Substance abuse prevention programmes among

adolescents in Zeerust: a systematic review

Irene Patience Mohasoa

Deputy Director: Student Development

11 April 2017

PRESENTATION OUTLINE

• Introduction

• Literature Review

• Research Methodology

• Findings and Discussions

• Conclusion

INTRODUCTION Substance abuse among adolescents continues to be a major problem worldwide and in

particular South Africa (Alhyas et al., 2015; Chakravarthy, 2013; Kalantarkousheh et al., 2014;

Dada et al., 2014; Setlalentoa, Ryke & Strydom, 2015; Shah, & Lotfipour, 2013; United Nations

Office on Drugs and Crime, 2015). Various organisations including both private and public

institutions are continually developing strategies to curb substance abuse among adolescents.

These strategies ranges from policies prohibiting the sale and use of substance by minors,

restricting advertising of substances requiring an inscription of warning signs on the outside of

both alcoholic beverages as well as cigarette packages based on both national and international

health promotion acts; use of substances in public places (Liquor Act, 2003; Tobacco Product

Control Act 1993; Tobacco Products Amendment Bill B24, 2006; World Health Organisation

Framework Convention on Tobacco Control, 2003; World Health Organisation, 2013) as well as

policies prohibiting the use of substances in schools (South African Schools Act, 1996) and the

National Strategy for the prevention and management of alcohol and drug use amongst learners

in schools (Department of Education, 2013).

Study Aim: The aim of this study was to gain understanding of adolescent’s perceptions on

substance abuse prevention programmes in the Ramotshere Moiloa Municipality, North West

Province of South Africa in order to formulate recommendations on the development and

implementation of substance abuse prevention programmes.

“The key to growth is the introduction of higher dimensions of consciousness into our

awareness”- Lau Tzu

This session confirms the Institutional and Departmental commitment regarding research.

LITERATURE REVIEW

This study was guided by the Western and African traditional perspectives on the etiology of substance abuse

• Developmental theory

• Disease or biological theories

• Psychological theories

• Learning theories

• Progression theories

• Economic theories

• Symbolic interaction theories

• Social control theory

• Availability theories

• Cultural and traditional perspectives

Comparative analysis of substance abuse prevention strategies in Australia, Canada, Netherlands, Portugal,

Switzerland, United Kingdom, United States of America, and South Africa were also conducted (International

Centre for the Prevention of Crime, 2015; National Drug Master Plan, 2013)

“When I read great literature, great drama, speeches, or sermons, I feel that the human mind has not

achieved anything greater than the ability to share feelings and thoughts through language”. - James

Earl Jones

RESEARCH METHODOLOGY

Social Constructivism, qualitative research approach and exploratory research design

Setting

Ramotshere Moiloa Municipality, previously referred to as Zeerust District, North West Province of South Africa.

Purposive and snowball sampling: 35 participants inclusive of African male and female adolescents,

parents, educators, social workers, mental health professionals, traditional leader; traditional healer.

Documents reviewed in this study included devices to be used for Drug Testing and the Procedures to be

followed (2008); “Ke Moja, I am fine without drugs strategy” (2003); Life Orientation Curriculum and

Assessment Policy Statement (2012); Liquor Act (2003); National Drug Master Plan (2013); Policy framework

for the management of drug abuse by learners in public schools and in Further Education and Training

Institutions (2002); Prevention of and Treatment for substance abuse act (2008); Programme of Action (2008);

and Rapid Participatory Assessment (2009); South African Schools Act (1996); The National Strategy for the

prevention and management of alcohol and drug use amongst learners in schools (Department of Education,

2013); Strategic Plan for South African Police Service (2014); National rural safety strategy (2010); South

African Police Service annual report 2015/2016

RESEARCH METHODOLOGY CONT…

Ethical considerations: permission to conduct the study, informed consent , protection of confidentiality,

debriefing, voluntary participation, respect for participants, anonymity of research participants, beneficence,

and reciprocity (Berg, 2009; Cho & Lee, 2014; Creswell, 2014; De Vos et al., 2011; Hallinan et al., 2016;

Hennink, Hutter, & Bailey, 2011; Li et al., 2016; Segrott et al., 2014; Woods, 2006).

Data Collection: Individual Interviews, focus group discussions, and document review

Data Analysis: Thematic Analysis was considered and the work of Creswell (2014); Aronson, (1994); Attride-

Stirling (2001); Braun and Clarke (2006); Brikci and Green (2007); Cho and Lee (2014); Hennink et al., (2011);

Marshall and Rossman (2011) assisted in analysing data.

Credibility and Authenticity: triangulation of data using various data sources; member checks and reviews

by supervisor, qualitative research specialists and substance abuse prevention specialists ((Brikci & Green,

2007; Lee & Cho, 2014; Marshall & Rossman, 2011; Nichter et al, 2015; Onwuegbuzie et al., 2012; Patton,

2015; Roller, 2014; Tonkin-Crine, 2016).

“The worst thing that contemporary qualitative research can imply is that, in this post-modern age,

anything goes. The trick is to produce intelligent, disciplined work on the very edge of the abyss”. –

David Silverman

FINDINGS AND DISCUSSIONS

Substances abused:

Consistent with the United Nations Office on Drugs and Crime (2016) mostly abused substances include

alcohol and cannabis. There was limited reporting of the following substances: cocaine, methylated spirit, snuff

and glue (Mothibi, 2014; Setlalentoa et al., 2015).

“Adolescents use glue, cocaine, dagga, tobacco, nyaope, alcohol, brandy, black label, tlokwe, and amstel”.

(Adolescents)

Adolescents use cocaine”. (Adolescents)

They use methylated spirit”. (Traditional leader)

Adolescents abuse snuff”. (Social worker)

Adolescents drink tlokwe” (Parent)

“Teenagers from Zeerust also use substances. Dagga is the number one substance of abuse, and then alcohol,

and glue. Hard drugs, we don’t hear about them. Adolescents mainly use dagga”. (Mental Health Professional)

“Yes they use drugs. Both males and females use alcohol, cigarettes, and dagga”. (Traditional healer)

“They use alcohol and dagga. Alcohol is the most common substance abused by adolescents”. (Traditional

leader)

“Adolescents use a concoction of traditional beer called “Segonyamahlo”. It means “eye plucker”. It is made

up of cake flour, ginger beer, battery acid; fermentation process is not the same. Once a person uses it, he or

she will sleep over two days and mostly at risk of rape. Both males and females use it”. (Social worker)

FINDINGS AND DISCUSSIONS CONT…

Risk factors for substance use (Individual, family, and environmental factors)

“A need to be happy and for entertainment”. (One of the adolescents)

“There is cyber bullying by other learners using cell phone applications such as whatsup messages, facebook

and sms’s where a person will just insult you and even bully you through sms messages” (Adolescent).

“There is no specific reason. They use substances for fun, for enjoyment and to keep themselves busy”.

(Mental health nurse)

“Parents who give their children more money to buy food at school during break”. (One of the adolescents)

“There is a new trend; they will save their transport and pocket money and use it at the tavern. They prefer

hiking and not pay for a taxi or bus when coming to school or going home after school. When you ask them

why are they hiking and not using a bus or taxi; they will tell you that they are saving it for use during the

weekend at the tavern. So they save money to spend it at the tavern with alcohol”. (One of the educators)

“There is no progress with their studies. You will find a leaner not progressing academically. As such they

repeat grades, doing same subjects which they struggle to pass. They are not aware of other opportunities that

may be available for them; where they can do other subjects which they will be able to pass. They get

frustrated and then use drugs”. (One of the educators)

“Most of the parents are working in neighboring farms. After work, some of them will drink alcohol”.

(Traditional leader)

“No one is employed in their families. Some children drink alcohol, smoke cigarette and dagga because of

poverty at home”. (Parent)

Family reasons: domestic violence, divorce,

Environmental factors: peer group pressure; adopting lifestyles;

Substance abuse prevention programmes: school based programmes, life orientation; NGO’s

Substance abuse treatment: Challenges regarding treatment facilities: lack of treatment facilities; Limited

treatment facilities;

Recommendations on substance abuse prevention

Involvement of stakeholders: Parents, adolescents, traditional leaders, were identified as stakeholders that

need to be included for substance abuse prevention

Programme reflections

There is evidence of evaluation of the substance abuse prevention programmes; however, other stakeholders

such as adolescents, educators, were not provided with evaluation forms. They relied on verbal feedback

provided by stakeholders attending prevention programmes. Only the DOS had evidence of forms used. DOH

confirmed that they use evaluation form s during workshops

FINDINGS AND DISCUSSIONS CONT…

“Adolescents use substances because of domestic violence”. (One of the adolescents)

“Disruptions, instability in the family, divorce”. (Clinical psychologist)

“Some adolescents are depressed because they are from child headed families”. (One of the educators)

“I am employed in Randburg, Gauteng as a domestic worker. My children are taken care of by my younger

sister”. (Parent)

“The other reason is that we have many taverns in our community. So, young people will get it there.

Cigarette is also used because we have tuck shops owned by…… (Referring to Foreign Nationals) who sell to

young people. They don’t care whether these are young people or not. They sell to them”. (Traditional healer)

“These substances are easily available and easily accessed in any of the shops around and shebeens. I feel

that the government is opening gates for foreign nationals who are selling drugs in saloons and tuck

shops”.

“My grandmother saw a plantation of cannabis not far from her house and she was afraid to report to the

police because of fear of being attacked and killed by those who planted it”. (Adolescent)

“Sometimes their own relatives from Gauteng will bring such drugs to our village. Some even end up coming

here to sell”. (Traditional healer)

“There are no sports fields where our children can play games like in other areas such as Gauteng”. (One of

parents)

“The other reason why some people use drugs is because they are bewitched translated from Setswana as

“Baloilwe”. This is African magic. (Traditional healer)

FINDINGS AND DISCUSSIONS CONT…

Substance abuse prevention programmes

“There is a Life Orientation learning area. This is implemented from grades 7 to 12 in our schools. In that

learning area, they teach us about prevention of substance abuse”. (One of the adolescents)

“There are programs such as Love Life, TADA and RADS. Through these programmes, information about

substance abuse is provided”. (One of the adolescents)

“We have Bakwena N4 Project and we are also provided with Road Safety Manuals. Focus is on road safety;

the link between substance abuse and road accidents”. (One of the adolescents)

Professionals recommended

“We need parents, educators, our adolescents, social workers, nurses, pastors, police officers, our councillors,

and traditional leaders. Parents must raise children in a proper way. “Le ojwa lesale metsi” translated as

children must be taught to behave well at an early age”.

“Other people like us as traditional healers must participate in these programmes. We can share

information on how we treat such problems. As I said, we can work with medical doctors to treat this”.

“I think traditional leaders must also be involved because they are our leaders. When they speak, most of the

time community members will respect what they say. Even young people will listen to them.

Incentives

“Through Bakwena Project, the best drama received a trophy; all learners receive participation certificates;

vouchers depending on the amounts allocated. We had a parent who won a radio; other learners won data

bundles”. (One of the educators)

FINDINGS AND DISCUSSIONS CONT…

Impediments for substance abuse prevention

“Due to limited financial resources, we hold substance abuse training workshops once a year”. (Social worker)

“I think because some are not interested in these programmes”. (Mental Health Nurse)

“I was not involved. The TADA Programme is developed by the Department of Social Development”. (Clinical

psychologist)

“As traditional leaders we are not involved in issues of substance abuse. We only take care of our villages. If

we were involved, we could assist those families. 80% of such families could be assisted”. (Traditional leader)

Involving parents

“Yes, guardians or parents should be involved because they are important people who can guide their

children about dangers of drugs. Again they must know where to report or get assistance when their children

use drugs. Our parents in our villages may not know these things. So, they must be involved so that they can

know how to help their children. Parents must be given information about drugs and how they can be

dangerous to their children and even kill them”. (One of the adolescents)

“Yes, parents need to be brought on board. They are primary caregivers. Mostly children become who they

are because of their parents. (Parent)

“By involving parents, that will enable them to teach their children how to cope with substance abuse problems

when faced with them or how to resist substance abuse problems”. (One of the educators)

Recommended activities

“We need to keep them busy with sports but with focus on substance information”. (One of the educators)

FINDINGS AND DISCUSSIONS CONT…

Barriers to treatment and after care support

“The two centres where we normally refer our learners are Sunpark, which is in Klerksdorp and Witrand, which

is in Potchefstroom. These organisations are private institutions funded by Department of Social Development

(DSD). DSD has a Memorandum of Understanding with these rehabilitation centres” and is allocated ten beds

per month. Once the application is approved; the patient is admitted for 3-4 weeks”.

“The problem is that after three weeks, there is no support provided to them. They are not able to attend

after care support groups because that hospital is far”. (Mental Health Professional)

“The vastness of the Ramotshere Municipality makes it difficult for social workers to provide after care support

to discharged patients”.

“The other challenge is that families are unable to handle a person after being discharged from the centre.

Most of the time, family members find it difficult to forgive the person once the person is discharged. In addition,

it takes long for a person to recover and maintain sobriety”. (Social worker)

Reflections on programmes implemented

“As members of the TADA Group, we allow other learners to evaluate activities we do about substance

abuse. We allow them to advise us so that next time we implement programmes, we can improve our

programmes. We also write reports to our educators”. (One of the adolescents)

“I want to understand the world from your point of view. I want to know what you know in the way you

know it. I want to understand the meaning of your experience, to walk in your shoes, to feel things as

you feel them, to explain things as you explain them. Will you become my teacher and help me

understand”? –James P. Spradley

LIMITATIONS

Data sources

Data collected in this study was limited to the documents analysed, individual interviews with two adolescents,

educators, mental health worker, clinical psychologist, 2 parents, social worker, traditional healer, traditional

leaders, as well as focus group interviews with twenty two adolescents from two secondary schools only in

Zeerust. That excluded other adolescents from other schools, their parents, police officers, NGO’s, and other

government departments that could have offered additional relevant information on substance abuse

prevention programmes for adolescents.

RECOMMENDATIONS

Policy framework

There is a need to enforce regulations against the sale of alcoholic beverages and tobacco products to the

minors (Department of Trade and Industry, 2015; Liquor Act, 2003).

Training and development

There is a need to provide a continuous training and development on substance abuse prevention to the

adolescents, educators, health workers, parents, social workers, law enforcers, NGO’s, religious leaders,

traditional leaders, traditional healers, tavern owners, ward councillors, business people, and other

stakeholders implementing substance abuse prevention programs among adolescents (Setlalentoa et al.,

2015).

Being a member of a TADA group may form part of Life Orientation compulsory certificate tasks that

adolescents may do from Grade 7 to 12 and implemented. The certificate may be issued at the end of grade

12; just before examinations and form part of the assessment tasks that contribute to their annual assessment

tasks for Life Orientation.

Recreational facilities

There is a need for the Departments of Arts and Culture, Education, Sports and Recreation, and the

Ramotshere Moiloa Municipality to provide recreational facilities such as sports fields and gyms for

adolescents. Recreational activities need to include anti substance abuse messages through sporting activities

and competitions, sports and recreation camps, swimming, mountain biking, marathons, and traditional dance

(Department of Sport and Recreation, 2012; Ke Moja I am fine without Drugs Strategy, 2003; National Drug

Master Plan, 2013).

RECOMMENDATIONS CONT…

Rehabilitation centres

The establishment of a rehabilitation centre in Zeerust is required. This is to address challenges experienced

with substance abuse problems and to ensure availability and easy access to rehabilitation services for the

previously disadvantaged rural communities such as those in Zeerust.

Reflections on substance abuse prevention

Training and development on the reflections of substance abuse prevention. In addition, they need to be

provided with the forms they may use to record the progress and challenges on programmes implemented

(International Centre for the Prevention of Crime, 2015; Linnell, 2014; National Drug Master Plan, 2013; The

Substance Abuse and Mental Health Services Administration, 2015).

Future studies

There is a need for a study to explore “Segonyamatlho” as a newly discovered substance of abuse among

adolescents as well as substances used to create Nyaope. In addition, there is a need for a study on the impact

of parental migration on substance abuse among left behind adolescents in rural areas of Zeerust.

Furthermore, there is a need for a study on whether traditional healing and spiritual healing is integrated in the

mental health framework for substance abuse related challenges in Zeerust.

CONCLUSION

Despite some of the gaps identified in the substance abuse prevention programmes implemented; it is really

humbling to note that there are substance abuse prevention programmes in Zeerust implementing school

based strategies and extra-curricular strategies in line with the provisions of the National Drug Master Plan

(2013) and the substance abuse prevention strategies of other countries (International Centre for the

Prevention of Crime, 2015; The Substance abuse and Mental Health Services Administration, 2014). In

addition, that stakeholder inclusive of adolescents themselves participates in the development, implementation,

and review of substance abuse prevention programmes in Zeerust.

“It always seems impossible until it’s done”. -Nelson Mandela