Introduction

 

            The
following paper is an essay based on the National Drug Master Plan in South
Africa between the years of 2012 and 2016. The purpose of this essay is to
state the extent to which evidence-based research has influenced the policy
with regard to the most effective ways of reducing illicit drug abuse in the country.
It will also explain the ideological and/or discursive considerations that are
associated with the chosen policy.

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Background

Illicit drug abuse in South Africa

 

         According
to Thomson (2013), illegal drug consumption in South Africa is double the world
norm. Some of the illicit drugs most commonly used in South Africa include
Cannabis, Heroine, Cocaine, Methamphetamine, Mandrax and Ecstasy (Pelzer,
Ramlagan, Johnson & Mafuya, 2010). The major contributing factors to the
abuse of these drugs are primarily poverty, reduced mental health, poor
personal and social competence, unemployment, lack of education and peer
pressure (United Nations Office on Drugs and Crime, 2004). Sadly, abusing
illicit drugs does not only result from
the above-mentioned factors, but can actually lead to many of those factors as well. In addition to this, the
South African Police Services (2014) have reported that up to 60% of all crimes
nationally are related to substance abuse. With South Africa being named one of
the drug capitals of the world (Christian Drug Support, 2014), there is a dire
need for interventions at policy level, to assist in curbing the alarmingly
high rate of illicit drug use in the country.

 

National Drug Master Plan 2012-2016

 

The word policy, can be defined as “a set of ideas or a plan of what to do in particular situations that has been agreed on officially by a group of people, a business organisation, a government, or a political party” (Cambridge Dictionaries,
2014). This being said, the National Drug Master Plan is a policy as it is a countrywide
plan drawn up by the Central Drug Authority (CDA), approved by the parliament
and supported by President Jacob Zuma. It is a set of guidelines that has been
developed to serve as a basis for cost-effective and holistic strategies to bring
about a reduction in the supply and demand of illicit drugs as well as reduce
the harms associated with these drugs (CDA, 2012). The stakeholders involved in
the policy include up to 12 different government departments, as well as many
more research institutions and supporting companies, some of which include the
South African Revenue Service and the National Youth Development Agency.

 

Evidence-Based Research in Policy, and its Affects On
the Health and Lives of Users

 

The National
Drug Master Plan is a policy that was not simply drawn up based on assumption,
but rather rigorous research across all aspects of illicit drug use in South
Africa. This began at community level, where needs assessments were carried out
in various communities hard hit with the problem. This allowed the CDA to draw
up a comprehensive list of community needs in order to tackle the problem of
illicit drug abuse, based on what the community members said themselves. This
list will further be described in the paper under the section of ideas and
ideals. The NDMP was also developed using notions from previous policies that
have been effective. From these past policies, it was observed that when
combatting illicit drug use, a multidisciplinary approach works best. This
means that the policy should not be based on a single strategy, but many
integrated strategies to tackle the problem. With this in mind, the CDA
formulated the policy on a 3-approach basis, namely demand reduction of illicit
drugs, supply reduction of illicit drugs and harm reduction of illicit drugs,
focusing on methods to limit the damage caused to users.

 

Within the
communities researched, not only did the CDA learn about what the communities
need, but also where they stand in terms of employment, age, population
distribution, gender, social gradient, the types of drugs most used and the
demand for treatment etc. This gave the CDA a clear and holistic look at how
some of the specific community factors affect drug abuse and what people are
willing to do to stop. This will also be elaborated on further under the
ideological considerations section further down in this paper. Before writing
up the NDMP, the CDA, together with other stakeholders conducted research on
past policies tackling the same issue to determine exactly what worked and what
did not. Other policies and their effects are listed within the NDMP. Some of
the knowledge gained from this included:

1)                   
There is no single effective drug policy- due to the
fact that there is no single drug problem; there is no single miracle that will
effectively tackle drug abuse.

2)                   
Prevention programmes have modest impact- whether it
be amongst family, school or community, merely prevention programmes don’t
serve to give the most satisfying impact unless done in conjunction with other
strategies.

3)                   
Increased punishment yields little benefit- being imprisoned
for illegal drug consumption has shown no real decrease in drug use.

4)                   
Crop destruction does not result in a decrease in
supply- destroying drug-producing plants has not shown a reduction in the
average supply of drugs.

 

The NDMP states
that all policies can and should be grounded on evidence-based research to
increase efficacy and effectiveness of the policy. It goes on to say that
scientific research carried out for policy development is crucial as it serves
as proof or verification of what has worked, what has not and what can be
altered. The NDMP categorised the scientific research conducted by the CDA into
three main categories. Firstly, efficacy
studies, this can also be called evaluation studies as it measures the natural
changes due to the intervention over time. Some of the efficacy studies
reviewed for the development of the NDMP include peer help/social support
interventions, which would fall under behavior change. Numerous studies using
this intervention as part of an integrated approach depicted a reduction in not
just drug use, but crime and infections too. Secondly, there are natural
experiments, which monitor the changes in environment with regard to the way it
affects drug use. Last, but not least, there are effectiveness researches,
which serve to observe how effective an intervention is and why. All three
types of scientific research were used in the development of the NDMP to ensure
the quality and value of the policy.

 

            Monitoring and evaluation of the
previous NDMP used between the years of 2006-2011 was also done to improve and
further adapt the policy for 2012-2016. This can also be called evidence-based
research, as it is the process of finding out what is significant and what is
not.

 

            For the past two-years the CDA has
been involved in a pilot project, looking at Injecting Drug Use (IDU) and its
relation to the increasing numbers of disease infections, namely HIV/AIDS. The
NDMP has been developed also with this issue in mind, and the CDA have
researched previous policy formulations on IDU, concluding that addressing IDU
effectively reduces the spread of HIV/AIDS and other infections, even much more
than originally assumed. This is the reason why the NDMP has focus on IDU, as
it will improve the health of users not just from a drug point of view, but
beyond.

 

            Last, but not least, evidence-based
research has shown that policy addressing employment has a substantial impact
on the health of communities. This is because, when employment status is
increased and income is generated, people have more control over their lives in
terms of making healthy, rational decisions and even seeking care or treatment.
Having a steady income also allows an individual to be more mentally,
personally and socially stable, resulting in less people seeking drugs to
alleviate their psychological pain. Employment reduces poverty, which as said
in the beginning of this paper, is one of the biggest contributors to drug
abuse. After researching this in detail, the CDA have included addressing
poverty and unemployment in the NDMP.

 

(Central Drug
Authority, 2012)

 

 

 

 

Ideological and Discursive Considerations Within the
NDMP

 

            According
to the Oxford Dictionary (2014), the term ideology can be defined as “a system of ideas and ideals,
especially one that forms the basis of economic or political theory and policy”.
Some of its synonyms include beliefs, principles, ethics, theory and
philosophy.

 

Ideas Surrounding the NDMP

 

1)    The idea of moving from a top-down approach
to a bottom-up approach: the bottom-up approach is an idea that differs
drastically from the ‘one-size fits all’ conventional national policy approach.
By utilising this method, the NDMP aims to put primary emphasis on the
community itself to develop different solutions to address specific needs. In
addition to this, the NDMP has adopted a continuous monitoring and evaluation tactic,
not just on policy activities, but still focusing on the needs of the
community. This allows for constant improvement and measure of achievement by
looking at indicators, outcomes, targets etc.

2)    The idea of the term ‘drugs’: for purposes
of the NDMP, the term drugs is derived from the Drug-Trafficking Act (Act No.
140 of 1992), which include commonly abused licit drugs like OTC drugs, to
alcohol, tobacco and other volatile solvents, as well as other undefined and
illicit substances which may cause harm and are dependence-forming. The NDMP is
a policy that addresses all of the above drugs.

3)    The idea that rural areas need less
attention compared to urban areas: due to the fact that urban areas hold the
majority of the drug user population at 43%, many past policies have put their
focus there. The CDA observed that up to 33% of the drug user population lies
within rural areas, although less than urban, it is fast increasing, and so
have made addressing rural communities just as much a priority area as urban.

 

 

(CDA, 2012).

 

Ideals Surrounding the NDMP

 

            The ideals of the NDMP
are basically the principles of the policy and what is needed to be done to
make the policy intervention a successful one, and is focused on addressing
what the community needs to combat illicit drug use.

 

1)    Better parenting: due to the fact that
parents and family are the primary contacts and caregivers of children, the
need for the development and application of parental skills and competencies
will enable people from a young age to deal with the issues surrounding
substance abuse.

2)    Increase in recreational facilities: this provides
opportunities, especially directed at the youth to pass time in a fun and safe
manner, time that could otherwise be used to take drugs.

3)    Emphasis on spirituality: the provision of
facilities that enhance spirituality and religious observance will mean an
increase in people identifying their value believing they can do better than
drugs, and following a different, healthier and happier path of life.

4)    Law enforcement: by applying protocols,
laws, policies and practices to those who do not abide by the law, will reduce
the threat of substance abuse if done in conjunction with other strategies.

5)    Rehabilitation: this gives existing users
a chance to turn their lives around for themselves and their loved ones. This
includes detoxification, aftercare and reintegration into society.

 

(CDA, 2012).

Ethical Considerations Surrounding the NDMP

 

            The NDMP being a national policy plan means that it
has been implemented across South Africa, in both rural and urban environments.
This being said, it is of utmost importance to facilitate interventions that
are successful- brining about overall benefit, but to also be culturally
sensitive. This includes sensitivity to both language and practices so that no
one is offended in the process. Data collected in the needs assessment and
throughout application of the policy will also include personal and sensitive
information regarding topics such as drug use, disease status etc. This is why
it is important to not just get informed consent to receive this information,
but to also keep it confidential. No harm is to be done in any way, before,
during and even after the policy implementation.

 

Theoretical Support of the NDMP

 

There are two
main theories supporting the NDMP; namely the Biological Theory, as well as the
Theory of Behavior Change.

 

1)                   
The Biological Theory: With regard to illicit drug
abuse, this theory focuses on the effects of drugs on the biological physiology
of the user. According the National Health Service (2014), Cannabis is a
calming drug, but can have serious effects on the body. This includes changing
chemical balances in the brain resulting in poor mental health, and when smoked,
increases a person’s risk of developing asthma, lung cancer and cardiovascular
disease. Cocaine and Heroin causes a short-lived intense ‘high’ (Drug Free
World, 2014). It has many side effects such as loss of appetite, nausea,
hallucinations, vomiting, paranoia, damaged blood vessels, malnutrition and
depression to name a few. There are hundreds of other drugs that have the
ability to cause havoc in the body. Drug addiction leads to serious damage in
every aspect and can easily result in death.

2)                   
Theory of Behavior Change: This is the predominant
theory surrounding drug abuse. This is because no matter what intervention is
in place, it will always come to the decision of the user to stop and make a
change. One of the models within this theory, known as the Health Belief Model
would be apt in this policy as all the strategies in the policy will lead the
individual to make a decision based on their perceived susceptibility, severity
and benefits as well as determine their cues to action and be able to maintain
their decision of giving up their addiction (University of Twente, 2014).

 

 

Conclusions

 

         The
National Drug Master Plan 2012-2016 has the ability to be highly effective if
all the stakeholders involved are able to pull their weight. Being developed on
the highest forms of evidence-based research means it is a comprehensive and
very strategic plan, aimed for success. The parliament, minister of social development
and the president have all pledged their support for the policy, and it will
surely reduce the high rate of illicit drug use in South Africa by decreasing
the supply, demand and harms of the drugs. A large part of the NDMP is based
around ideological theories that have proved to be worth the effort. From here,
we must allow the policy to be implemented correctly to bring about the desired
outcomes for the overall benefit of the country now, and in the years to come.

 

 

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