Feasibility and Acceptability of Screening and Brief Interventions to Address Alcohol and Other Drug Use among Patients Presenting for Emergency Services in Cape Town, South Africa
Despite evidence from high income countries, it is not known whether screening and brief interventions (SBI) for alcohol and other drug (AOD) use are feasible to implement in low and middle income countries. This paper describes the feasibility and acceptability of a peer-led SBI for AOD-using patients presenting with injuries at emergency services in Cape Town, South Africa. Data were extracted from program records on the number of eligible patients screened and the number of program refusals. A questionnaire examined preliminary responses to the intervention for 30 patients who had completed the program and 10 emergency personnel. Peer counselors were also interviewed to identify barriers to implementation. Of the 1458 patients screened, 21% (305) met inclusion criteria, of which 74% (225) were enrolled in the intervention. Of the 30 patients interviewed, most (83%) found the program useful. Emergency personnel were supportive of the program but felt that visibility and reach could improve. Peer counselors identified the need for better integration of the program into emergency services and for additional training and support. In conclusion, with limited additional resources, peer-led SBIs for AOD use are feasible to conduct in South African emergency services and are acceptable to patients and emergency personnel. 1. Introduction South Africa has high rates of alcohol and other drug (AOD)-related problems, with these problems being particularly prevalent in the Western Cape Province of the country. For example, findings from a recent nationally representative survey indicate that the lifetime prevalence for any AOD use disorder (defined by DSM-IV criteria for abuse or dependence) was 20.3% in this province, which far exceeds the national average of 13.3% [1]. Furthermore, according to several nationally representative surveys, the Western Cape has one of the highest prevalence rates of hazardous and harmful alcohol use in the country [2, 3]. These high levels of problematic AOD use are a major concern for public health in the province, especially given evidence that AOD use is strongly associated with interpersonal violence and injury [4–8], which is the second leading cause of life years lost in the province after HIV/AIDS [9]. Evidence from earlier studies suggests that AOD use is associated with interpersonal violence and injury in several ways. First, AOD use leads to disinhibition which can trigger aggressive behavior and violence [10–12]. Second, people who are intoxicated are more likely to become victims of violence; mainly because AOD use
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