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The ways we intervene in curbing addiction to substances has shifted from the medical era, focusing on acute care, to a comprehensive chronic care model. People need long-term support to stay off substances, as well as immediate help to stop using them.
But in South Africa there is silence on alternative and innovative ways people recover. The country has an over-reliance on the medical model. This is despite an acknowledgement that addiction as a disease has physiological effects that have an impact on other areas of functioning. This calls for the adoption of a bio-psycho-social approach which proposes that illness and disease conditions are not only biological but have that they have psychological and social dimensions. Managing addiction requires taking account of all these factors.
My PhD research examined alternative and innovative approaches to curbing the use of a heroin variant known locally as whoonga or nyaope. Opiod use has risen exponentially in the country over the past 20 years. Over 60% of those confined to rehabilitation centres are young black South Africans.
I closely examined the experiences of six young African men between the ages of 20 and 33 who desisted from using the opioid for an average of 3.3 years. They were recruited from the communities of Inanda, Ntuzuma and KwaMashu, north-west of Durban in South Africa.
At the core of the study was an attempt to examine alternative and innovative approaches in curbing whoonga addiction that support recovery and promote prevention.
In my research study the six young men took very different routes to recovery. Some recovered with institutional support, some without. Some took the medical route, others didn’t. Some needed familial and community support. Others didn’t.
The experiences of the six individuals showed that people do recover from addiction, but that when this happens away from the medical or institutional world it’s not recorded.
I concluded from my findings that South Africa should manage opioid addiction by incorporating socio-economic factors into the design of any interventions. These include unemployment, a lack of skills, boredom and a norm of cannabis smoking among youth. Policies should also take account of spiritual issues so that they align with people’s belief systems. There should be an openness to inviting other healing methods, including traditional ones.
Drug use in South Africa
Addiction to whoonga or nyaope transforms participants in profound and harmful ways. The drug is extremely potent and addictive, producing an intensely pleasurable high.
The drug can be snorted, inhaled, injected and mixed with other lighter drugs. In cases of opioid addiction in South Africa, the drug is mixed with cannabis.
Whoonga addiction is usually initiated in pursuit of pleasure, escaping difficult life situations and boredom. The influence of friends and peers dominates.
But it soon becomes a burden. The body becomes a site for pain. And the addicted person stops caring about themselves, others and other life concerns.
Roads to recovery
Participants in this study provide evidence of overcoming whoonga addiction.
Participants found an inner resolve, an idea that to initiate desistance comes from the internal will inside the person. But that this needs to be supported. This echoes the idea of recovery capital – that recovery can be initiated by an individual, but for it to flourish, both internal and external resources are needed. This means that people who were taking opiods were supported to remain sober and to flourish, and in some cases, to initiate quitting.
Support from the family and the community proved necessary to stay sober and achieve a career and flourish, even for participants who underwent solo dry detoxification. This is the most painful and challenging way of quitting without medication to ease pain or going to a rehabilitation institution.
After desistance, challenges of the “risk environment” remained. These were the threats to the recovery process that were associated with initiating drug use in the first place.
Recovery was welcomed by family, peers and the community, who presented participants as models to those who had not stopped, showing them that it was possible. Participants were offered an opportunity to generate a nationwide trend – using social media – to encourage others to quit.
The study demonstrated the use of multiple and complementary ways – professional, non-professional and sole trajectories – to achieve recovery.
The government needs a strategy for dealing with opioid addiction. This should guide different agencies, streamline and coordinate resources, and involve multi-sectoral collaborative approaches.
The strategy should include professional and non-professional ways – including innovative ways – of supporting recovery. In the US, organisations such as Alcohol/Narcotics Anonymous have accepted the movement from a focus on acute care to a focus on chronic care. The UK and Australia have lobbied for legislation and implemented some recovery houses. In the South, Brazil reported on its first recovery house in 2019.
There should also be a concerted campaign to debunk myths about whoonga or nyaope. For example, that they are opioid-based entities. The campaign should also focus on inviting alternative ways of dealing with drug addiction that are sensitive to local needs and use readily available resources.
The country has very few public rehabilitation centres, and those run by the private sector are expensive. This points to the need to devote attention to the fact that communities can play an immense role, including as preventative and after-care agents.
Another innovative approach would be to create peer recovery support groups. These groups would provide communities of former whoonga addicts with a place to go. And participants would present hope to those addicted and the community that overcoming whoonga addiction is a reality. In turn this would alleviate stigma.
Such communities are best positioned to support early recovery experiments in empathic and non-judgemental ways.
Alternative preventative measures should also be put in place. These could, for example, reorientate young people to traditional African ways that support and bolster a sense of pride in who they are.
Instilling mechanisms of earning membership to the community, and guidance on navigating the transition to adulthood, for example, rites of passage among youth, would be necessary. The message is that actions and behaviours reverberate, affecting their communities. For young people to understand the plight of their own communities, teaching individual responsibility for the health and welfare of communities is essential for prevention.
Thabani Khumalo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.