Carol Venter from ICAS is one of South Africa’s leading specialists in the field of substance abuse and addiction. On 20 January Carol presented EAPA-SA’s first Eduweb webinar of 2021, providing 180 attendees with a valuable update on substance abuse in South Africa during the COVID-19 pandemic, with information gleaned from Medical Research Council (MRC) research as well as anecdotal evidence from The South African National Council on Alcoholism and Drug Dependence (SANCA) and her own findings. Read on for some valuable insights brought by Carol in her presentation.

Drug abuse statistics in the South African context

Research reveals that South Africans consume twice the volume of alcohol as the world norm.

  • According to the MRC, 15% of the South African population has an addiction problem –inclusive of behavioural addictions. 
  • The ripple effect of addictions is that one addict affects 16 people directly or indirectly – from family and friends, to colleagues and managers who get involved supportively. 
  • Addiction costs the country’s state coffers R20 billion per annum in terms of health and trauma cases etc.
  • Only one in 18 people steps up to get help, mainly due to the perceived stigma attached to having an addiction and their jobs being at risk.  With people currently struggling in a depressed job market, addicted people in the workplace are more nervous than ever to step forward to get help with their addiction in fear it will jeopardise their jobs.  
  • According to the MRC, 67% of addicts are actively employed in the South African workforce. Therefore, it is not mainly jobless or homeless people – or the youth – who are suffering from addictions.

Substances most widely used in South Africa

Alcohol is the primary substance used at work in South Africa.  Cannabis, cocaine, heroin and methamphetamines are commonly used among employees at home – in some instances during working hours while working from home.

“Alcohol is the primary substance used at work in South Africa.” 

South Africa’s most prevalent drugs are:   

  • Hubbly bubbly – flavoured tobaccos or dagga smoked through water or alcohol and shared in a group 
  • Nicotine – found in cigarettes
  • Cannabis – which has been decriminalised in South Africa, yet the country awaits official guidelines in terms of acceptable levels of intoxication.  It remains illegal to smoke cannabis in the workplace or in public
  • Mandrax – initially manufactured as a sleeping tablet it was removed from the legal market in the 1970s. South Africa is a significant manufacturer of Mandrax
  • Crystal Meth – methamphetamines ares a cheap and highly addictive stimulant known in South Africa as Tik
  • Nyaope/Wonga – is dagga-based with other drugs mixed into it and generally smoked in South Africa
  • Cocaine – a stimulant that is predominantly a “white collar” drug, which is snorted
  • Crack cocaine – chemically identical to cocaine but cheaper. “Crack” is smoked 
  • LSD – a hallucinogenic drug  made of potent mood changing chemicals, popularised in the 1960s
  • Ecstasy – formally known as MDMA. XTC became popular in the rave culture in the 80s 
  • Heroin – South Africans do not have a drug injecting culture and heroin is used less in South Africa than in USA and UK 
  • OTC medications – over the counter medication abuse, including meds such as painkillers and cough syrup, is under-reported in South Africa and so does not show up in local statistics
  • Prescription medications – these commonly include medications containing the opiate Codeine and mood stabilisers such as Urbanol, which is highly addictive

COVID-19 pandemic – substance abuse lessons learned

At the start of Level 5 lockdown there was a full ban on the sale of cigarettes and alcohol, which was reinstituted to an adjusted Level 3 lockdown in December 2020. On the back of this prohibition, COVID-19 numbers have been dropping.  However, without any research on hand it is not yet clear if there is a correlation between prohibition and the decreasing rate in coronavirus infections.

Crime, trauma cases and the incidence of drinking and driving decreased over the 2020/2021 holiday period as the majority of people elected to stay at home. Astoundingly, Chris Hani Baragwanath Hospital in Gauteng reported zero cases of alcohol-related trauma on New Year’s Eve, 2020. It is not widely enough known that the current legal tolerance to blood-alcohol levels in drivers is 0.00g/100ml.

Due to stress and uncertainty, along with more people being confined to their homes, there has been a notable increase in relationship stress, domestic violence and grievous bodily harm (GBD) over lockdown. For many, home no longer constitutes a safe haven while members of the family are at school or work.

There has been a black market boom in the illegal sale of alcohol. Many South Africans have partaken in criminal activity by selling or buying black market booze and cigarettes. Lockdown is having a negative effect on the distribution of illicit drugs. With the closing of borders affecting the illicit drug trade, US research has found changed patterns of substance abuse, where people are using drugs that are accessible, found in their homes. For example, a cocaine user may access Ritalin or other stimulants to keep them going.  Plus there is more drug experimentation taking place.

An increased number of people have reached out for help seeking support and counselling for problems that include depression, anxiety, substance abuse, going through chemical withdrawals, wanting to know how to quit cigarettes and cope with cravings.

An increased number of people have reached out for help seeking support and counselling…

Due to the high levels of stress and anxiety that prevail there has been an increase in substance abuse.  South African awaits formal research as to the actual statistics. 

Organisations and programmes that provide support and treatment of substance abuse have had to adhere to prescribed social distancing practises. Many, such as ICAS, have taken their support and programmes online. Telephone counselling has become popular. However, not everyone in South Africa has access to a laptop or data – or even a mobile phone.  

Alcohol consumption in South Africa  

In the absence of a South African statistic it is interesting to note that research in the UK finds a 17% increase in consumption of alcohol among Britons during lockdown.

  • South Africans are the sixth biggest alcohol drinkers in the world according to the World Health Organisation (WHO) 
  • 35% of South Africans drink alcohol
  • 60% of these drinkers engage in heavy and binge drinking with binge drinking defined as having four drinks in two hours  – at least twice a week 
  • 62 000 deaths per annum in South Africa are directly related to alcohol

Current risks associated with drinking over lockdown inlcude:

  • Community transmission of COVID-19
  • Alcohol related traumas
  • Interpersonal violence fuelled by abuse and withdrawal
  • Compromised lung health and a decrease in general immunity 

 

Lockdown isolation is makes us more susceptible to substance abuse and behavioural addictions

Isolation has led to a startling increase in levels of depression. The pandemic is also having a marked effect on people’s health and emotional wellbeing with increased stress, anxiety levels and illhealth found in ourselves and our families while struggling with the negative effects of isolation. 

People are suffering from psychological distress. What were just pandemic statistics are now real cases of illness and bereavements close to home with close friends and family succumbing to COVID-19. And, anticipatory loss is causing anxiet

Forbidden fruit can lead to a tendency for binge drinking when the alcohol ban is lifted and working from home has blurred the lines between our personal and work spaces.  A survey taken in the UK in December with 100 respondents who work from home reported that nine out of 10 of them indicated that they are drinking working hours. It’s easier to drink at lunchtime or drink before the close of working hours.

“Forbidden fruit can lead to a tendency for binge drinking when the alcohol ban is lifted…” 

Women who are battling to find a work-life balance while having ready access to alcohol at home are at risk.  It is important to learn how managers can support women and put a stop to that behaviour?

Seeking comfort in self-medication leads to the brain’s reward system being triggered with a surge of serotonin or dopamine. There is anecdotal evidence of people turning to homemade alcohol-drug concoctions and even drinking hand sanitiser.

For individuals who are addicted and in recovery, social isolation has affected their treatment progress. Thus, they are at greater risk of relapse and an increased risk of using readily available OTC.  

 

Guidelines for EAP practitioners, HR practitioners and Managers

Some people have adapted and found ways to connect, but for many they can’t see family members or travel like they used to.  This isolation leads to people being more susceptible to addictions.  In the words of author and journalist Johann Hari: “The opposite of addiction is connection” – not sobriety.  Thus relationships are the antidote to addiction.  Deepening the connection between substance abusers and their families and communities helps to cure the root cause of addiction.  

It is important to screen our patients for substance abuse disorders when they present high levels of anxiety and stress:

  • Look deeper
  • Ask questions
  • Explore their coping mechanisms 
  • Be alert for signs of behavioural addictions (gambling, online shopping, porn, eating) and be cognisant that they are alone all day without people looking over their shoulder.  

A comprehensive list of the signs of addiction should be compiled for practitioners and management as it is not easy to detect these with a sporadic telephone call or video call. For example:

  • Red or tired eyes
  • Dishevelled appearance
  • Weight gain 
  • Any evidence of stress or anxiety 

It is important to find creative ways to connect with clients virtually. 

  • For example: Embracing technology not just to support vital therapeutic relationships but also to connect with our colleagues.   
  • It is a good idea to put together quick and easy exercises that will regularly connect people.

Continued education and raising awareness in the workplace is vital. 

  • It is a good idea to use SMS and Whatsapp campaigns to continually educate employees along with online talks to keep management up to date. 
  • It is vital to convey that substance abuse and addiction is not a taboo subject.

Continue to review policies that address substance abuse in the workplace

  • To consolidate how the organisation is going to manage substance abuse
  • To reiterate what the platforms there are to support employees.  
  • To enforce that the standing policies substance abuse still stand

 

Review whether management is referring employees to EAP when necessary.  

  • Do supervisors and team leaders know EAP is available and how to make the referral?  

 

Promote work-life balance.

  • Help employees to navigate the blurred lines between work and home 
  • Assist them in making healthy lifestyle choices
  • Have hard or guiding conversations where necessary.  

 

What are employers doing to practically help employees build resilience and grit?  

  • Offer help with healthy eating ideas or a Zoom exercise session in the morning. Run competitions that encourage employees to reach the daily step count. 

 

How are EAPs and HR practitioners connecting with ourselves and practicing self-recovery?

What are we doing to normalise addiction as an unhealthy coping mechanism to ensure that stepping up for help will not cause a person to lose their job or be stigmatised?

  • Practice compassion and empathy – do not blame and shame.

 

Carol answered the following questions in the interactive webinar Q&A session:

Can alcohol abuse lead to some mental illnesses?

“Yes it can. Alcohol is a central nervous system depressant and so serotonin and dopamine levels in the body are affected by alcohol intake. So, depression can be an outcome of alcohol abuse because of how this affects the body’s chemical balance and also because of the stress the addiction causes along with the loss of self-worth and pride that ensues.  It can also exacerbate depression and mental ill-health.”

 

Do you think that rehab can help someone who is indecisive about getting on the wagon?

“Textbooks say, “No”. Without internal motivation and being ready to take this step addicts will not recover. However, some people will go into rehab just to get someone off their back, maybe full of anger and resentment, and then, through receiving good therapy, the penny will drop leading to a shift in their attitude.  It’s worth a try.”

 

How can one get an addict to declare or admit their drug abuse?

“One way is a constructive intervention by loved ones who will prepare concerns and the evidence that may lead to an addict admitting they have a problem.

Another way is to find a way to start and have supportive conversations without pressure (“When you are ready”). Warmth and non-judgemental acceptance is essential as well as to make false accusations toward the person.”

 

What are some of the signs of an employee drinking during working hours when working from home?

“An increase in number of errors, a change in performance, taking extra sick days, not meeting deadlines, a change in behaviour or missing meetings are some of the signs.”

Can workplace policy curb drinking from home?

“Yes it can. The first step is policy adherence and to educate employees as to the consequence of this negative behaviour.  Address the behaviour head on – organisations can be too lenient. A no drinking policy is hours based – not venue based. It makes no difference whether the employee is at the office or working from home. Policy wording should be updated to make  this clear in the light of lockdown and an increase in working from home.”

 

Are there rehabs for behavioural addictions?

“Yes. Most facilities also cover behavioural addictions such as gambling, eating disorders, use of pornography etc.”

 

If an individual has a couple of drinks every day is this an addiction?

“Not necessarily, but there can be negative consequences, because alcohol abuse is a functional addiction – it is a progressive disease that escalates. It could be an addiction if it has a negative effect on the individual’s health or if other people are being affected.

 

Can drinking escalate the incidence of COVID-19 infection?

There is no current research in this regard.

Mrs. Carol Venter

Mrs. Carol Venter

ICAS: Client Services Manager

 

Carol Venter is a Social Worker who started her career at SANCA Alcohol & Drug Central Eastern Cape in 1997 and went on to hold the position of Director until leaving the Organisation in 2006. Carol lectured the substance abuse courses for the Rhodes University Social Work Department for many years and is a treatment professional with the National Responsible Gambling Programme.

Carol Venter has recently completed her Masters in Occupational Social Work at Wits University. Her research study was on substance abuse in the workplace and the impact of the short-term, solution focused approached used by EAP’s in the problem. Mrs. Venter has 8 years experience in the EAP field and have been actively involved in the substance abuse and addiction field for over 20 years through her work at educational institutions, NGOs, in the EAP field and in private practice. The topic of substance abuse and addiction is truly her passion!