Prevention of and Treatment for Substance Abuse Bill [B12-2008]: Input by treatment centres

Meeting report

Prevention of and Treatment for Substance Abuse Bill: Submissions
Stepping Stones Treatment Centre submission
Mr Peter Powis, Clinical Director,  Stepping Stones Treatment Centre, said that the Centre was concerned that the concept of Dual Diagnosis was not recognised in the Bill and that this was an imperative concept especially for the people who abused chemical substances. He added that there was a need for skilled people to assist in this matter, and that such skilled workers should be professionally able to assist with the treatment and the prevention of substance abuse. He pointed out those patients who were under treatment needed to be individually educated in a way that fitted in with the individual and his or her culture. He emphasised the importance of boosting confidence levels during treatment, and said it was necessary to make the patients aware that what they were suffering was not a disease but a medical condition that needed to be assisted. He stated that the emotional and social needs of substance abusers needed to be catered for and developed accordingly during treatment. He then went on to say that life skills were a critical developmental aspect. He noted that it is very important for treatment centres to engage in the SWOT (Strengths, Weaknesses Opportunities and Threats) analyses with their patients and stress the importance of developing healthy relationships so as to become reintegrated back into society. He stated that it is very important to identify substance abusers at an early stage of addiction before damage was done. He pointed out that support groups like the Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) played a vital role during recovery. He then said that addicts needed to be constantly orientated so that they did not feel alienated when they got back into society, and that valuable support systems needed to be set up for ex addicts.

Discussion
Kgosi K Morwamoche (ANC)  said that it seemed as if Stepping Stones’ presentation focused only on urban areas and was speaking of supplying treatment for addicts based in the urban areas. He then asked at what stage was the Centre going to attend to addicts based in the rural areas.

The Chairperson stated that relapses were the real challenge in the process of treatment and that the real cure for addiction was abstinence. He elaborated that the solution or the treatment procedure should not be seen as a once off but that it should be permanent and ongoing. He then said that perhaps the legislation should deal with ex-addicts who, having gone through treatment, then started abusing substances again. They should be able to be dealt with by the law, and could be convicted for their criminal abuse of substances.

A Member asked if there were any challenges within Department of Social Development (DSD) and what the chances were of helping people that had been abusing substances for a long period.

The Chairperson stated that interventions in that regard needed to be different and that even the Department of Sports and Recreation could intervene and make available sports facilities in areas, particularly in the rural areas, to keep teenagers busy and away from disturbances like drugs and gangs.

Stepping Stones agreed that rural areas were potential and critical areas that needed to be addressed and included in the planning of treatment centres. Provision needed to be made in the Bill for a system dealing with relapses that occurred after and during treatment. It was pointed out that treatment of substance abuse needed to be skilfully handled and managed and should be placed under the context of a healing process. The current legislation was not responsive to such a provision. The Bill should stipulate that all treatment centres needed to implement relapse programmes as part of their driving force. Furthermore, there needed to be a place in the system for Tough Love by the families if treatment centres failed at treating their patients.

Ms J Semple (ANC) stated that this point was acknowledged and should be recognised in the Bill.

The Chairperson stated that substance abusers tended to have very low self- esteem about themselves and that in certain cases they would always resort to violence as a means of compensation and an attempt to cover up. He then stated that the system could not fight violence with violence, and that Tough Love, in his view, should never be an option when treating patients.

Toevlug Treatment Centre Submission
Dr Hendrik Van Heerden, Therapeutic Head, Toevlug Treatment Centre, stated that with regard to Treatment and Treatment Programmes, highly specialised workers were needed to undertake the training and treatment. He stated that the Centre had been engaged in 30 years of highly integrated programmes at all levels of intervention. He pointed out that although the Centre offered good treatment programmes, the prevention of substance abuse was always better than cure. He then mentioned that the Centre offered a Horizon Treatment that was aimed at youth who abuses substances, by teaching life skills in many schools. In his presentation, he pointed out that early intervention was an important aspect of treatment. He then mentioned that the Centre had also implemented a Cottage Programme, which trained staff to enable them to get better results from treatment. The Centre also implemented employment assistance programmes that would raise awareness in the workplaces. He pointed out that it was very important to get family members of substance abusers involved in the last stages of treatment. He emphasised the importance of creating support groups for the patients who were discharged after finishing the treatment programme and that people should be allowed to go back to their treatment centres for further assessment and evaluation, in order to keep in contact with them.

Discussion:
Ms Semple asked where the Toevlug Centre received its funding, and whether the patients were required to contribute by paying fees when joining the programme. She asked if this Centre allowed for their patients to return to their facilities after the completion of the treatment programme. She also asked what the success rate of their treatment programme was.

Mr Morwamoche asked which rural areas this treatment centre dealt with, and he also asked what their attitude was on the treatment that was offered by traditional doctors. He also asked if the Centre recognised the process of spiritual healing.

The Chairperson asked the Centre’s views on the stipulations in the Bill that all specialised systems for the treatment and prevention of Substance Abuse should be set aside, and that training need not be done for workers who treated the patients who were substance abusers.

Mr Van Heerden stated that it was imperative to have high levels of specialised systems like Treatment Centres, so that the treatment programme could be fully and effectively carried out. He then stated that Toevlug was semi-funded by the State and that 40% of their funds were received from patients who paid fees for treatment. He then mentioned that patients were allowed to come back to the facilities. It was not possible to measure a success rate. This could not be followed through; it was possible for a patient to be drug-free, for instance, for ten years and thereafter still go back to using substances. Most patients, however, did successfully complete the treatment programme. He then stated that Toevlug was a Christian Treatment Centre, so spiritual intervention as part of the process of healing was recognised, and that Toevlug would allow people of all religions into their treatment programme.

Mr van Heerden stated that traditional methods of treatment were recognised and that traditional healers needed to acquire more skills in treating the core problem of substance abusers. He pointed out that spiritually-inclined patients had a much better chance at completing treatment programmes as they had the support of their churches in society. He also stated that spiritual intervention was an important aspect of the healing process and that it could not be looked at in isolation.

Mr L Nzimande (ANC) noted that the Bill stipulated that there should be accreditation. He asked where  and how did this Centre get their skills and how did they measure them. He asked on what context is the Centre’s spiritual healing was based.

Mr Van Heerden stated that the Centre engaged in a lot of research with regard to substance abuse, its treatment and prevention. He pointed out that the Centre also trained psychologists and social workers. The research and training programme was ongoing and worked hand in hand with the ever-changing needs of society, because of the fact that new trends always came up. He would thus see it as very important to develop skills according to current societal values. He then concluded by saying that the Centre housed patients from all walks of life and not only limited themselves to patients who were Christians.

Teen Challenge Treatment Centre Submission
Mr Jacobus Nomdol, Executive Director, Teen Challenge, stated that the Teen Challenge Centre did not only concentrate on the treatment of substance abuse, but also focused on gang violence as a form of social disorder. He stated that the Centre offered a 14-month residential treatment facility and that patients were admitted voluntarily. He elaborated that before admitting a patient into the programme, the Centre offered a pre-orientation visit whereby a patient would be introduced to the facility. He emphasised the importance of having mentors assigned to the patients during the treatment programme, as a valuable support mechanism. He then stated that it was very important for the patients’ close family members also to be involved in treatment programmes so as to assist the Centres. He added that this would also be important in restoring broken family relationships with the patients. He concluded by saying that the Centre had 1 038 programmes and that the Bill allowed for the Centre to continue.

The Salvation Army Submission
Major Peter Lovick, Administrator, The Salvation Army, stated that the State needed to allocate funds to assist treatment centres so that they could acquire resources for programmes. He elaborated that education played a vital role in both the recovery process and in prevention programmes. He advised that the teachers’ curriculum should be revisited to make provision for teachers in schools to effectively educate the learners about drugs. He stated that accreditation of treatment programmes was very important and that dual diagnosis needed to be emphasised in the Bill. The Director pointed out that the Bill also should make emphasis on after care facilities. He pointed out that resources were limited and that the demand for treating substance abusers was becoming higher. He pointed out that specialised treatment was vital to protect the masses against the abuse of substances. In this regard, the Bill then also needed to place more emphasis on public education.

Discussion
Ms H Bogopane- Zulu (ANC) stated that norms and standards issues were already emphasised in the Bill, and that there should not be a big gap between private treatment centres and public treatment centres. She stated that the Department of Social Development should always monitor treatment programmes to keep a sufficient balance between the rich and the poor.

Ms Weber stated that preventative education should ideally start at pre-school levels, and that it was important to always identify potential problem areas. She pointed out that prevention was very important, and she agreed that both treatment centres and the Bill should make provision for after care facilities.

The Chairperson stated that the Centres should look again at the Bill and attempt to see whether it would assist them in creating an element of transformation.

The meeting was adjourned.