This report includes statistics regarding new clients who entered the Cape Town Drug Counselling Centre’s (CtdCC) treatment programme during 2008, in terms of:

• Demographic profile – referral, age, gender, and residential area;
• Drugging profile – commonly reported drugs of choice;
• Financial profile – employment status, spending patterns on drugs, crime.

The CtdCC is a community based organisation that provides intensive and comprehensive outpatient treatment to clients from disadvantaged, lower income, and under resourced areas in Cape Town and surrounds. These statistics need to be viewed in this context. In all, 787 new clients entered our treatment programmes, 185 at Mitchell’s Plain (MP), and 602 at Observatory (Obs). Of the clients treated at Observatory, 28 lived in Mitchell’s Plain. An additional 85 returning clients were excluded from the data except for ‘Presenting Drug’.

Demographic profile

Ethnic Groups

While the majority of our clients are Coloured (77%), the percentage of Black clients has almost doubled this year to 9%, with the remainder being White (13%).

Table 1: Ethnic Groups

Residential Areas

Overall we drew clients from 167 suburbs. The residential areas most represented overall during 2008 (in order of frequency) were: Mitchell’s Plain, Athlone, Woodstock, Hanover Park, Manenberg, Cape Town Central, Grassy Park, Lansdowne, Bonteheuwel, Retreat, Kensington, Delft and Milnerton.

Gender

The majority of our clients are male (77%). This gender ratio is consistent with worldwide trends amongst people seeking treatment for drug problems. It does not necessarily reflect the proportion of female drug abusers in the community, and may be influenced by social attitudes and other barriers which make it harder for women to seek help for drug problems.

As these findings imply that women are a minority group within our service, we are particularly sensitive to their needs.

Gender ratios did not differ significantly between the two branches.

Referral Sources

About 55% of our referrals came directly from the community itself (family, friend, employer, school and self).

Table 2: Referral sources

Age

Table 3 reflects the presenting age (PA) of clients and the age of onset for drug use (AO). The highest AO category was in the teens (70%) but at least 17% started taking drugs before the age of 13, with an additional 7% unable to recall when they started. This reflects the continuing trend over the years of a decreasing age of onset. This is of extreme concern as the younger you are when you first start using, the more likely you are to become addicted. In addition to this the prognosis for a successful recovery is poorer, as psychological and emotional tools are still in their infancy.

Table 3: Age Profile

From the Presenting Age, it is clear that the CtdCC’s client base comprises mostly young people, with the highest represented age-group being the twenties (52%) followed by teenagers (26%). There were 5 clients under the age of 13. The CtdCC places a strong emphasis on adolescents and has a specialised adolescent treatment stream.

Drugging Profile

Presenting drugs

Table 4 shows our clients’ main drugs of choice. Almost three-quarters of our clients are using Tik (Crystal Methamphetamine) or Heroin. The dramatic increase in the use of Tik has been sustained this year (43%). However, what has been overlooked is the steady increase of Heroin use over a number of years. This year in particular has shown a sharp increase to 29% of clients from 19% in 2007. Treatment of Heroin addiction is especially difficult, due to the severe withdrawal symptoms experienced. We depend heavily on the detoxification unit at Stikland Hospital for inpatient detox. We are also able to prescribe Subutex, a non-opiod detox medication, on an outpatient basis. Of all clients 7% reported substance abuse induced psychotic episodes, mostly due to Tik use.

Table 4: Presenting Drugs

Financial profile

Drug spending patterns

Approximately 83% (n=652) of new clients reported the amount of money they spent on drugs on a monthly basis. These answers are reflected in Table 6. The average monthly expenditure on drugs was R4 322.29. Extrapolating this figure to our whole client base, we estimate that our clients, if still drugging, would have spent over R40 million on drugs alone during 2008. The impact of this, considering that only 27% of our clients are formally employed, is that most of our clients are involved in illegal activities to fund their drug use.

Table 5: Monthly Drug Spending Patterns

Employment status

Employment levels amongst our clients remain low with the majority of clients being either unemployed (53%); or scholars/students (19%). As we charge fees on a sliding scale (according to income), the fact that so few are employed greatly reduces the contribution which clients make to the financial sustainability of our services.

Table 6: Employment status

Involvement in Crime

Of all clients in 2008, 75% either admitted to, or had been convicted of, criminal activities and 42% had spent time in holding cells.

HIV/Aids

While we do not collect data on the HIV prevalence rate amongst our clients, ongoing research in South Africa suggests that drug use is associated indirectly with HIV transmission. Research indicates that, compared to non-drug users, drug users are more likely to engage in risky sexual behaviours such as unprotected sex and sex with multiple partners, due to impaired judgment associated with substance abuse. CtdCC has voluntary counseling and HIV testing as part of our services, as well as risk reduction strategies and psycho-educational HIV lectures.

Related statistics are that 8% of clients reported intravenous drug use, 6% indicated that they had engaged in sex work/transactional sex, and 7% reported some same sex activity.