whether to amend the regulations or let them pass? The DSD intended to do the latter. There were certain processes that made it difficult for monitoring. One of those was that at the moment one could not access a treatment centre at any time. There had to be prior notice. If one sent in a team of experts to a treatment centre, the treatment centre would reform itself overnight and appear to perform well. When people were interviewed, they said the right things. There were more complexities in the treatment model.

Ms Kopane stated that she had visited a treatment centre in 2009 and was let inside, so her experience differed from that of Mr Madonsela.

The Chairperson reminded Ms Kopane that she was a Member of Parliament and had access to more institutions than your average South African.

Ms Kopane recognized this point, but stated that this was not why she was let in. The Committee and the DSD and CDA need to sit down and talk about the quality of the treatment centres. It was not good. Also, the impression was made that these centres were inhabited by the rich and did not do much to give access to those with less money.

The Chairperson said that the way forward was for the Committee to meet with the Departments of Justice and Education.

The meeting was adjourned.

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