Substance abuse and the family: An examination of the South African policy context

Support Needs of Parents of Adolescents Abusing Substances in Selected Hospitals in Limpopo Province

Parents with adolescents who abuse substances need support. They have high stress levels and low quality of life compared to other parents. This is because they have unmet support needs, do not know what to do to help their adolescents, and are distressed. Most studies focus on the support needs of adolescents. Less is known about the specific support needs of their parents. This study explores the support needs of parents of adolescents abusing substances and being treated in five hospitals in Limpopo Province. A qualitative research approach was applied with an explorative, descriptive, and contextual design using semi-structured interviews to understand parents’ views. Data saturation was reached at the 14th parent. Data were analyzed using the Tesch method. The parents mainly wanted informational and emotional support. The study identified specific parent-related support needs and adolescent-related support needs. This study is the first to explore the support needs of parents of adolescents abusing substances in a South African rural context.

Oral Health Status of Illicit Drug Users in a Health District in South Africa

OBJECTIVES

 The prevalence of illicit drug use and its associated oral health complications have been increasing in South Africa (SA). There has been a paucity of studies to determine the oral health status among illicit drug users in SA. This study aimed to determine the oral health knowledge, practices, and status of illicit drug users at rehabilitation centers in a district in SA.

MATERIALS AND METHODS

 This was a cross-sectional study conducted at four rehabilitation centers in Pretoria, SA. Data were collected using a validated self-administered questionnaire and an oral examination. The questionnaire consisted of three parts: demographics, oral health knowledge, and oral health practices. The oral examination was conducted by a calibrated researcher and included caries, periodontal status, dental erosion, trauma, and soft tissue lesions.

STATISTICAL ANALYSIS

 The data were analyzed using the Statistical Package for Social Sciences (SPSS) software.

RESULTS

 The mean age was 25.5 (±7.49) years with 91% being male. The majority (84%) of patients were Black, and almost all (87%) had never received oral health education; 55% were not aware that illicit drugs could have an impact on the oral health status and 40% had never had a prior dental consultation. The caries prevalence was 68% with a mean decayed, missing and filled teeth (DMFT) score of 5.3 (±6.18). More than half (58%) required periodontal treatment and there were minimal soft and hard tissue lesions diagnosed. Those who perceived their teeth to be in a poor condition had a significantly higher Decayed, Missing and Filled Teeth (DMFT) score compared with those who perceived their oral health to be good. Just under half (41.9%) of the participants did not need any periodontal intervention, with the other half presenting with plaque retention or calculus and thus needed oral hygiene intervention inclusive of scaling and polishing. There was minimal evidence of pathological oral lesions with only 1.5% presenting with necrotizing periodontal disease (NPD). Overall, there was generalized poor oral hygiene CONCLUSION:  Many of the participants had poor oral hygiene knowledge and practices and a relatively high prevalence of caries. It is imperative that oral health promotion and education is incorporated into the medical interventions provided at rehabilitation centers.

Engaging Community Partners to Understand and Respond to Substance Use and Addiction Crisis Facing Families in Prince Albert, Saskatchewan

Substance use is a persisting health care crisis that has led to residents’ addiction to diverse substances in Prince Albert, Saskatchewan. This public health issue affects not only those with a substance use disorder but also those within their circle of family and friends. This paper aims to outline the community engagement processes that we undertook to identify community priorities for addressing the substance use and addiction issues facing them. We began the community engagement using a patient-oriented research process, which led to the development of a grant application. Following the awarding of this grant application by the Saskatchewan Health Research Foundation and Saskatchewan Centre for Patient-Oriented Research, we conducted interviews with family members affected by addiction in the city. The study provided us with significant insight into the impacts of substance use disorders on family members. The importance of collaboration among people with lived experience, health care providers, and community partners helped us to identify our research questions. Community members also actively participated in the data collection, analysis, and presentation of the findings where priorities for the interventions were identified. The conversations we had because of the community’s engagement and participation in the research process enhanced our understanding of the realities of caring for people with substance use disorders and the importance of family involvement throughout the process. We also learned lessons regarding community engagement and participation in research on a stigmatizing and complex topic.

Mediation pathways for reduced substance use among parents in South Africa: a randomized controlled trial

BACKGROUND

Substance use is a major public health concern worldwide. Alcohol and drug use have increased during recent decades in many low- and middle-income countries, with South Africa, where this study was conducted, having among the highest rates in the world. Despite existing evidence on the effectiveness of family-based interventions in reducing substance use among parents and caregivers in low- and middle-income countries, little is known about the mechanism of change that contributes to the reduction. This study investigated mediators of change in a parenting programme (Parenting for Lifelong Health [PLH]) on reducing substance use among parents and caregivers of adolescents through three potential mediators: parental depression, parenting stress and family poverty.

METHODS

The current study used a pragmatic cluster randomized controlled trial design. The total sample comprised 552 parent and caregiver of adolescents M = 49.37(SD = 14.69) who were recruited from 40 communities in South Africa's Eastern Cape. Participants completed a structured confidential self-report questionnaire at baseline and a follow-up test 5 to 9 months after the intervention. Structural equation modeling was conducted to investigate direct and indirect effects.

RESULTS

Analyses indicated that the effect of the PLH intervention on reducing parental substance use was mediated in one indirect pathway: improvement in parental mental health (reduction in parental depression levels). No mediation pathways from the PLH intervention on parental substance use could be associated with parenting stress or family poverty.

CONCLUSIONS

The findings of the study suggest that intervention approaches targeting mental health among parents and caregivers have promise for reducing parental substance use. These findings emphasize the need to create supportive environments and systems for parents who suffer from emotional strain and mental health problems, particularly within families experiencing adversity.

TRIAL REGISTRATION

Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. The trial can be found by searching for the key word 'Sinovuyo' on the Pan-African Clinical Trials Registry website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119.

The adaptation of an evidence-based brief intervention for substance-using adolescents and their caregivers

Objective: Adolescent substance use is prevalent and associated with additional risk behaviours. Research shows that evidence-based brief interventions with adolescents and their main caregiver may mitigate the progression of substance use. Method: We used the ADAPT-ITT framework to develop a needs-based, culturally-sensitive intervention. Five focus groups with adolescents (n = 30), three focus groups with separate main caregivers of adolescents who use substances (n = 21), key informant interviews and an expert meeting, were conducted. Results: Adolescents described the need to decrease risk behaviours, while adolescents and caregivers requested additional support. The core components of the original intervention were retained, with some additions. The newly adapted RAD-PAL intervention was viewed as acceptable. Conclusion: Despite apparent acceptability, we need to test feasibility and efficacy in a trial.

Mothers' experiences of coping with adolescent substance abuse: a phenomenological inquiry

BACKGROUND AND STUDY AIM

Adolescent substance abuse significantly impacts on the lives of mothers. This paper explores the coping responses of mothers whose adolescents have been admitted to treatment for substance abuse.

DESIGN AND METHOD

A multiple case study design was adopted and the data were collected through one-on-one interviews facilitated by the Lifegrid. Interpretative phenomenological analysis was used to interrogate the data.

RESULTS

Coping emerged as a complex construct in our analysis. The mothers' used problem-focused and emotion-focused coping in different combinations of withdrawing, tolerating and engaged coping responses. The mothers' coping responses were also influenced by individual and relational factors like subjective distress and the mother-adolescent relationship.

CONCLUSIONS

We argue that research and practice initiatives should consider using a multidimensional perspective of parental coping that recognises the heterogeneity of mothers' coping responses. Impact statement: The current paper offers new insights into the complexities of mothers' coping responses to adolescent substance abuse.