02 October 2008

South Africa's silent victims

Children of people who abuse alcohol or drugs have become the silent victims of a growing problem. Sadly, South African statistics are right up there with the rest of the world.

Imagine growing up in a home where your parents regularly abused drugs or alcohol. Where nothing is more important than their next drink or hit, and simple life basics, such as eating and washing, are not a priority. Many South African children don't have to imagine such a horrendous scenario - because it's their reality.

Sarah Fisher (executive director Substance Misuse: Advocacy, Research and Training) recently gave a presentation at the Children and Injuries Conference in Cape Town. She spoke about the growing number of children in SA who are what she dubbed the "silent victims" of this problem.

Lots of kids report family drinking
Fisher was part of a school-based prevention programme for high school learners in Cape Town which was focused on warning people about the dangers of alcohol and drugs.

In the post-programme questionnaires, Fisher asked learners: "Do you have a close family member (parent, grandparent, brother or sister) who you think has a drinking or drug problem?" The response was staggering.

"Out of about 70 000 learners over a period of four years, just over 30% of grade 8 - 12 learners said ‘yes’. Alcohol was the main problem," she said.

The survey also revealed that in the lower grades the percentage was higher, and in some cases up to 60% of the learners admitted a close family member had a problem.

"It was unclear if this was because they perceived it as a problem when they were younger, but as they got older began to see it as ‘normal’ (i.e. the learners' perception had changed), or because as we went up the grades the children who stayed in school longer were from less problematic families."

Fisher said that while this wasn't actually a formal study, it provided insight into the fact that South Africa is not very much different to anywhere else in the world when it comes to parents who abuse drugs and alcohol.

The South African problem
While the number of people who abuse drugs and alcohol in SA is growing, Fisher pointed out that referring to this problem as "addiction" was not entirely accurate.

"Addiction comes at the end of a long line of damage, and far more people who use alcohol and drugs riskily cause far more problems than people who have become dependent. Problem drinkers cause as much damage, and the ordinary person who has three glasses of wine/beer (over the legal limit) at a braai and gets into a car can often terrify their child who has been sensitised at school to that sort of thing. The mother who gets drunk at a school function is just as damaging as the dad who smokes cigarettes, as children know it kills people," she said.

Yet she added that children whose parents regularly abuse alcohol and drugs, such as tik, are often the most "damaged" because they often suffer gross physical and sexual abuse as a result of their parents' intoxicated state.

What about the children?
Fisher said that children in such situations are often very angry, although sometimes passively, and they often have difficulties with relationships, and concentration.

"Children who have lived in methamphetamine/tik-affected households, they are often very, very, very angry – they have lived in angry chaos, been exposed to all sorts of weird (often sexual) stuff and are considered so ‘at risk’ that in some states in the US they have set up special services for these children. All the research tells us that kids who grow up in alcohol- and drug-affected homes often use drugs and alcohol themselves," she said.

The anger, she said, is often mostly directed at the parent who doesn’t drink or use drugs, because they feel that the sober one should be able to do something about it, especially if there is physical abuse going on.

"Some children overachieve in order to deal with it, proving to the world there’s nothing wrong in the family and hoping like mad that success will somehow stop the problem," she explained.

Continuing the vicious cycle
Fisher noted that alcohol misuse is "a major contributor to general family dysfunction and children in homes where parents are misusing alcohol are at risk of neglect and abuse".

She cited research which showed that:

  • Children of parents with alcohol problems or who have several family members who abuse alcohol are at greater risk for alcohol problems, and often start drinking at a younger age and progress towards problems quickly. They're also between four and 10 times more likely to develop problems with alcohol themselves than children who have no close relatives with alcohol problems.

  • Money for alcohol often takes precedence over other household financial needs, often leaving families unable to afford even basic goods and services.

  • Continuing patterns of drinking threaten family life and events that take place when a family member is intoxicated can also have long-lasting consequences, as can alcohol-related violence.

  • Among Grade Eight and 11 learners in Cape Town a significant association was found between past-month use of alcohol and the number of days absent from school and repeating a grade. The odds of repeating a grade were 60% higher for learners who consumed alcohol. (Whether this relationship was causal or occurred through another factor was not established).

What is the most abused substance in SA?
Alcohol. Fisher referred to the Alcohol Abuse Reduction Strategy prepared by herself and her colleagues for the Department of Community Safety Liquor Control Project in 2007.

A review of the Medical Research Council's research on alcohol and drug abuse in the Western Cape between 1997 and 2004 showed that:

  • One in three males and one in five females in Grade 11 in Cape Town had engaged in binge drinking over the previous two weeks (1997), and 80% of adolescent drinkers have been drunk at least once (2002).
  • Over one quarter of drinkers in the Western Cape drink at “risky” levels over weekends (1998).
  • More than one in two non-natural deaths in Cape Town in 2002 involved alcohol levels 0.05g/100ml.

Is there a solution?
Fisher said she believed the solution lies in "a range of different levels of accessible, effective culturally competent interventions that we know work because research tells us so. We haven’t got time to guess or experiment."

She added that while many people are doing many things, the problem is that there is not very much co-ordination between the relevant groups. Another big problem, she said, is that we're not listening to the research.

"It is a primary health issue – a chronic relapsing health condition (fundamental and molecular changes in the brain and body) much like diabetes or heart disease. By the way, more people recover who have been diagnosed with alcohol and drug disorders including dependence/addiction, than those diagnosed with cancer.

"Diabetics and heart patients relapse into their unhealthy lifestyles far more often than drug and alcohol patients who have been treated by qualified professionals using research-based programmes (including medications). No-one judges the heart patient who continues to smoke cigarettes or the diabetic who has a limb cut off because they refuse to stop eating sugar…" she concluded.

Source: Sarah Fisher (executive director Substance Misuse: Advocacy, Research and Training); Parry CDH Substance abuse trends in the Western Cape: Summary; World Health Organisation. World Health report 2002; Parry CDH, Dewing S. A Public Health Approach to addressing Alcohol Related CrimeAfrican Journal of Drug and Alcohol Studies, Vol 5 (2) 2006; Alcohol and Drug Abuse Trends: January – June 2006 (Phase 20): SACENDU, ADARU, MRC (Cape Town); Parry CDH. (2005). South Africa: alcohol today. Addiction 100: 426-429; World Health Organisation (2005) Alcohol and Interpersonal Violence. International Policy Briefing. Draft Document. Geneva; NIAAA, NIH. Alcohol Alerts No 67: Underage Drinking January 2006; WHO Working Group. Report of et al. WHO working Group on Lifestyles and Behaviour Change. Copenhagen: WHO 1999; Flisher AJ, Parry CDH, Evans J, Muller M and Lombard C. (2003). Substance use by adolescents in Cape Town: prevalence and correlates. Journal of Adolescent Health, 32, 58-65. South African National Department of Social Development. Policy on the Management of Substance Abuse. Pretoria, 2005.

(Amy Henderson,, October 2008)

Read more:
Drugs: special report
Damaging our children


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