Cape Town - The Western Cape government is struggling to meet the increasing demand for rehabilitation facilities, despite doubling spending by more than R40 million in the past five years.
In some cases, this has led to waiting periods of up to four months at the city’s treatment centres.
In 2008, the Department of Social Development spent R40m on rehab facilities, with the figure rising to R82.6m in this financial year.
Social Development MEC Albert Fritz said that since 2008 the number of treatment centres in the province had increased from seven to 24 while thenumber of spaces at treatment centres had risen from 3 000 in 2008 to 5 000 this year.
Fritz said the substances most commonly abused in the Western Cape were alcohol, dagga and tik.
At a special briefing last week, mayor Patricia de Lille said the city offered a free 16-week outpatient alcohol and drug treatment programme at its five Matrix clinics – all of which had seen an increase in demand.
She said the Cape Town Drug Centre in Mitchells Plain alone had recorded a 15 percent rise in the number of people admitted for rehabilitation. There had also been an increase of 34 percent in the number of patients seeking treatment at the city’s Matrix facilities in Parkwood, Milnerton and Delft South.
De Lille said the growth in numbers had been largely among adolescents.
There are three government in-patient facilities – De Novo Treatment Centre in Kraaifontein, Kensington Treatment Centre in Maitland and the Western Cape Youth Rehabilitation Centre in Eerste River. The centres treat more than 160 people at a time in an eight- to nine-week programme.
In-patient facilities offer a people with severe addictions a place to stay for a fixed term, with 24-hour assistance and care, meals and activities.
Outpatient treatment requires that the client attend regular individual and group treatment sessions while learning to cope in their home environment with the support of family, friends or their community.
With in-patient treatment, Fritz’s department spends an estimated R1 000 a day on each person. This includes the costs of treatment, food, activities and staff. The cost varies from one person to the next because addicts do not necessarily require the same type of treatment. Some need psychiatric and medical assistance, while others do not.
The manager of the De Novo Treatment Centre, Charmaine Fledermaus, said there was sometimes a long waiting list because of the number of court-ordered patients referred for rehab.
Previously, 100 people had been on the waiting list. The centre had, however, managed to reduce this to a more “manageable” 70 people.
Fledermaus said addiction was a “relapsing” disease. There was no way of attributing a success rate to a treatment centre because “it really is up to the person”.
An ideal scenario would be to have a research programme where each patient could be monitored for a year or two to measure their success, but even with large investments being made in the Western Cape, resources were limited.
Those people who need continuing care rely on social workers and community-based aftercare facilities.
Fritz said once clients had completed their programme they received aftercare comprising individual support and follow-up sessions with their case manager and group sessions with organisations such as Alcoholics Anonymous.
When the Cape Times visited De Novo last week, people had been divided into groups. Some were participating in group sessions, while others were watching a film in the library or participating in art classes.
De Novo takes an eclectic approach, combining psychological, psychiatric and medical treatment with occupational therapy and life skills.
Sports, debating, art classes and gardening are also ways of providing therapy.
“It’s all part of the package,” said Fledermaus.
“We try a little bit of every model.”
Leana Goosen, facilities manager for the three government centres, said in-patient care should be the last resort and for severe patients only.
She said people tended to want in-patient treatment as a “one-stop cure”, but it was a longer-term problem that required long-term help at home and in communities.
The clinical director of the Harmony Addictions Clinic in Hout Bay, Farahnaaz Dyer, said the facility took in about 30 patients.
She said some Harmony clinics occasionally had waiting lists, but this was not usual because they were expensive. A high-end private treatment programme could cost as much as R60 000.
While the treatment programme is 30 days, the centres recommend that clients stay for secondary and tertiary care if they can afford to. Some might even move into a “sober living” community.
“For some people, it’s risky to go home. The longer they can stay, the better because it will have a better outcome if they have been addicted for a long time,” said Dyer.
“For various reasons they don’t go home, and stay with us. I wish everyone could afford this kind of help.”
David Fourie, regional director of the South African National Council on Alcoholism and Drug Dependence, said he would like to see outpatient treatment as an entry point of treating substance abuse.
“If people can manage with outpatient treatment, this is better for them” because sooner or later they have to return to their home environment, Fourie said.
“It’s better they can handle being there (at home) in the first place.”
Outpatient treatment help with relapse prevention was monitored in the home environment and was much easier for people to apply to their lives.
Fourie also said patients should attend individual and group sessions in community-based treatment centres.