South African Psychiatry Review - Volume 8, Issue 1, 2005
Volume 8, Issue 1, 2005
Research symposium : Division of Psychiatry, Faculty of Health Sciences University of the Witwatersrand, JohannesburgSource: South African Psychiatry Review 8 (2005)More Less
A moral deliberation on the tragic standoff between the substance dependent client and the therapist : original articleAuthor Willem Petrus PienaarSource: South African Psychiatry Review 8, pp 11 –14 (2005)More Less
Substance dependent patients are trapped within their addictive behavior. They must deny, minimize, rationalize, intellectualize and project to keep going. Therapists see this as poor motivation in 'difficult' patients with a chronic relapsing disorder. Patients 'avoid' therapists and therapists 'avoid' patients. The problem for patients, love-ones and society lingers on. Society (patients) must trust caregivers in order to seek help. Caregivers must be committed to caring for substance dependent patients. This gap can only be bridged if the caregiver accepts this 'chronic relapsing illness', is skilled in motivational interviewing, and is able to balance duty of care and beneficence with the respect for autonomy (self determination) and the right to refuse treatment. The essence of the moral dilemma lies within the concept of patient competency to make informed decisions in the face of being 'trapped within his/her illness. The argument that the patient, at some stage of his/her illness, is not competent to make a rational treatment decision will be discussed. The paper will focus on motivational interviewing, autonomy, virtue, human rights, duty to care, justice and common good, and the need to induce sound moral arguments in the treatment strategies of patients with substance dependence.
Access to substance abuse treatment services for black South Africans : findings from audits of specialist treatment facilities in Cape Town and Gauteng : original articleSource: South African Psychiatry Review 8, pp 15 –19 (2005)More Less
<I>Background:</I> The increased demand for substance abuse treatment has led to concern about the accessibility of existing services to black South Africans. To date, research has not examined the accessibility of services, even though access has been shown to impact on retention and treatment outcomes. <br><I>Method:</I> Cross-sectional audits of substance abuse treatment facilities were conducted in Cape Town (2002) and Gauteng (2003). Data on client characteristics, facility characteristics, and service delivery characteristics were collected using the Treatment Services Audit questionnaire. <br><I>Aims:</I> To describe the extent to which substance abuse treatment services are accessible to black clients and the extent to which facilities target barriers that restrict black clients from accessing substance abuse treatment. <br><I>Results:</I> At both sites, black clients are under-represented at treatment facilities. Private non-profit, outpatient facilities serve the highest proportion of black clients. Compared to private for-profit and state facilities, private non-profit facilities are the most likely to provide services that address the logistical, cultural and linguistic barriers that restrict black clients from accessing treatment. Outpatient facilities are more likely than inpatient facilities to address these barriers. <br><I>Conclusions:</I> Based on the above findings, a number of recommendations are made to improve the accessibility of treatment services for black clients, such as establishing state outpatient treatment facilities and addressing the indirect costs associated with treatment.
A review of policy-relevant strategies and interventions to address the burden of alcohol on individuals and society in South Africa : original articleAuthor Charles D.H. ParrySource: South African Psychiatry Review 8, pp 20 –24 (2005)More Less
This paper focuses on alcohol intervention strategies likely to be effective in a country like South Africa. It begins with an appraisal of the latest data on the burden of harm associated with the misuse of alcohol, globally, regionally and in South Africa. The main part of the paper comprises a critical analysis of a broad array of policy-relevant interventions to address the burden of alcohol on individuals and society. The paper ends with a listing of alcohol intervention strategies most likely to have the greatest efficacy for South Africa together with comments on issues relating to implementation of a national alcohol strategy.
Author Charles PerkelSource: South African Psychiatry Review 8, pp 25 –30 (2005)More Less
In South Africa cannabis is cheap, easily available and easy to grow. There is an old tradition of use that predates modern laws, and little evidence to show that such laws have altered use patterns at all. Yet research shows us that cannabis is not harmless. How much so remains a tough question to answer. To debate the issues of decriminalisation is to acknowledge the failures of the legal approach to cannabis in South Africa. It is not the same as legalization and it does not assume that cannabis is without dangers.