In recovery? As COVID recedes, SA's growing substance abuse problem revealed

Many South Africans with mental health problems admit they're not seeking help and are instead self-medicating with dangerous and addictive substances.

A table inside a heroin den holds spent lighters, a used needle, old cigarette ends and piece of foil used for chasing the drug in Woodstock, Cape Town. Picture: Thomas Holder/EWN

JOHANNESBURG - "I sat this morning with a police officer who starts drinking early afternoon at work without a problem. There is no control. He's doing so with his colleagues in the place," said Hermant Nowbath, a KwaZulu-Natal based psychiatrist who specialises in substance abuse.

South Africa's complex relationship with alcohol stretches as far back as the apartheid years. It can’t be separated from the social, political and economic circumstances the country faces. Nowbath believes that COVID-19 has heaped pressure on the substance abuse problem South Africans have been battling with for generations.

South Africa's "beers and bros" culture has always been socially acceptable, and alcoholism can easily go unnoticed in a social environment, until someone is caught out.

"If you look at the wine industry in the Cape, there is a dop system where people were paid and part of their wages came from alcohol. It encouraged drinking; it increases the dependency. Across the board, women in the area were affected and started drinking. That's the historic, political context in which we work. If you look at the apartheid days, if you were not white, you required a permit to buy alcohol. It was controlled in that manner. This tied into a whole host of socioeconomic factors that were there - our old system of migrant labour, which still exists today. When you rip people away from their homes of origin, you stick them up to live in sometimes single hostels and you put a beer hole in the place, what on Earth are you going to create? And that is the problem," Nowbath explained.

ENTER THE PANDEMIC

Two years ago, COVID-19 landed in South Africa. Nobody knew what the mental health impact of this would be. Many lost their jobs, families, work demanded required longer work hours for less pay and changes to their environment, to name a few. The familiar became the unfamiliar overnight.

Experts say South Africa has reached its "recovery stage" of the pandemic but the impact on mental health seems to be far from slowing down.

The lingering impacts mean that many anxious children and adults have turned to or relapsed into abusing substances as a way of self-medication.

A 2021 study [published in the Lancet Journal](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21), looked at the global burden of anxiety and depression and found that South Africa had one of the highest percentage change in prevalence of major depressive disorders as people try to adjust to COVID-19.

It has found that there is not enough mental health support to meet the exploding global outcry.

It found that "this pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option."

It also found that in many countries, mental health has been neglected even before the pandemic.

"Before 2020, mental disorders were leading causes of the global health-related burden, with depressive and anxiety disorders being leading contributors to this burden. The emergence of the COVID-19 pandemic has created an environment where many determinants of poor mental health are exacerbated. The need for up-to-date information on the mental health impacts of COVID-19 in a way that informs health system responses is imperative."

FILE: A heroin addict using a glass pipe or 'lolly' in Woodstock, Cape Town. Picture: Thomas Holder/EWN

MAKING CONNECTIONS

On home soil, experts are drawing direct links between the pandemic, substance abuse and mental health.

"We noticed that relapse was very prevalent. People were unable to truly seek help during this time. Now we have re-opened our meetings. We have seen the meetings of AA full again, with many newcomers suggesting an increase in addictions," said Dr Varoshini Nadesan, a non-alcoholic trustee of the board of Alcoholics Anonymous. This has led to more people seeking help.

"Interestingly, the [Lancet] study has revealed that the younger age groups were more affected than older age groups. But taking no action to address the burden of major depressive disorder, anxiety disorder, should not be an option. Turning to substance use and alcoholism is something that we are there to reach out to and support people who are going through this process," said Nadesan.

According to the latest available data from the World Health Organization (WHO), South Africans ranked as the fifth-highest alcohol consumption population, compared to the rest of the world. There are no new studies to evaluate the patterns during the pandemic.

The International Society of Substance Use Professionals recently published a study on South Africans’ demand for alcohol during the national lockdown. It confirmed the red flags pointed out by other studies.

"The demand for alcohol use in South Africa is considerably high and a state of national disaster confirmed how problematic this issue is. We cannot continue to be oblivious of the problem relationship between South Africa and the alcohol use. The burden of disease will continue to grow significantly if there is no action taken against the underage drinking in South Africa and the unlicensed liquor outlets that meet the demand for underage drinking," Nadesan said.

Picture: Thomas Holder/EWN

LOST YOUTH

In Alexandra township, Eyewitness News spoke to a 21-year-old who, after matriculating last year, battled enormous pressure to feed his two siblings.

"COVID is putting more stress on us here in Alexandra. I escape reality when I smoke this thing [drugs] then I don’t think too much about life,” he said.

Another 20-year-old man told Eyewitness News that Cat was his drug of choice and to support his addiction he had resorted to crime.

“With the pandemic we had to stay at home, begging for something but no one will tell you to go to school,” he said.

They are both receiving help from local NGO Eagles of Hope. Chairperson Mandla Mnisi said that the pandemic had hit children and young adults the hardest.

“They didn’t go to school and after a minute on the street, they get influenced by drugs,” Mnisi said.

Later, Eyewitness News spoke to siblings aged 12, 13 and 15 who hadn’t been to school since the start of the pandemic. Their parents relied on a R1,700 grant to provide for the five-member family. That works out to just R340 for each person for the entire month.

The oldest remarked: “I’m just smoking glue, dagga and cigarettes. We feel great when we are smoking. When someone hits us, we don’t feel it.”

The children's mother, who is unemployed, said that COVID-19 had turned their lives upside down.

"I’m not working. I can’t buy all the things that they want. I think this is why they are doing all of this. COVID made it worse - I used to do odd jobs," she said.