An integrated model of aftercare for substance use disorder clients in KwaZulu-Natal.

Abstract

Background: There is currently a high global burden of substance use, which is burdensome to the public health and welfare system. Adequate treatment, including aftercare services, tends to be limited worldwide. In South Africa (SA), substance abuse contributes considerably to morbidity and mortality and treatment services are not only limited but also fragmented among stakeholders. These problems are compounded by a number of factors, including the absence of aftercare policies, treatment models, a lack of resources, and an absence of norms and standards for aftercare services. Consequently, most persons with Substance Use Disorders (SUDs) do not receive aftercare. Furthermore, there is high relapse and many re-admissions of persons with SUDs, which exacerbates the burden on the health care and welfare systems. The situation appears to be worse in rural districts. South African policies have called for the development of an aftercare model of care for persons with SUDs, which has not been realised to date. Aim: The aim of the study was to propose an integrated model of aftercare for persons with SU post-inpatient treatment phase in a public facility in KwaZulu-Natal. Methodology: A qualitative study in two phases. The first phase: policy analysis, and the second phase had two stages: Stage one was semi-structured and focus group interviews with forty-six participants who represented all five levels of the Beer’s Viable System Model (VSM) from governmental and non-governmental organisations (NGOs). Stage two semi-structured interviews with five persons with SUDs and their family members (n=5). Data was analysed thematically using the Braun and Clarke approach. Results: Findings indicated that South African policies did not provide clear guidelines on aftercare. Aftercare was found to be lacking, fragmented, poorly coordinated among service providers and not well integrated into the substance use treatment system. The needs of service users demonstrated the extent and nature of aftercare required. Conclusion: The extent and nature of aftercare services warranted aftercare services that are integrated into SUD treatment systems, lifelong orientated, and responsive to the needs of persons with SUDs and their families. An integrated recovery management model of care is proposed together with relapse management strategies.