Picture: ISTOCK
Picture: ISTOCK

Four out of 10 patients in drug rehabilitation centres in the Western Cape have mental health problems, according to the South African Community Epidemiology Network on Drug Use.

Yet their underlying mental health issues are frequently neglected or undiagnosed, compromising their chances of recovery, says Lize Weich, head of addiction services at Stikland Psychiatric Hospital.

In SA, the division of labour that makes mental issues the responsibility of the health department and drug and alcohol addiction that of social welfare compounds the challenge. Most other countries view addiction as a medical disorder and house its services solely within health, she says.

Weich heads Cape Town’s only medical opioid detoxification unit, which provides care to patients so stigmatised that no other state hospital has been prepared to take them on.

"There is a misunderstanding that if you have a drug addiction you are a violent criminal," she says. "People need to understand that it is an addict’s illness that is driving their behaviour."

This compassion is clearly evident among the women and men who work in the 10-bed opioid detoxification ward. There is no waiting list because staff will never turn away an addict trying to get clean.

I was diagnosed with ADHD when I was a child. Only recently did I realise it played a big part in me using heroin. It helped me calm down.

The unit is so clean that even its door knobs gleam and the cleaners have been known to take pity on recovering addicts complaining about the healthy food and bake cookies for them.

The week-long medical detoxification at Stikland is just one step on a patient’s path to recovery. After they are discharged, they will go into an out-patient programme that helps them to understand their addiction and how to deal with their emotions, and teaches them the skills to reject drugs.

Weich regards addiction as a chronic disorder. Thus a relapse is not a reason to give up on a patient but an indication they should adjust the treatment.

"With any chronic illness, be it asthma or diabetes, there will be times when things go wrong," she says. "There are often little slips with addicts, but we can still improve their functionality, increase their participation in the community, reduce crime and improve their welfare."

Many addicts try to stop using drugs multiple times before they find an approach that works for them.

"Even when I was in active addiction I could always get assistance here, be it harm reduction or detox," says Derek (not his real name), a 29-year old recovering heroin addict who has been admitted to Stikland half-a-dozen times.

He started using drugs at the age of 15 and, like many of the unit’s patients, has an underlying mental illness that is intimately intertwined with his addiction.

"I was diagnosed with ADHD when I was a child. Only recently did I realise it played a big part in me using heroin. It helped me calm down."

Derek has been clean for 18 months, has his first job and is studying for his matric exams. This time he hopes he has well and truly kicked the habit, helped by Suboxone, an opioid substitute that reduces cravings.