Is relapse preventable? An integrated model of aftercare for people with substance use disorder in KwaZulu-Natal, South Africa

Title : Is relapse preventable? An integrated model of aftercare for people with substance use disorder in KwaZulu-Natal, South Africa

Abstract:

Introduction

There is currently a high global burden of substance use, which is burdensome to the public health and welfare system. Adequate treatment, including aftercare services, is often limited worldwide. In South Africa (SA), substance abuse contributes considerably to morbidity and mortality and treatment services are not only limited but also fragmented among stakeholders.  Furthermore, there is a high rate of relapse despite efforts to prevent relapse, which raises a question: Is relapse preventable?

Objectives

This study aimed to propose an integrated model of aftercare for individuals with substance use disorders following the inpatient treatment phase in a public facility in KwaZulu-Natal, South Africa.

Methods

A qualitative study in two phases. The first phase involved policy analysis, and the second phase consisted of two stages. Stage one was semi-structured and included focus group interviews with forty-six participants (n=46) representing all five levels of Beer’s Viable System Model, drawn from governmental and non-governmental organisations. Stage two consisted of semi-structured interviews with five persons with SUDs and their family members (n=5). Data was analysed thematically.

Results

Findings indicated that South African policies did not provide clear guidelines on aftercare. Aftercare was found to be lacking, fragmented, poorly coordinated among service providers and not well integrated into the substance use treatment system. The needs of service users demonstrated the extent and nature of aftercare required, including the need for relapse management as opposed to relapse prevention. An integrated model is proposed, including principles of relapse management.  

Conclusion

The extent and nature of aftercare services warrant integrated, lifelong, and responsive aftercare services within SUD treatment systems, tailored to meet the needs of individuals with SUDs and their families. An integrated recovery management model of care is proposed, along with relapse management strategies essential for healthcare practitioners.

Biography:

Dr December Mpanza is a senior lecturer and head of the department of Occupational Therapy at the University of KwaZulu-Natal, South Africa. He is an Occupational Therapist and Public Health scholar with over 17 years of experience in clinical practice, academia, leadership, and public health systems research. His work focuses on substance use disorders, mental health, rehabilitation systems, and models of care, including aftercare, particularly in public health contexts in South Africa. He is also the founder and director of Seamless Occupational Therapy, a private practice in South Africa focusing in mental health and addiction.