It’€™s here that thousands of people struggling to shake a crippling substance abuse addiction rotate through the halls of the country’€™s drug rehabilitation treatment facilities. But if they don’€™t have medical aid or private funding, their attempts to make their home in one of the country’€™s rehab facilities for a three- or six-week in-patient program is a daunting, sometimes impossible, task.

Alcohol remains the number one drug of choice for South Africans, with a drinking population boasting one of the world’€™s highest rates of alcohol consumption, according to the most recent World Health Organization report in 2004.   Each drinker here is estimated to guzzle 16.7 litres of alcohol per year. More than 27 percent of South African men and nearly 10 percent of women admitted to being alcohol dependent, according to a 1998 survey in that report.

Other substances have a strong hold in the country as well.  The Central Drug Authority, the monitoring body within the Department of Social Development that oversees drug issues, estimates that 3.2 million South Africans use marijuana, 100 000 used opiates, 290 000 used cocaine, and 320 000 used ATS.

Brendon started on the road to addiction by smoking dagga on his 17th birthday. Today, the 33-year-old Johannesburg resident says that when he wanted to get help shaking his cocaine and alcohol addiction, it was nearly unattainable.

‘€œThere was also an economic obstacle as I couldn’€™t afford to send myself and for a few years I never had medical aid after I left the bank [where he worked].When I was finally ready to speak to my family, I was worried they would not be able to help me because of the cost,’€ he said.

The cost of a private rehabilitation treatment facilities typically begins around R17 000 for a six-week stay and can go up to more than R90000. Most medical aids will cover up to 75 percent of that cost.

Only 16 percent of the more than 10 000 who entered into rehabilitation services between January and June last year used medical aid to pay, according to calculations from numbers from the most recently available statistics by the South African Community Epidemiology Network on Drug Use.  

‘€œIt is obviously preferable to have someone [who has a serious addiction] in an in-patient facility but availability and affordability is always a problem,’€ said Andres Pluddermann, senior scientist in the Medical Research Council’€™s Alcohol and Drug Abuse Research Unit.

Today, hundreds of people are on waiting lists for a government-subsidized spot’€”reserved for those who cannot afford treatment and don’€™t have medical aid’€” in drug rehabilitation treatment facilities across the country. Most will wait at least two months and sometimes more before a bed opens up, according to more than a dozen rehabiliation facility directors who spoke with Health-e News Service.

Dr Stan de Smidt, manager of the Western Cape’€™s state-owned rehabilitation facility, De Novo Treatment Centre said the 100-bed facility had at least 180 people on their waiting list. He said the waiting period was at least two months.

Madadeni Rehabilitation Centre, a state-owned facility in the outskirts of KwaZulu Natal, will only admit new patients in October this year because of the influx of people on their waiting list

Government subsidises in-patient beds in drug-treatment facilities, for impoverished addicts without medical aid. The subsidy covers a varying proportion of their care while the facilities fund the remaining balance’€”typically several thousands Rands–of the patient’€™s expense through fundraising and donations.

According to the country’€™s leading nationwide rehabilitation organisation the South African National Council on Alcoholism and Drug Dependence, the total number of people in treatment has increased 34 percent to 11 682 addicts in 2010, from 8 713 in 2006. Their figures show a 6 percent increase over last year’€™s 11 012.

SANCA has 31 centres and 30 satellite centres nationwide; 10 are in-patient.

 Meanwhile, some provinces, like Limpopo and Northern Cape, have no registered in-patient rehabs at all. Addicts there are sent to in-patient facilities in the Western Cape, Mpumalanga or Gauteng. There, they are put on the end of waiting lists as out-of-province-residents, awaiting the generosity of that province’€™s finances.

Limpopo’€™s Far North Alcohol and Drug Centre Polokwane, an out-patient facility, director Riette Vin Der Linde said that without an in-patient facility in the province, the burden of treating Limpopo residents with substance abuse problems falls on other provinces, which can be met with resistance.

‘€œWe struggle to get them in because [provinces] look at their people first,’€ said Vin Der Linde.

The implications to rural areas are far-reaching.

‘€œPeople who enter treatment are often those who are at the last point or near the final point of their problem so you would find a lot of problems with alcohol abuse in more rural areas where there aren’€™t any services and very little being done by centres to do prevention work,’€ said Pluddermann. ‘€œThose problems are probably quite likely to continue unchecked.’€

The lack of services has implications for broader society as well.

‘€œIf we don’€™t deal with substance abuse as being a major problem, all your other efforts in your problem areas are not going to be effective as they should be,’€ said Dr. David Bayever, deputy president of the Central Drug Authority, the body within the Department of Social Development overseeing substance and rehabilitation issues.

Hope is not entirely lost. Letitia Bosch, substance abuse coordinator for the City of Cape Town, said outpatient facilities’€”which typically cost less’€” could help cut down on waiting lists.

‘€œTraditionally people believe that it is better to send those with substance abuse problems away but that is not always an option. The message we are trying to convey is that people do not need to be sent away for them to be treated,’€ she said.

She acknowledged that out-patient won’€™t work for everyone. The severity and duration of your addiction as well as the type of drug, such as heroin, also determine if you need in-patient care.

A new bill to update the current Prevention of and Treatment for Substance Abuse Act, enacted in 2008, proposes that the government establish at least one in-patient facility in each province to help address these problems. Other regulations and restrictions included in the bill would create more stringent guidelines for rehabiliation centres to follow. The CDA is also drafting a new National Drug Master Plan, to address the evolving substance problem.

‘€œThe job is far bigger than what we are capable of dealing with, in that we are only 12 people,’€ said Bayever.   ‘€œThe new act ‘€¦ will double the number of facilities so that already in itself is a move in the right direction.  [It recognizes] the importance of dealing with substance abuse as an underlying common thread beneath other social ills.’€