Alcohol and drugs – Triangle Project

Many people use alcohol, tobacco and other drugs, and everybody has their own reasons and motivations. Not everyone who drinks or uses drugs experiences significant problems or dependence.

Substances can be classified as either depressants, stimulants or hallucinogens. Depressants slow down the brain and the body (alcohol, heroin and other opiates, cannabis, mandrax). Stimulants speed up the brain and the body (amphetamines, kat, cocaine, ecstasy, nicotine). Hallucinogens change the way you see, hear or think about things (acid, ketamine, DMT).

Substance use in South Africa is widespread and the relationship between substance use and HIV and hepatitis C risk is well documented. However, in order to understand the relationship and for it to be meaningful, one cannot ignore the broader social context. A culture of violence and forced removals, which in part give rise to gang culture as a sense of belonging, inequality, poverty and living in areas with high rates of violence or fear of violence all play a role in placing people at risk of substance abuse and risk taking behaviour.

South Africa still faces challenges related directly to its historical experiences with apartheid. Large racial and gender disparities persist in terms of income, access to education, housing, and health care. High rates of unemployment adversely affect equal access to jobs, particularly among South African women, specifically Black African women, who often lack adequate education and job skills and are more likely than men in all racial categories to be unemployed. It should not be surprising then that being Black, a woman and lesbian puts one at a high risk of substance abuse. Moreover, many LGBTIQ people and people living with HIV may use drugs or alcohol to cope with stigma, discrimination, low self-esteem, deal with trauma and to enhance sexual experiences.

Drinking or using drugs too much may cause mental illness, different cancers, heart problems, infections, and also cause relationship, employment and financial problems. Depending on how often, how much and whether you snort, smoke, swallow or inject these substances will determine if you eventually become dependent on drugs and alcohol so much that you need to have it every day.

Is my alcohol or drug use problematic?

Are you concerned that your alcohol or drug use has gotten out of control? Below are some questions that can help you think about your alcohol or drug use. While it can be difficult to admit how much you have drunk or used, it is best to be honest with yourself, especially if you need help or want to change.

Have you ever felt like you should cut down on your drinking or drug use?
Is your drinking or drug use affecting your relationships with family, friends or partners?
Is your drinking or drug use affecting your work life, or day-to-day life? Are you still drunk, high or coming down at times when you’re expected to be sober?
Have you gotten into financial difficulties due to your alcohol or drugs use?
Are you able to enjoy yourself in social situations without drinking or using?
Are there things you used to be passionate about before you started drinking or using more often? Is drinking or using and recovering taking up time you used to spend on other things that you enjoy doing?
Do you ever use alcohol or drugs to self-medicate (drinking or using to relieve stress or get rid of negative feelings)?
Have you ever put yourself at risk while drinking or using drugs?

Want to reduce your alcohol or drug use?

It doesn’t matter how much or how often you drink or use drugs, if you want to change, control, reduce or stop completely, there are ways to help you do that. Different strategies will work better for different people, and it might take some time to find what works best for you.

Calling a helpline can be a good place to start. Listed below are a range of helplines in South Africa, specialising in different services. Seeking out supportive family and friends can also be an important way to stop or reduce.

Try keeping a journal or writing things down to keep track of your drinking or drug use. The more you know about your own use, the easier it will be to find strategies to reduce or stop.

How much do you drink or use? How often?
In what situations do you drink or use? (at parties? at home? with friends? alone?)
How do you feel before, during and after you drink or use drugs?
What gives you the feeling of wanting to drink or to use?

Changing your circle of friends might be a necessary step. If your whole social life, and your friends in it, revolves around drinking or drug use, you might need to step away from that (at least for a while) in order to reduce your own use. This may be difficult, but you need to put your own health and wellbeing first.

Attending peer support or group programmes such as Alcoholics Anonymous, Narcotics Anonymous or other 12-step programme might work for you. Check out their websites for meeting locations and times.

In-patient treatment facilities might be useful, but are not easily accessible due to lengthy waiting lists, and private rehabilitation centres are far out of reach for most people due to exorbitant fees charged.

Alcohol, drug and mental health helpline numbers in South Africa

Suicide crisis line:
0800 567 567 or sms 31393

Depression and Mental Health Helpline:
call 0800 567 567 daily between 8am and 8pm for counselling and referral if you’re suffering from depression, anxiety or mental health issues

The South African Depression and Anxiety Group (SADAG):
011 262 6396

Mental health line:
011 783 1474

Substance Abuse Helpline:
0800 121314 can give you help and information about alcohol and drug abuse. SMS line: 32312

The National Tobacco Quit Line:
at 011 720 3145 can give you information on tobacco and how to stop smoking.

Alcoholics Anonymous SA National Helpline:
0861 435 722

Al-Anon:
(for family and friends of alcoholics): 0861 252 666

Alateen:
(group for young people with alcohol problems): 0861 252 666 or 021 595 4508

Narcotics Anonymous:
083 900 6962

Narconon South Africa:
011 622 3998

LifeLine Western Cape (Cape Town):
021 461 1113

Triangle Project helpline:
021 712 6699

How to manage triggers?

A trigger is a thing, emotion or event that makes you want to drink or use. It might be something good, that makes you want to celebrate with alcohol or drugs, or something bad that makes you want to drink or use to de-stress or get rid of negative emotions. Anything might be a trigger, and it will be different for everyone.

Try making a list of all the things, emotions, places and people that make you want to drink or use, and then think of ways to manage each of these triggers. This might involve thinking of alternatives that you enjoy doing, avoiding places or settings where you know you will drink or use too much, or finding different ways to manage what you’re feeling. You can also set yourself limits, and spend time with friends who will encourage you to stick to those limits.

Needle and Syringe Programme (NSP)

Triangle Projects operates a needle and syringe programme (NSP) for people who inject drugs (PWID). You can pick up new injecting equipment and safely dispose of used gear from Triangle Project’s on-site clinic, or from our mobile services. It is important to use new gear every time (if possible) and to NEVER SHARE injecting equipment with anyone. Sharing equipment is one of the easiest ways to transmit HIV and other blood borne viruses such as hepatitis C.

Harm reduction – what is it?

Harm reduction refers to a set of policies, programmes and practices that aims to reduce the potential health, social and economic consequences associated with psychoactive drugs in people unable or unwilling to stop. The defining features of this approach are the prevention of harm, rather than the prevention of drug use itself, and the focus on people who continue to use drugs.

The harm reduction approach is based on a strong commitment to public health and human rights, including the right to the highest attainable standard of health, to social services, to work, to benefit from scientific progress, to freedom from arbitrary detention and freedom from cruel, inhuman or degrading treatment. A person does not forfeit these rights if they use or become addicted to drugs, and evidence shows that public health outcomes are best achieved when human rights are upheld.

Harm reduction is evidence-based and cost-effective. It utilises methods that are practical, feasible, effective, safe and cost-effective to have a high impact on individual and community health. This approach targets the causes of risks and harms, and allows the tailoring of interventions to address specific factors that make people who use drugs particularly vulnerable. This may include age, gender, sexuality, race and socio-economic status.

Harm reduction acknowledges the significance of any positive incremental change individuals can make in their lives. It does not advocate the use of drugs or addiction, but acknowledges the autonomy of the individual, while assisting them to make changes in their lives for the better.

While complete cessation of drug use may be desirable and possible for some, it may be unfeasible for many individuals to stop completely, or all at once. Therefore, harm reduction interventions facilitate incremental change that meets people’s needs where they currently are in their lives. This also helps individuals view progress through small achievements, rather than feelings of failure due to relapsing from complete abstinence.

These incremental changes may include:

Using fewer drugs or alcohol;
Using less harmful drugs;
Consuming drugs in a less harmful manner (smoking or ingesting, rather than injecting);
If injecting, utilising safer injecting practices (for example, using new needles and syringes every time, and never sharing);
Opioid substitutions therapy (OST), such as buprenorphine, methadone or naltrexone, if addicted to heroin or other opiate;
Engaging in social services such as peer support, group meetings or counselling;
Engaging affirming clinic services to self-report alcohol abuse, drug abuse or risky sexual practices;
Addressing social and economic factors that may exacerbate harms resultant from drug use

With regards to substance abuse, the harm reduction approach is not to suggest that addiction cannot be overcome or that the end goal is not being sober. Yet while abstinence puts the focus on what one is not doing, harm reduction allows individuals to look at how moving away from chaotic substance use is about what you are doing or could potentially do.

Recovery is always a continuum and always includes some form of harm reduction, in the fullest sense of that term.

Triangle Project’s services

Triangle Project’s harm reduction approach includes the following services:

A non-judgemental environment where clients are able to speak openly about their addiction or risky sexual practices
Professional therapy with sessional workers who have expertise with substance abuse addiction
The distribution of barrier methods for both male, female and gender non-conforming clients
A referral mechanism for clients who wish to enter a treatment programme
Post-exposure prophylaxis (PEP) for clients who may have been exposed to HIV
A needle and syringe programme (NSP) for people who inject drugs (PWID)
Workshops of the risk of substance abuse
IEC Material on substance abuse, risk and services offered