Substance-use disorders are a major global public health concern. The recent South African stress and health study (SASH) indicated a high lifetime prevalence (13.3%) and early onset (21 years) of such disorders, 1 with significantly higher rates in the Western Cape compared with other provinces. Substance-abuse treatment services are limited in the Western Cape, where existing services are overwhelmed by the demand for treatment. 2 Increasing the range of treatment services is one way of improving access. 2 The existing system relies heavily on provision of highthreshold treatment services by specialist providers; few lowthreshold early-intervention services are available at a primary healthcare level. This limits access to care as high-threshold services are costly. More cost-effective lower threshold services are preferable.Evidence suggests that screening, brief intervention, and referral to treatment (SBIRT) is effective for addressing mild to moderate substance-related problems and is feasible to implement.3,4 However, there is little evidence for the effectiveness or feasibility of SBIRT for substance use in South Africa. We describe preliminary outcomes from a hospital-based SBIRT programme. MethodsThe SBIRT programme emerged from the realisation that substancerelated psychoses were observed in more than 80% of the 250 monthly patients seeking psychiatric services in G F Jooste Hospital (David Fourie, personal communication). A substance-abuse intervention model was developed by SANCA Western Cape, the Department of Social Development, the Department of Health and Cape Town Drug Counselling Centre. Implementation of the model saw the initiation of a substance-abuse services centre at the hospital, staffed by a social worker, an auxiliary social worker and a research assistant.Over a 7-month period, patients referred to the centre were given verbal and written information about the programme. A modified version of the alcohol, smoking and substance involvement screening test (ASSIST) was used to screen patients for substance use.5 Patients were categorised as low-, moderate-or high-risk depending on the severity of substance use. Patient sociodemographic information was collected. Immediately following screening, patients received a brief intervention (based on motivational interviewing) from the social worker. Motivational interviewing provides information or advice, motivates a change in substance use and teaches skills to reduce substance use by behavioural change.4 High-risk participants were referred to specialist substance-abuse treatment centres following intervention, as they were more likely to have substance dependence or related health conditions. 5 An uncontrolled one-group pre-and post-test outcomes evaluation was performed by an independent external evaluator. All enrolled participants were evaluated. At the 3-month follow-up, the ASSIST was re-administered to all patients and a feedback questionnaire was completed. OutcomesPrimary outcome: substance use The ASSIST 5 -validated in several d...

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BackgroundThe field of heroin use disorder intervention has been in transition in South Africa since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin users' use of supplementary intervention services and intervention outcomes, heroin use disorder intervention programmes in South Africa generally fail to meet international research-based intervention standards.MethodsSemi-structured interviews with ten heroin use disorder specialists were conducted and the interviews were subjected to content analysis.Results and DiscussionIn terms of theory and practice, findings of the study suggest that the field of heroin use disorder intervention in South Africa remains fragmented and transitional. Specifically, limited strategic public health care polices that address the syndromes' complexities have been implemented within the South Africa context.ConclusionsAlthough many interventions and procedures have begun to be integrated routinely into heroin use disorder clinical practice within the South African context, comorbidity factors, such as psychiatric illness and HIV/AIDS, need to be more cogently addressed. Pragmatic and evidence-based public health care policies designed to reduce the harmful consequences associated with heroin use still needs to be implemented in the South African context.

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It is widely accepted that a discontinuity or gap exists between clinical research