title: Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study.
abstract: BACKGROUND
  Since 2000, there has been a dramatic increase in methamphetamine use in South Africa, but little is known about the experiences of out-of-treatment users. This mixed-methods study describes the substance use histories, addiction symptoms, and treatment experiences of a community-recruited sample of methamphetamine users in Cape Town.
  
  
  METHODS
  Using respondent driven sampling, 360 methamphetamine users (44% female) completed structured clinical interviews to assess substance abuse and treatment history and computerized surveys to assess drug-related risks. A sub-sample of 30 participants completed in-depth interviews to qualitatively explore experiences with methamphetamine use and drug treatment.
  
  
  RESULTS
  Participants had used methamphetamine for an average of 7.06 years (SD=3.64). They reported using methamphetamine on an average of 23.49 of the past 30 days (SD=8.90); 60% used daily. The majority (90%) met ICD-10 criteria for dependence, and many reported severe social, financial, and legal consequences. While only 10% had ever received drug treatment, 90% reported that they wanted treatment. In the qualitative interviews, participants reported multiple barriers to treatment, including beliefs that treatment is ineffective and relapse is inevitable in their social context. They also identified important motivators, including desires to be drug free and improve family functioning.
  
  
  CONCLUSIONS
  This study yields valuable information to more effectively respond to emerging methamphetamine epidemics in South Africa and other low- and middle-income countries. Interventions to increase uptake of evidence-based services must actively seek out drug users and build motivation for treatment, and offer continuing care services to prevent relapse. Community education campaigns are also needed.
authors.affiliation: Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: christina.meade@duke.edu.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
authors.affiliation: Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: sheri.towe@duke.edu.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Towe
authors.affiliation: Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: ryan.lion@duke.edu.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Lion
authors.affiliation: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Box 19070, Tygerberg 7505, South Africa. Electronic address: bronwyn.myers@mrc.ac.za.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Myers
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa. Electronic address: dskinner@sun.ac.za.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Duke University, Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: stephen.kimani@duke.edu.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kimani
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa. Electronic address: dpieterse2014@gmail.com.
authors.forename: Desiree
authors.initials: D
authors.lastname: Pieterse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019969:Amphetamine-Related Disorders / Q000523:psychology* / Q000534:rehabilitation*; D055030:Drug Users; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008694:Methamphetamine; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care; D012907:Smoking; D012959:Socioeconomic Factors; D013019:South Africa; D019966:Substance-Related Disorders / Q000150:complications; D055815:Young Adult
chemical_list: D008694:Methamphetamine
keywords: Addiction; Drug abuse; Methamphetamine; South Africa; Substance abuse treatment