'The Addiction Was Making Things Harder for My Mental Health': A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service

The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach.

Cannabis use in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

The most available data on the prevalence of cannabis use come from population surveys conducted in high-income countries in North America, Oceania and Europe. Less is known about the prevalence of cannabis use in Africa. This systematic review aimed to summarize general population-level cannabis use in sub-Saharan Africa since 2010.

METHODS

A comprehensive search was conducted in PubMed, EMBASE, PsycINFO and AJOL databases in addition to Global Health Data Exchange and grey literature without language restriction. Search terms related to 'substance', 'Substance-Related Disorders' and 'Prevalence' and 'Africa South of the Sahara' were used. Studies that reported cannabis use in the general population were selected, while studies from clinical populations and high-risk groups were excluded. Prevalence data on cannabis use in the general population of adolescents (10-17 years) and adults (≥ 18 years) in sub-Saharan Africa were extracted.

RESULTS

The study included 53 studies for the quantitative meta-analysis and included 13 239 participants. Among adolescents, the life-time, 12-month and 6-month prevalence of cannabis use were 7.9% [95% confidence interval (CI) = 5.4-10.9%], 5.2% (95% CI = 1.7-10.3%) and 4.5% (95% CI = 3.3-5.8%), respectively. The corresponding life-time, 12-month and 6-month prevalence of cannabis use among adults were 12.6% (95% CI = 6.1-21.2%), 2.2% (95% CI = 1.7-2.7%, with data only available from Tanzania and Uganda) and 4.7% (95% CI = 3.3-6.4%), respectively. The male-to-female life-time cannabis use relative risk was 1.90 (95% CI = 1.25-2.98) among adolescents and 1.67 (CI = 0.63-4.39) among adults.

CONCLUSIONS

Life-time cannabis use prevalence in sub-Saharan Africa appears to be approximately 12% for adults and just under 8% for adolescents.

Depression Symptoms among Family Members of Nyaope Users in the City of Tshwane, South Africa

Substance abuse brings major negative social and health impacts in South Africa. Nyaope, a cocktail drug commonly used in the Tshwane townships, has been well documented to be highly addictive and very difficult to quit. The resultant difficulties include financial, social, and mental, specifically depression and anxiety. This study aims to quantify the depression levels among family members with nyaope users in Tshwane, South Africa. The study used a quantitative cross-sectional design to collect data in nine Tshwane communities. The patient health questionnaire-9 (PHQ-9) screening tool and demographic data collection questionnaires were used to collect data from a sample of 390 male and female family members who included mothers, fathers, grandparents, aunts, uncles, partners, and siblings of nyaope users, and who share a home with them. The ages of the participants ranged from 18 to 87 years, with a mean age of 47 years, while the ages of the nyaope users ranged from 17 to 55 years, with a mean age of 30 years. Depression scores ranged from 0 to 27 with a mean of 7. Depressive symptoms, as measured by the PHQ-9 scores of 5 and above, were reported by 49% of the sample. The levels of depression symptoms ranged from mild to severe, and the severity was higher among female, unemployed, and single participants. As with many others, these participants were not diagnosed and therefore were not treated. The study, therefore, identified that living with nyaope users is associated with the development of different levels of depression symptoms and has resulted in reduced quality of life among family members. The study recommends interventions that intentionally focus on families who live with individuals who are addicted to nyaope. Those interventions should focus on screening and treatment of depression and other mental disorders.

The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

High cellphone use associated with greater risk of depression among young women aged 15-24 years in Soweto and Durban, South Africa

BACKGROUND

The ubiquity of cellular phone (cellphone) use in young people's daily lives has emerged as a priority area of concern for youth mental health.

OBJECTIVE

This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa.

METHODS

We analysed cross-sectional, baseline survey data among youth aged 16-24 who participated in a dual-site cohort study, 'AYAZAZI', conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with 'high cellphone use' defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders.

RESULTS

Of 425 participants with a median age of 19 years (IQR = 18-21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16-2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47-4.31), but not among men (aOR: 0.87, 95% CI: 0.35-2.16).

CONCLUSIONS

Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.

The impact of adverse childhood experiences on the health and health behaviors of young Australian women

BACKGROUND

Adverse childhood experiences have been linked to poor health and adverse health behavior in adulthood.

OBJECTIVE

This study aimed to estimate the prevalence of adverse childhood experiences among young Australian women (aged 20-25) and examine associations between adverse childhood experiences and adult health behaviors and physical and mental health.

PARTICIPANTS AND SETTINGS

Data were from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health, who completed the Adverse Childhood Experiences Scale at Survey 3 in 2015 (N = 8609).

METHODS

Outcomes included: self-rated health, sexual health, psychological distress, depression, anxiety, suicide ideation, self-harm, substance abuse (drinking, smoking, illicit drugs), severe obesity, and exercise. Prevalence of childhood adversities were presented, with the association between childhood adversity and outcomes evaluated using log-binomial multivariable regressions (99% CI).

RESULTS

While 59% of women reported experiencing at least one childhood adversity, 10% of participants reported adverse childhood experiences across four or more categories, indicating a significant burden of risk for young Australian women. Women reporting four or more categories had higher rates of poor physical health (adjPR = 1.79, 99% CI = 1.51-2.12), sexually transmitted infections (adjPR = 1.36, 99% CI = 1.11-1.67), and poor mental health (adjPR = 2.78, 99% CI = 2.34-3.32), and increased rates of severe obesity (adjPR = 2.14, 99% CI = 1.61-2.86) and smoking (adjPR = 2.23, 99% CI = 1.89-2.64).

CONCLUSION

Using nationally representative data, this study shows adverse childhood experiences directly impact physical and mental health, and health behaviors in adulthood among young Australian women. The management of health and wellbeing in adulthood should look beyond the contemporaneous factors, incorporating a focus on how childhood adversity may negatively influence health behavior, health and wellbeing in later life.

Alcohol use predicts emergency psychiatric unit admission for non-fatal suicidal behaviour in the Western Cape (South Africa): a case-control study

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establish whether there were significant differences in patterns of substance use between the two groups.Methods: We employed a case-control design (N = 50) and collected data about participants' substance use in Cape Town, South Africa. Data were analysed using Chi-square and Mann-Whitney tests, factor analysis, and logistic regressions.Results: Prevalence of lifetime Alcohol Use Disorder (AUD) was 60% in the NFSB group and 28% in the control group. 12% of the NFSB group and 20% of the control group had a lifetime Tobacco Use Disorder. Prevalence of lifetime illicit Substance Use Disorder was 44% in the NFSB group and 60% in the control group. Hospital admission for NFSB was associated with: any past 24-hour alcohol use; quantity of past 24-hour alcohol use; quantity of past-month alcohol use; lifetime AUD; past 12-month AUD; and current AUD; and was not associated with the use of any other substances (p<.05). Past 12-month AUD was the best predictor of hospital admission for NFSB, controlling for, respectively, any past 24-hour alcohol use (aOR = 13.33, p = .023) and quantity of past 24-hour alcohol use (aOR = 9.01, p = .022)Conclusions: Patients admitted to emergency psychiatric units for NFSB have increased needs for the treatment of AUDs compared to patients admitted for another psychiatric emergency. Findings support calls for interventions to prevent NFSB among psychiatric patients with a history of AUD.Key pointsRates of substance use among patients admitted to emergency psychiatric units in South Africa were high compared to the general population.Hazardous alcohol use was uniquely associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.Tobacco use and illicit substance use were not associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.The association between hazardous alcohol use and hospital admission for non-fatal suicidal behaviour did not appear to be affected by demographic variables.Patients admitted to hospital for non-fatal suicidal behaviour have increased needs for the treatment of alcohol use disorders compared to other psychiatric patients.

Relationship between childhood abuse and substance misuse problems is mediated by substance use coping motives, in school attending South African adolescents

BACKGROUND

In adults, it has been shown that the relationship between childhood abuse and substance misuse problems is mediated by the belief that substance use helps cope with negative affective states. By contrast, in adolescents, it is unknown whether drug use coping motives play this same mediating role.

METHODS

Secondary analysis of 1149 school attending adolescents in Cape Town, South Africa (average age = 16.24 years, range = 13-23; 60% female). Questionnaire measures obtained during a single test session (among a larger battery) assessed childhood trauma (CTQ), alcohol (AUDIT) and drug problems (DUDIT), and coping orientation (A-COPE) which contained three items assessing drug use to cope with negative affect.

RESULTS

The three types of childhood abuse measured by the CTQ - emotional, physical and sexual - were positively associated with greater alcohol/drug problems, and drug use coping motives. Drug use coping motives mediated the relationships between childhood abuse types and alcohol/drug problems, and these mediational pathways remained significant when gender and other subscales of the A-COPE were included as covariates.

CONCLUSIONS

These data are preliminary insofar as drug use coping motives were assessed with a non-validated subscale of the A-COPE. Nevertheless, drug use to cope with negative affect mediated the relationship between all three types of childhood abuse (emotional, physical, sexual) and alcohol/drug problems in school attending adolescents. The implication is that drug prevention programs for this risk group should seek to mitigate drug use coping motives.

Burden of depressive symptoms and non-alcohol substance abuse; and their association with alcohol use and partner violence: a cross-sectional study in four sub-Saharan Africa countries

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR  =  1.49, p  =  0.008), NAS abuse (PR  =  2.06, p  =  0.02) and IPV (PR  =  2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p  =  0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR  =  2.16, p  =  0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.

Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.