AFTERCARE TO CHEMICALLY ADDICTED ADOLESCENTS: PRACTICE GUIDELINES FROM A SOCIAL WORK PERSPECTIVE by MARICHEN ANN VAN DER WESTHUIZEN Student Number: 4120-524-3 submitted in accordance with the requirements for the degree of DOCTOR OF PHILOSOPHY in the subject SOCIAL WORK at the UNIVERSITY OF SOUTH AFRICA Promoter: Dr. A.H. Alpaslan Joint promoter: Dr. M.S. de Jager Date submitted: June 2010 Student Number: 4120-524-3 I declare that “Aftercare to chemically addicted adolescents: Practice guidelines form a social work perspective”, is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references. ______________________________ ________________ Mrs. MA van der Westhuizen Date Acknowledgements I would like to thank those who have enabled me to start and complete this study with their help, support and encouragement: Professionally - • Colleagues at Walvis Bay Child and Family Centre and Hesketh King Treatment Centre, who introduced me to the field of addiction and the miracle of recovery. • My promoter, Dr. Alpaslan, for his remarkable ability to guide and support me. • My joint promoter, Dr. Mariana de Jager, for her patience and guidance. • My editor, Helen Allen, and independent coder, Laetitia le Roux, for giving such wonderful support. Personally - • My husband, Wynand, who gave me the freedom, support and encouragement to follow my dreams. • My parents, David and Valerie Basson, for their example. • My brother, Michel Basson, for inspiring me to be curious and to look further than the obvious. • My sister, Denise Basson, for joining me. • Nicolai and Jan-Hendrik, who helped me to keep a balance, and who ensured hours of fun in between the work. • My friends, especially Marina Conradie, Annelie Smit, Paula Neethling, Ute Robertze, Nell van Heerden, Nan Eyles, Nadia von Wielligh and Willem du Toit, who believed in me and who encouraged me when I wanted to give up. • Mariana de Jager, for showing me how strong we really are, and for not giving up. I would like to dedicate this study to God, and to all the people suffering from chemical addiction, who taught me so much about the obstacles of this problem, and also about the miracle of recovery. ABSTRACT The susceptibility of adolescents to chemical addiction has become a major international concern. Approximately 25% of people in Central Asia and Eastern Europe who inject chemical substances are under the age of 20 years (Youth at the United Nations, 2006), while up to 75% of unintentional injuries among adolescents in America are related to substance abuse (Page & Page, 2003:196). On the national level, approximately 25% of adolescents under the age of 20 are involved in substance abuse (Western Cape Department of Social Services and Poverty Alleviation Transformation Plan, 2006:13). Focusing on the Western Cape, a report from the South African Epidemiology Network (2007:3) highlights that the youngest patient in in-patient treatment was nine years of age, and among 2 798 persons who received in-patient treatment, 27% were under the age of 20, more than any other age group in treatment. Treatment of adolescent chemical addiction should include preparation for treatment, treatment, and also aftercare services to ensure that the addicted adolescent develops skills to maintain sobriety (Meyer, 2005:292-293). Section Six of the South African Prevention and Treatment of Drug Dependency Act (1992) prescribes that chemically addicted persons should have access to professional aftercare services to ensure that treatment is not terminated prematurely. The motivation for this study was based on the fact that, despite this statutory requirement, the Western Cape Drug Forum (2005:3) identified the need for the development of aftercare services in 2005, indicating the lack of focus on aftercare as part of treatment. This concern was confirmed by practitioners in the field of adolescent chemical addiction and findings resulted from previous research regarding relapse experiences of chemically addicted adolescents (Van der Westhuizen, 2007:129-130). Flowing from the research problem, described above, the goal for this research was to develop practice guidelines from a Social Work perspective relating to the provision of aftercare services to chemically addicted adolescents. In order to operationalise this goal, the following task objectives guided this research study: • To explore and describe the specific aftercare needs of relapsed chemically addicted adolescents following treatment relating to services by social workers; • To explore and describe the perceptions and experiences of social workers regarding aftercare services chemically addicted adolescents; • To review literature that relates to aftercare services to chemically addicted adolescents; • Based on the above findings, to develop practice guidelines from a social work perspective relating to the rendering of aftercare services by social workers to chemically addicted adolescents following treatment. The researcher made use of the qualitative research approach to explore and describe the participants’ perceptions of the research problem. This research endeavour fell in the ambit of applied research, as it was aimed at the development of aftercare practice guidelines to address the identified lack of aftercare service delivery to chemically addicted adolescents. The researcher made use of the intervention research design, employing the Intervention Design and Development (IDD) Model of Rothman and Thomas (1994:3-51). For the purpose of this study, the researcher made use of Phases 1 and 2, Step 2 of Phase 3 and Step 1 of Phase 4 of the IDD-model, as summarised below. Phase 1: Problem analysis and project planning: The first step conducted in this phase was to identify and involve the participants. The populations for the purpose of this study were: 1) all chemically addicted adolescents in the Western Cape who had relapsed after in-patient treatment, and 2) all Social Work service providers dealing with adolescent chemical addiction in the Western Cape. The purposive sampling technique enabled the researcher to access a sample for the specific reason to provide insight into the particular field of interest. The sample size for this study was determined by data saturation. During the second step, the researcher gained entry and cooperation from the settings. Access to the sample selected from the population of chemically addicted adolescents was obtained through contact with the adolescent in-patient treatment centres in the Western Cape. In order to gain access to the sample selected from the population of social workers rendering services to chemically addicted adolescents, the researcher negotiated entrée to the participants by means of an introduction letter to Social Work service providers working with chemically addicted adolescents. Interviews with willing participants/parents/guardians were arranged, during which time the purpose of the study and the research process were given to them. Consent forms were signed prior to the commencement of the third step, identifying the concerns of the population. The researcher used the exploratory, descriptive and contextual research designs as a qualitative strategy of inquiry with both the adolescent and Social Work interest groups. The methods of data collection were narratives in order to explore and describe the needs of chemically addicted adolescents, and focus groups as a method of qualitative interviewing to promote understanding from the social workers’ point of view. The method of data recording for the data obtained from the adolescents was their written narratives. Data obtained from the social workers was recorded by means of tape-recordings and field notes, which was transcribed later. The fourth step in the first phase was to analyse the identified concerns. Tesch’s (in Creswell, 2009:186) eight steps for qualitative data analysis were implemented by both the researcher and an independent coder once data became repetitive and data saturation was reached. Concluding from the themes and sub-themes emanating from the data obtained from the adolescent interest group, their previous experiences of social workers led to negative perceptions of aftercare workers due to: a disregard for and lack of assessment of their personal needs; a judgemental attitude of the social worker, and a perceived lack of passion for their work. Social workers who continued to motivate chemically addicted adolescents to re-enter treatment following a relapse were perceived in a positive light. Chemically addicted adolescents have a need for a relationship with the social worker rendering aftercare services, and such a relationship should be characterised by trust, a belief that they can confide in the social worker, openness, genuine interest and a concern for the adolescent, the social worker acting as a role model, objectivity and a non-judgemental attitude. The unavailability and inaccessibility of Social Work aftercare services to chemically addicted adolescents is concerning, and this impacted negatively on the development of a personal, trusting relationship with aftercare workers. Chemically addicted adolescents have the need and expectation that social workers who render aftercare services should be knowledgeable about addiction and recovery, that they must be informed about the content of the treatment programmes which the adolescents attended, and be able to assist them to continue with the growth achieved during