Substance Abuse Among Sesotho Speakers
University of the Free
Louw, D. A. P. Ph.D.
University of the Free
University of the Free
Mosotho L, Louw AP, & Calitz FJW (2010). Substance abuse among Sesotho speakers. International
Journal of Psychosocial Rehabilitation. Vol
study was supported by National Research Foundation (NRF)-South Africa.
Correspondence: Dr. L. Mosotho, University of the Free State, Department of Psychiatry, P.O. Box 339, Bloemfontein, 9300, South Africa.
Substance abuse is one of the biggest challenges
facing South Africa today. Social deviances such as
poverty, crime and other social disintegrations are consequences of a high
prevalence of substance abuse. This
research investigates clinical manifestations of substance abuse among Sesotho
speakers. A sample 106 participants
diagnosed with substance abuse was evaluated using the Psychiatric Interview
Questionnaire. Alcohol is found to be
the most widely abused substance, followed by nicotine and cannabis. The participants presented with a wide range of cognitive, affective and
Key words: Culture, substance abuse, mental health, clinical manifestations
Substance abuse is defined as the abuse of alcohol and drugs which
may be culturally determined, and it varies between socio-cultural groups
(Abbott & Chase, 2008). Substance
abuse is a major cause of social deviances such as crime, domestic violence,
poverty, decreased productivity, family and marital disintegration,
exacerbation of chronic and fatal diseases (e.g. HIV-Aids, tuberculosis, diabetes
and cancer) in South Africa, according to the South African
National Drug Master Plan (1999). Kraus et al. (2009) describe high levels of
alcohol intake as one of the main sources of social harms and problems. The
situation is aggravated by the fact that most parents do not feel free to
discuss drug-related issues with their children. Substance abuse is therefore,
to a large extent, a concealed psychological disorder. Excessive use of alcohol
is likely to lead into risky behaviour such as practising unprotected sex which
may expose individuals to the risk of contracting deadly diseases such as
HIV-AIDS (Morojele, et al., 2005). Just like in most, if not all other
countries, alcohol is the most commonly abused substance in South Africa. It adversely affects millions of
South Africans, many of them being innocent victims. However, South African
socio-economic and political changes have made the country attractive to
investors and foreign trade; for this reason, the region has been turned into a
world drug centre, luring international crime syndicates. Also because of its
climate and many isolated geographical areas, South Africa is one of the biggest producers of
cannabis in the world. It is thus
understandable why South Africa has become a regional and international
hub for trafficking various types of narcotic drugs. Another common but often
neglected form of substance abuse in South Africa involves over-the-counter and
prescription medication, which is highly prevalent (Myers et al., 2003).
Nevertheless, most research on
substance abuse in South Africa has been in urban areas, leaving
certain rural areas and cultural groups in particular, neglected.
The aim of this study was to find out
how substance abuse-related disorders are clinically manifested among Sesotho
speakers in Mangaung – Bloemfontein, South Africa.
Brady and Randall (1999) report that
although the occurrence of substance abuse and dependence is more common among
men than women, the prevalence rates show that a diagnosis of substance abuse
is not gender specific. The literature has shown that substance abuse among men
and women is not clearly specific as far as differences are concerned. Men usually begin to abuse substances earlier
than women do. In the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR, 2000) and
ICD- 10 (WHO, 1992) the epidemiology of specific substance abuse disorders is
not clearly detailed.
Parry (1998) rightly points out that
there are no reliable systems that can facilitate the thorough collection of
data on substance abuse in South Africa. The available information is usually
obtained from research conducted in an isolated location and from information
gathered through police arrests and seizures. However, at the same time it is
generally noted that substance abuse is rapidly permeating the poorer sectors
of South African society (Morojele, 2000). Despite this precarious situation,
Flisher and Stein (2000) report that most South African mental health professional
societies do not address substance abuse as a priority issue. This point of
view comes after they have observed and reviewed the conferences organized and
conducted by professional societies such as the South African Society of
Psychiatry, the Psychological Society of South Africa, the Epidemiological
Society of Southern Africa, and the South African Association of Child and
Adolescent Psychiatry and Allied Disciplines. This does not imply, however,
that valuable research on substance abuse in South Africa has not been conducted. For example,
Peltzer et al. (2002) state that it is difficult to estimate accurately the
prevalence of substance abuse in South Africa.
This may be due to, according to the present authors, the social and
geographical complexity of South Africa. It was found that the prevalence of
substance abuse, especially alcohol (22,2%), tobacco (12,0%), cannabis (6,6%),
opiate type drugs (6,9%) and inhalants among university students in Limpopo Province, was very similar to those found in Kenya, East Africa. The results showed that alcohol, followed by
nicotine and marijuana was the most commonly abused substance.
In the Western Cape, research was conducted to investigate
the incidence of alcohol intake among pregnant women attending antenatal
clinics in various health establishments.
Croxford and Viljoen (1999) reported a disturbingly high rate (42,8%) of
alcohol ingestion among pregnant women. About 46,0% of the participants
admitted smoking, whilst combined abuse of alcohol and nicotine was 29,6%. Still in the Western Cape, Peden and Bautz (2000) investigated
the link between substance abuse and physical trauma in Cape Town.
It was found that about 60,0% of patients reporting with injuries tested
positive for the presence of alcohol.
The injuries were inflicted through traffic accidents, interpersonal
violence and self-inflicted injuries. Van der Spuy (2000) goes further arguing
that substance abuse, in general, is one of the major causes of high rate of
trauma in that 7,0% of the drivers with higher blood alcohol concentration are
responsible for 29,0% of non-fatal and 47,0% of fatal driver injuries. Intoxicated pedestrians also account for
40,0% of the national traffic death toll in South Africa. Cannabis and Mandrax accounted for
41,8% of injured patients.
Attempting to shed light on
over-the-counter and prescription medicine abuse, Myers et al. (2003) argue
that over-the-counter and prescription medicine abuse should be considered a
major social and health risk and burden. It was found that benzodiazepines and
analgesics are the most commonly abused drugs in Cape Town.
Women were more prone to abuse these drugs than men.
The Province of KwaZulu-Natal is no exception as far as substance
abuse is concerned. Taylor et al. (2003)
studied the prevalence and associated factors of substance abuse among rural
pupils in this province. It was found
that there was high rate of substance abuse among these learners. Alcohol
(52,9%) was the main substance of abuse, followed by cannabis (16,9%), while
13,0% admitted to smoking more than one cigarette per day. Furthermore, Brook
et al. (2006) considered personal attributes and peer substance use as the main
driver of the highest percentage of the variables in the abuse of substance
among young people. It seems that even health professionals are not immune to
the dangers of substance abuse. Marais
et al. (2002) investigated the prevalence of alcohol abuse among medical
students at the University of the Free State.
It was found that 28,3% of medical students at sixth-year level abused
alcohol excessively. Bateman (2004) reviewed research projects on substance
abuse among medical practitioners in South Africa. However, the studies only focused on
medical professionals who suffered from substance dependency and were therefore
a highly selected group. The research, nonetheless, confirms that a significant
percentage of medical professionals develop substance dependency during their
It is clear that alcohol is the most
commonly abused substance in South Africa. Next to the already mentioned
consequences of substance abuse (accidents, aggressive behaviour, etc,) the
correlation between substance abuse and the development of mental disorders and
violent behaviour should not be underestimated. For example, there are ongoing
debates on the link between substance abuse and psychosis. The fundamental
question is what precipitates what? Brink et al. (2003), upon investigating the
impact of substance abuse on psychosis, reported that such abuse has a
significant effect on the onset of Psychotic behaviour among patients in the Western Cape.
The finding was that a significant percentage (27%) had used or abused
substances more than once a week in the three months prior to their becoming psychotic. The conclusion was that substance abuse is
very common among Psychiatric patients.
In a review article, Padayachee and
Singh (2003) link intimate violent behaviour with substance abuse. The argument is that substances, especially
alcohol, play a role in the incidence of domestic violence. However, people’s response to substance abuse
differs from culture to culture. It is
argued that violence caused by substance abuse is assimilated socially rather
than caused by involuntary reactions.
Culture and substance
Culture is an assimilated system of
beliefs, values, rules, meanings, and practices that are transmitted from one
generation to the next in patterned ways (Flaskerud, 2000). Culture therefore expresses and reflects the
manner of looking at, perceiving, and experiencing the world. Swartz (2008)
emphasizes that there are discrete cultural groups globally, and the issue is
about the appropriateness, correctness and accessibility of adequate mental
health services in a culturally diverse society such as South Africa with officially eleven ethnic groups
and languages. Against this background, it is understandable that culture plays
a vital role in the development of certain attitudes and behaviours towards
alcohol and other drugs (Zickler, 1999; Grob, 1992).
Heath (2001) rightly points out that it
is globally recognized that various cultural and ethnic groupings use a wide
variety of alcohol and drugs in many different ways. Mental health
professionals are often not well equipped to work with clients from cultures
different from their own (Amodeo & Jones, 1997). Mental health services
providers should be able to recognize, appreciate, respect and engage cultural
issues of the people they are treating (Quintero et al., 2007). Moreover, Withy
et al. (2007) point out that substance treatment programmes require culturally
tailored-made approaches to be effective and successful. Room et al. (1996) go
further, emphasizing the urgent need for the development of a cross-culturally
applicable diagnostic criteria and assessment tools that can be appropriately
used in different cultures.
Though some significant changes have
been observed in various cultures, nonetheless, there are still some
expectations based on gender regarding drinking behaviours and drunkenness,
meaning that it is somehow acceptable for males to be seen drunk (Kulis et al.,
2003).The most common substances of abuse worldwide are alcohol, cannabis,
cocaine, ecstasy, heroin, LSD and mandrax. Pharmacologically, alcohol is
considered a depressant drug. For many,
the abuse of alcohol is a multi-factorial process related to genetic,
psychological and socio-cultural forces Batel (1996). Each culture has its own
unique interpretation and perception of alcohol abuse. Mental illness, guilt and
tolerance thresholds are manifested differently in different cultures.
In many cultures, beverages of alcohol
make up significant and valued dimensions of life (Barry III, 1982). In the main, most literature places excessive
emphasis on alcohol, albeit those other hard and harmful drugs have already
penetrated many communities.
Room (2001) categorizes drinking
behaviour into two dimensions: “wet” and “dry” societies. According to the nosology in dry societies,
alcohol is taken apart from everyday life as a unique valuable commodity for
special occasions, hence drinking is traditionally sporadic, is often used
during special days or weekends, with a high proportion of drinking involving
drunkenness. But “wet” societies use
alcohol as part of everyday life, and such use usually accompanies meals. An example of alcohol that is often used in
“wet” societies is red wine which is often used during meals.
Drinking behaviour in various societies
has been viewed in different ways in the world.
Alcohol is a substance with psychoactive ingredients. For that reason,
access to alcohol may be restricted. On the other hand, alcohol is seen as part
of nutrition rather than a drug, and therefore, access to alcohol may be
relatively unrestricted (Schmidt & Room, 1999). There are also cultural variations in the
regulation of quantity, duration and behavioural dimensions of drinking and
drunkenness. People across the globe may
differ significantly in the degree to which particular substance-related
problems are viewed as serious issues in their communities. Other cultural aspects of drinking include
the problematization of dependence, drinking-related states and experiences,
the extent to which attention is paid to the potential involvement of substance
in adverse situations and the reality of culture specific presentation of
alcohol disturbances that are not properly captured in either the DSM-IV-TR or
The continuum between normal and
abnormal (pathological) drinking was explored by Bennet and Janca (1993), who
focused on how people from various cultural backgrounds distinguish between
normal and abnormal drinking which might be labelled harmful, abusive, heavy,
dependent and pathological consumption.
It is also mentioned that people within the same culture display
different ideas and experiences regarding alcohol consumption, whether these
are normal or pathological. It was found
that people (sample) from Greece and Spain agreed that normal drinking was
possible and was a very important aspect of their cultures. Arizona respondents gave mixed views
concerning normal drinking and pathological drinking. The first group of respondents argued that
normal drinking was not possible, hence normal drinking equalled binge
drinking, while other negligible numbers of respondents believed that normal
drinking was possible because it was more apparent in other cultures than among
the Navajo themselves. In Bangalore, India, it was reported that respondents
generally argued that normal drinking was not possible within their cultures.
Brannock and Schandler (1990)
investigated cultural and cognitive factors among groups of black, white and
Hispanic adolescent drinkers. White
respondents manifested more frequent drinking behaviour than black and Hispanic
groups. However, there was a significant difference between Blacks and
Hispanics as far as drinking behaviour was concerned. Whites drank more socially, and drank in
response to distress, while black respondees reported less drinking among
friends and peers.
In Dallas, Houston and San Antonio, a comparative study on the link
between aggressive criminal activities and substance abuse among Mexican
American, black and white arrestees was carried out. The purpose was to predict the outcome of
aggressive crime on the basis of substance abuse (both hard drugs and alcohol)
and cultural group variables within the total male sample of 2,364 (Valdez et
al., 1997). It was found that Mexican
Americans were more likely to be arrested for aggressive crimes than either
African Americans or European Americans.
However, effects of both illicit drugs and alcohol were found to be
similar for all ethnic groups. This
means that although hard drug abuse and aggressive behaviours receive most of
the attention across the globe, alcohol itself is still the prominent substance
responsible for violent behaviours across the range of ethnic groups consisting
of Hispanics, Blacks and Whites. Alcohol
is evidently linked to domestic violence, especially among middle class men.
In Singapore, in the Far East, Hong & Isralowitz (1989)
conducted a cross-cultural study on alcohol consumption behaviour among Singapore college students. The assumption was
that Singapore Indian college students would display higher rates of drinking
problem behaviour than Chinese students.
The findings were that about 70,0% of Chinese participants mentioned that
they consumed alcohol in comparison to 63,0% of the Indian respondents who used
the substance. Regarding gender, 80,0%
of Chinese males and 60,0% of females used alcohol. Making a comparison, it can be stated that a
slightly lower percentage of alcohol users were found in the Indian
sample. Chinese students liked beer
while Indians preferred red wine. There
were differences in the effects of substance abuse among Chinese and Indian
respondents in terms of having a hangover, vomiting because of drinking,
driving a car under the influence of alcohol, social and occupational
impairment such as missing a class because of the after effects, and causing
disharmony in interpersonal relationship.
Indians displayed a tendency of more problematic behaviour than the
cross-cultural applicability of Jellinek’s Progression Technique in a sample of
Navajo men and women, Venner and Miller (2001) found the following as far as
the progression of alcohol problems was concerned: that in general, Navajo respondees tasted
alcohol for the first time around age 16; violation of legal, social norms and
rules took place in the early twenties, and the first experience of blackout
occurred in the mid-twenties. Many
happenings centred around 28 years of age, events that were related to social
and interpersonal relationships, while they carried on with their drinking
habits despite problems. First
hospitalization, attempts to quit drinking and nutritional neglect occurred by
their early thirties. Aspects typical of
dependence appeared later in the progression.
Changes in tolerance and the drinking of non-beverage alcohol such as
mouthwash or hairspray were the last to be reported. Symptomatologically, the participants (20 out
of 46) experienced loss of interest in life, heavy drinking episodes lasting
for at least two days. They also
reported a decrease in moral standards and vague spiritual desires, physical withdrawal
symptoms such as being afraid and tremors.
Most importantly, Navajo women experienced hallucinations at the
beginning of their progression. Feeling
bad about drinking, experiencing augmented tolerance and quitting for a while
occurred in at least 20 ordinal positions later for the Navajo.
Once more, in
the United State of America, the study was conducted among primary
care patients with alcohol problems, comparing whether race made any difference
between two groups of participants (African Americans and Whites) with respect
to consumption, severity, consequences, readiness to change and coping
behaviour. Conigliaro et al. (2000)
reported that in comparison to white patients, African-American respondents
presenting with alcohol problems, and enrolled in a brief intervention
programme, met all the criteria for alcohol dependence or drug dependence, but
displayed the same levels of alcohol consumption compared to white
patients. There was a marked increase in
drug dependence among African Americans compared to Whites who met criteria for
drug dependence (43,0% versus 35,0%).
Again, it was discovered that alcohol and drug abuse were more serious
among African Americans than Whites.
However, there was no difference in alcohol consumption rate between the
two groups. African-American patients reported more symptoms of dependence and
less consumption than white patients. In
relation to readiness to change, both groups were equally ready to change their
drinking behaviour, but African Americans were more highly concerned about the
consequences of alcohol on their health and life in general.A similar study
was also conducted in the USA focusing on the prevalence, incidence
and stability of dependence-related problems and social consequences among Whites,
Blacks and Hispanics: 1984 – 1992 (Caetano, 1997). The findings were that Hispanic men displayed
a higher incidence of frequent heavy drinking, much more than other ethnic
groups and women. Again the higher
incidence and stability of dependence problems were found to be more prevalent
among Hispanic men than Blacks and Whites.
Stability referred to an indicator of chronicity, while the incidence
denoted the proportion of people who did not report a disturbance in 1984, but
did so in 1992. The dependence-related disturbances are: salience of drink-seeking behaviour, loss of
control, withdrawal and tolerance symptoms as well as relief drinking. In general, the results showed that Blacks
displayed a higher incidence of both dependence-related and social
consequences, as well as more marked stability of social consequences compared
with whites. Social consequences refer
to financial difficulties, social and legal problems, health-related issues,
marital dysfunction, as well as social and occupational impairment.
In California, the sub-tribes of Chumash Indians use
Datura, which is a hallucinogenic substance (Grobstein & Rios, 1992). This decoction is used in pubertal custom to
celebrate the passage of the youth into adulthood. The potion consists of the leaves, roots and
stems, which are soaked in water.
There have been
several reports on wide varieties of illicit drugs such s cannabis, cocaine,
Lsd, ecstasy, mandrax and heroin in South Africa. There is a new home-made drug called
methcathinone popularly known as “cat”, which is a cocktail of methamphetamine
mixed with other substances (Lillah, 2003). This drug is secretly prepared in
the kitchen by anyone with a recipe and sold exclusively in a white powder form.
It can be diluted in liquids or mixed with other substances in capsule form in
order to be injected intravenously. The most dangerous part of this drug is
that it is deadly addictive. Common symptoms include increased energy,
euphoria, flight of the mind, feelings of invincibility. The side effects are
reported to be terrible and include, tremors, insomnia, somatic symptoms,
dehydration, sweating, nasal disturbances, anxiety, rapid heart rate, and loss
of weight; at worst, the addicted person may present with paranoia, convulsions
and various forms of hallucinations.
It was against
this background that it was decided to study how substance abuse-related
disorders are clinically manifested among Sesotho speakers in Mangaung, South Africa.
The Mangaung Township in Bloemfontein, South Africa, was selected as the geographical area
for the completion of the research. For
this exploratory descriptive study, the participants consisted of 106 Sesotho
speakers diagnosed with substance abuse.
They were drawn from the population of patients visiting various health
establishments in the area. All patients
presenting to a specific health facility who qualified, during the period when
the researchers were based at the facility, were included. The time periods
varied from one month to two years. The
participants were evaluated and diagnosed by a multi-professional team which
typically consisted of a psychiatry doctor (registrar), clinical psychologist
and a psychiatric nurse (in certain areas, social workers, occupational
therapists and/or physiotherapists also formed part of the team). The DSM-IV-TR criteria for substance abuse
were used as the inclusion criteria. The
participants were between 18 and 65 years of age, and both genders were
represented. Written informed consent
was obtained from each participant.
semi-structured interview, based on the Psychiatric Interview Questionnaire
(PIQ) used by the Department of Psychiatry at the University of the Free State, was used to elicit the information
(Mosotho et al., 2008). The PIQ is based
on the Clinician’s Thesaurus: The
Guidebook for Writing Psychological Reports (Zuckerman, 2000) and Outline of the Psychiatric History and
Mental Status Examination (MacKinnon and Yudofsky, 1986). The PIQ provides data on preliminary
identification (including demographic information), main complaints, personal
description, history of present illness, psychiatric review of systems,
previous mental illness, past personal history, a mental-status examination
consisting of: appearance, attitude and behaviour,
thought processes, perception, mood and affect, consciousness, orientation,
memory, tempo, intelligence, mode of thinking, judgment and insight, as well as
hypothalamic and autonomic functioning (Mosotho et al., 2008).
methods were used to describe the experiences of the participants regarding
their symptoms, as well as a way to elucidate the quantitative data. Qualitative methods that were used consisted
of two types of data collection: the
open-ended interview and clinical observation.
The interview data consist of direct quotations from participants about
their experiences, feelings, emotions, opinions and knowledge, while
observation data refer to detailed description of participants’ activities,
behaviours, actions and full range of interpersonal interactions and
organizational processes that are part of observable human experience (Patton,
1990). Individual interviews were
transcribed, and information gathered was grouped into themes. Themes are written in the subject’s own words
or transcribed as closely as possible (or a close rendition of the subject’s
account). These themes were divided into
psychological symptoms, physical (somatic) symptoms, as well as behavioural and
social symptoms. Quantitatively, a
descriptive statistical analysis was performed to provide indications of
frequency (incidence) of identifying demographic characteristics, signs and
symptoms of mental illness, and socio-cultural variables associated with
substance abuse that are covered in the questionnaire.
The study was
approved by the ethics committee and the council of the University of the Free State. The pilot study was conducted on 40
patients to investigate the practical feasibility of the research. Based on the pilot study findings, minor adjustments
on coding of the questionnaire were made.
Results and Discussion
About 54,0% of the participants were aged
between 18 and 35 years. The elderly (aged between 46 and 65) were most
affected by substance abuse disorders.
This finding confirms what was reported by Widlitz and Marin (2002) that
elderly people are also prone to develop substance addiction and dependence.
However, this issue is more likely to be overlooked and ignored by health
professionals. The fact remains; nonetheless, that substance abuse is common in
the general population and encompasses people of all ages and all
socio-economic levels (Weaver et al., 1999).
As far as gender is concerned, it was found that about 70,0% of the
participants were males. This
corresponds well with international literature and research findings that
substance abuse is usually higher among males than females (Kulis et al.,
As far as
education is concerned, it was found that relatively few participants had
passed grade 12. These low educational levels are understandable. It could also
be that substance abuse negatively affects an individual’s social and mental
functioning. Almost 60,0% of the
subjects were single. A possible explanation could lie in the fact that most
South African youth do not marry before the age of 30. Also, the fact that so
many of the participants were unemployed and could therefore not provide the
necessary financial security to their families, probably also played a
role. It is disturbing that a
significant percentage of participants who were diagnosed with serious
substance abuse disorders were students.
This result supports the findings by Marais et al. (2002) who reported a
prevalence rate of more than 25,0% of alcohol abuse among medical students in
the Mangaung area. The dominance of Christianity among the participants
corresponds well with the distribution of religions in South Africa. Another significant finding was that more than 40,0% of the
participants were involved in criminal activities. This is in agreement with what was reported
by Padayachee and Singh (2003) and Heffernan et al. (2003) who also found a
relatively high incidence of various crimes among substance abusers.
Alcohol was found to be the main substance
abused by the participants, followed by nicotine and cannabis respectively. About
40,0% of the participants abused more than one substance. The higher prevalence
of alcohol, nicotine and cannabis relative to other hard drugs such as heroin,
cocaine, crack and the like, might be attributed to accessibility and
affordability of the afore-mentioned drugs in the community. Taylor et al.
(2003) found a similar trend in KwaZulu-Natal Province and
the Eastern coastal region of South Africa. However, this finding is in contrast with other regions and cultural
groups in South Africa. Nearly 90,0% of the participants did have some form of social
support system. This is in accordance with findings by other researchers that
the social support system of individuals suffering from mental disorders is
adequate in the developing world, leading to a better prognosis and course than
is the case in developed nations (Dani & Thienshaus, 1996; Sartorius et
al., 1980; Jablensky et al., 1992).
The findings concerning the primary symptoms
are presented in Table 1. As it was impossible to determine the cause, it
should be noted, however, that the reported symptoms could not necessarily be
linked unequivocally to substance abuse, because they could have been
symptomatic of another underlying mental disorder. The inclusion criteria for classifying
symptoms as primary revealed a prevalence rate of at least 20,0%. Only dividing
symptoms into somatic and psychological categories would have been regarded as
overlapping and superficial. However,
for practical and discussion purposes, it was decided to make the distinction
between primary symptoms (20,0% and more) and secondary symptoms (less than
20,0% but more than 5,0%).The frequencies are the sum total of the symptoms
reported by the participants as well as those observed by the researcher.
Table 1: Primary
Substance Abuse Symptoms expressed by Sesotho speakers
hallucinations 55,0Poor concentration
Hallucinosis 27,2Irrelevant answers
affect 27,4Suicide ideation
affect 23,6Delusions of persecution 36,8
50,0Delusion of grandeur
Agitation 40,6Poor insight
judgment 53,0Concrete Mode of thinking 67,0
Table 1 shows that there was significant
comorbidity and over-lapping of symptoms such as impaired concentration, poor
memory, auditory and visual hallucinations, irritability, insomnia and
decreased libido. These symptoms were also found in other mental disorders,
especially schizophrenia and major depressive disorders among Sesotho speakers
(Mosotho, et al, 2008). However, it was found that the contents of
hallucinations in the participants were not clearly defined as it was the case
among patients suffering from depression, anxiety and schizophrenia.
substance abuse and especially alcohol abuse could lead to various physical
conditions, a marked deterioration in general health, malnutrition, poor
personal self-care and hygiene were also observed. It was therefore somewhat
surprising that participants expressed more and a wider variety of
psychological than physical symptoms. Cognition was affected more severely than
mood, affect and behaviour. Behavioural and social deviations such as violent
and aggressive acts, violation of social and legal norms seemed to have been
more frequent when a combination of substances was abused. These seemed to be
alcohol and cannabis in particular. A significant number of the participants
also expressed difficulties with absenteeism at work, decreased productivity,
poor labour discipline as well as general impairment in social, academic,
occupational and mental functioning. Moreover, they also experienced financial
difficulties, consequently neglecting their family and social responsibilities.
Next to the primary symptoms, there were also
secondary symptoms which could not be ignored.
The symptoms were classified as secondary as they contributed less than
20,0%, but more than 5,0%. These
symptoms varied markedly in terms of diversity and severity. Those secondary
symptoms are shown in Table 2.
2: Secondary symptoms of substance abuse expressed by Sesotho speakers
of referenceLoosening of associations
hallucinationsFlight of ideas
hallucinationsPressure of speech
hallucinationPoverty of speech
affectWalking around naked
FearPoor personal hygiene
DeteriorationPoor academic performance
with heartDecreased productivity
motivationLack of willpower
around aimlesslyFamily negligence
disturbancesStiffness of the neck
withdrawalLoss of weight
away from homeShort tempered
The variety of secondary symptoms is conspicuous. However, this
finding is in line with other researchers who also reported a wide range of
symptoms in substances abusers (Brink et al., 2003). The duration of the primary and secondary symptoms of substance abuse
among the participants is shown in Figure 1.
Figure 1: Duration of
symptoms in substance abusers__________________________________________________________________________________________________________________________________________________
It is clear that the majority of participants
experienced the symptoms for significant periods of time. In more than 60,0% of
the samples, the symptoms have persisted between two and three years. This
finding is disturbing because substance abuse negatively affects basically all
spheres of human functioning, these being the psychological, mental, physical
and social domains (see Tables 1 and 2).
As far as treatment is concerned, a relatively
high percentage (66,5%) of the participants simultaneously consulted both
Western-trained mental health professionals and traditional/spiritual healers
for their ailments. Although it was found that in the majority of cases the
Western model of treatment was the first choice, the finding confirms the
significant role played by traditional medicine in South Africa (Mkhize, 2003).
The general consensus is that substance abuse
is one of the major social and health problems, not only in South Africa, but throughout the world. It was found in the present study that
alcohol was the most commonly abused substance in Mangaung, followed by
nicotine and cannabis respectively. This finding was in contrast with other
results in South Africa where the prevalence of hard drugs such as heroin, cocaine, ecstasy
and mandrax was much higher among their research participants. Sesotho speakers
expressed a wide range of symptoms. The finding that the participants had
suffered for a relatively extended time from the symptoms was worrying.
Regarding treatment, the important role of traditional healers and medicine in
the Mangaung area was confirmed.
Although the present study has revealed
significant findings, these results should, however, be interpreted with
caution. Firstly, the participants were almost exclusively from one area of the
Free State Province, while Sesotho speakers are widely dispersed throughout the
province, other parts of South Africa and Lesotho. The generalization of the results should therefore be interpreted
cautiously. Another factor to be taken into consideration is that within the
Sesotho-speaking population there are many sub-cultural differences. The point is
that different groups of Sesotho speakers within the same geographical areas
may differ significantly. Additionally, it should be taken into account that
the data gathering to a large extent relied on self-report which, as is
generally accepted, often does not capture the real situation. This is
especially true in the case of substance abuse which in many cases is a
criminal offence in South
Nevertheless, the study remains significant because it does contribute to
important data in a field that has been largely neglected in South Africa.
Dealing with the substance abuse problem
among Sesotho speakers will not be easy. Next to fighting the abuse of alcohol,
as in most cultures, the high incidence of cannabis is an additional
aggravating and complex factor. The use of cannabis by black South Africans,
and therefore also Sesotho speakers, has been part of cultural practices for
centuries (like for example, wine drinking among Whites in especially the Western Cape). It
is also used in certain cultural rituals, while there is a strong belief in the
healing power of the drug. The cultural prescriptions regulating the use of
cannabis no longer serve to protect people as it did historically. The fact
that cannabis is also cheaper than both alcohol and nicotine adds to the dim
Special programmes that take the unique
cultural value systems into consideration should therefore be developed.
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empirical research concerning specific targeted groups. Such research is
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