Factors associated with illegal drug use in South Africa: A qualitative literature review

Master Thesis in Criminology Malmö University

91-120 Credits Department of Health and Society

Criminology Master’s Program 205 06 Malmö

FACTORS ASSOCIATED WITH

ILLEGAL DRUG USE IN SOUTH

AFRICA:

A QUALITATIVE LITERATURE REVIEW

FACTORS ASSOCIATED WITH

ILLEGAL DRUG USE IN SOUTH

AFRICA:

A QUALITATIVE LITERATURE REVIEW

RUMMAGE ISAAC

Isaac, Rummage. PERCEPTIONS OF ILLEGAL DRUG USE IN SOUTH AFRICA:

A QUALITATIVE LITERATURE REVIEW. Degree Project in Criminology 30 credits. Malmö University: Faculty of Health and Society, Department of Criminology, 2019.

Abstract

This study provides a comprehensive literature review of the recent peer-review and journal articles pertaining to illegal drug use in South Africa. Potential articles pertaining to South African illicit drug use published between 1994 and April 2019 were identified through an exhaustive literature pursuit. Forty-two articles, which were thematically analyzed, identifying socio-cultural and socio-demographic factors associated with illegal drug use. The results show that adolescents, youths and being of black African race were the most population groups abusing illicit drugs in South Africa, women were the least population group disturbed by illegal drug use and that this behaviour declined with education among female learners. The review uncovered important factors associated with illegal drug use. These include the easy availability of drugs, weak parental control, violence and poverty and unemployment. In addition, there have not been many studies in other races and social classes. Furthermore, most of the studies reviewed were done in major cities like Cape Town and Johannesburg, which makes this research challenging to be generalized. This study recognized gaps in the literature reviewed and alluded to possibilities for future practical research. This study proposes the delivery of ‘based strategies’ which focuses more on the distribution of evidence-based approaches and policies that are designed to meet the clear needs of communities. In addition, South Africa should implement longitudinal research about drug user life histories. Keywords: Criminology, Illegal drug use, Literature review, demographic, Socio-cultural, South Africa.

CONTENTS

Introduction.………..………....1

Relevance to Society and Criminology……….…..2

Legislation………2

Aim and objectives……….3

Research questions………...3

Key definitions………....3

Research Methodology……….…...4

Qualitative literature review………..4

Inclusionary criteria………....5 Research Ethics………..6 Results………..………..6 Discussion………..………13 Method discussion………..14 Results discussion………..14 Research Limitations………..15 Future Implications………..16 Conclusion ………..…………...17 References………..18 Appendix………..23

INTRODUCTION

The strong symbolic value of illicit drug use makes it a contested issue, which attracts mixed public opinion, intense media attention and close political scrutiny in South Africa (Pienaar & Savic, 2015). In a country like South Africa with its long exceptional history of entrenched oppression of the black majority, the issues confronting illicit drug use are particularly complicated and the need for carefully formulated research and future responses to this predicament. Yet despite this, the extent of solving or reducing illegal drug use in South Africa has received little scholarly attention to date (Peltzer & Phaswana-Mafuya, 2018).

Illicit drug use is among the most pressing problems facing South Africa and has been the cause of major concern for the crime and health experts for the past twenty years (Pienaar & Savic, 2015). Despite the alarming statistics, several recent studies have suggested that the scientific literature has not reflected the clear need for illicit drug abuse research within the South African population (Mokwena, 2014). The most commonly used illicit drugs in South Africa are cannabis, cocaine, amphetamine-type stimulants and opioids (World Health Organization, 2018). Previous different examinations in South Africa found that specific sociodemographic factors are associated with drug use, including both genders. However, females use fewer drugs than men. Moreover, young age, specific population groups, lower income or not employed, weak parental control, and geo-locality factors (Peltzer &Ramlagan, 2008) are all associated with illegal drug use in South Africa.

In addition, certain health risk behaviours such as common mental disorders like depression, and anxiety are also linked to illegal drug use. Furthermore, criminal victimization has been found to be associated with illegal drugs in South Africa (van Zyl, 2013; Madi & Matla, 2003; Morejele et al., 2006, Neser et al., 2001; Rocha-Silva, 1997).

There have been few literature reviews regarding illicit drug use in the past. However, the majority of these reports do not specifically focus on illegal national-level drug use in South Africa. Numerous smaller studies have also been conducted, and they focus on the micro level like small towns, cities or different demography. Furthermore, no comprehensive national survey of drug use exists in South Africa (Brook et al., 2006, Madi & Matla, 2003; Townsend et al., 2007; Peltzer &Ramlagan, 2018).

Although literature review studies have focused on the issue of illicit drug use in different demographics, they are very often discussed in a disconnected fashion and not viewed in their interrelatedness within a broad criminological value. More so, despite these initial reviews, there has been little tracking of the scientific research progress over the past 25 years related to illegal drug use in South Africa (Peltzer & Phaswana-Mafuya, 2018).

It is paramount to note that the language and content of this literature review are geared primarily on perceptions of the illicit drug use in South Africa and their relevance within the criminological sphere than divulging into the components and characteristics of illegal drugs. This review does not intend to be an exhaustive

summary of all literature concerning illegal drug use in South Africa. Instead, with a focus on literature published within the past 25years.

This research endeavours to consider the recurring themes and to select for discussion the most methodologically sound research and that which has the most considerable implications for future examinations of illegal drugs and its connection with different social and cultural factors in South Africa. Therefore, the purpose of this secondary analysis is to make more recent estimates on the frequency and factors associated with drug use in South Africa.

Relevance to Society and Criminology

Examining empirical research which examines the relationship between illegal drug use and crime is a complex and contested issue in a criminological lens in South Africa. The statistical relationship between unlawful drug use and crime is convincing at first glance, but it is not possible to draw a conclusion regarding a specific cause-and-effect link between the two phenomena (Peltzer & Ramlagan, 2010).

Moreover, evidence suggests that there is a strong association concerning prohibited drug use, health and criminal activity, which appears to be consistent across the empirical literature with regard to the relationship between illicit drug use and crime. (Moore, T. et al., 2007, p.369). However, these relationships are complex and dynamic, often associated with entrenched social and economic problems such as unemployment, socioeconomic inequality, and poor mental health.

Furthermore, Raskin, White, and Gorma (2002) allude that the complexity of this relationship further develops into lacking in evidence where an assumption that there is a causal relationship between illegal drug use and other negative supporting factors is made without sufficient supporting evidence, and the precise nature of the connection remains blurry. Therefore, the examination of these experiences through secondary evaluation is equally essential and long overdue in South Africa.

Legislation in relation to illegal drugs in South Africa

Drugs are classified as ‘illegal’, in South Africa when their use is forbidden by law. Fellingham et al. (2012) define illegal drugs as having different effects on people and these outcomes are influenced by factors that make them unpredictable and dangerous.

Furthermore, the South African Drugs and Drugs Trafficking Act defines illegal drugs as the use of (i) any dependence-producing substance; or (ii) any dangerous dependence-producing substance unless the person is a patient who has acquired or bought any such substance from a medical practitioner, dentist or practitioner acting in his professional capacity and in accordance with the requirements of the Medicines Act (ibid, 1992).

The South African Drugs and Drugs Trafficking Act prohibits all types of drugs possession, dealing, manufacturing, and dealing in a dangerous dependence-producing substance. To dissect the penalties affiliated with drug possession, the Act provides for different punishments for those found with different dealing and use of illegal drugs in South Africa. The use or possession of an illegal substance is liable to a fine or to imprisonment for no longer than five years, or to a fine and

imprisonment, dealing in an illegal drug is liable to a fine or to imprisonment for no longer than 10 years, or to a fine and imprisonment (ibid, 1992)

Moreover, those found illegally manufacturing a scheduled substance, or who uses or possesses a dangerous dependence-producing substance, are liable to a fine or to imprisonment for no longer than 15 years, or to both a fine and imprisonment, and finally the penalty for those dealing in a dangerous dependence-producing substance is liable to imprisonment for no longer than 25 years, or to both imprisonment and a fine (ibid, 1992).

Aim and Objectives

The aim of this study is to delineate the existing research, factors and practices regarding perceptions of illegal drug use in South Africa. For the purposes of this review, the term “perceptions” encompasses the existing literature which has been published (journal and peer-reviewed articles) from 1994 to the present day (April 2019). The second aim of the study is to assess the prevalence of illegal drug use. This aim will be conducted through a review of the literature and will look at factors through sociodemographic and sociocultural characteristics that influence the use of illegal drugs in South Africa. Finally, the third aim of this research is to draw conclusions and make recommendations as to where the future research´s direction. The academic criminology scholarships in western societies do not focus widely on African criminological relevance. Western criminology should connect and benefit from a South African criminological- informed perspective as this study will endeavour to do. Furthermore, this study will aid knowledge in cross-cultural studies in western Europe. Drug use studies are vital as they elucidate common and culturally unique pathways to drug use and their behaviours.

Thus, it is crucial for students and professionals alike to understand and relate the criminological position in South Africa, and this ultimately sheds more light to the theories of globalization and modernization in criminology. Comparing cultures and comparing crime offers new insights, current theories and chances of innovative perspectives on the general field of criminology, and this unifies the concepts of human groups and states (Beirne, 1983).

Research Questions

The following research questions were developed to obtain the required information:

1. What factors influence the use of illegal drugs in South Africa?

2. Which group in society is most affected by illegal drug use in South Africa? 3. How does unlawful drug use affect the community and social structure in South Africa?

4. Which regions or provinces are most affected by the illicit drugs in South Africa?

Key definitions

• Whoonga/Nyaope-These two terms can be used interchangeably depending on which part or region of South Africa one is from. Whoonga is an illegal drug, also known as nyaope, it is a dangerous and highly addictive South African street drug (Mokwena & Huma, 2014). Whoonga is a native and designer drug that has been in existence for the last 10 years

in South Africa. South African Justice Department of Justice defines it as, “consisting of a mixture of either heroin or dagga (cannabis) to which other harmful substances like antiretrovirals can be added” (Peltzer, 2007). Mokwena and Huma (2014) further define it as a mixture of low-grade heroin and other additives like rat poison or soap powder. Whoonga is sold in powder form, smoked by rolling it with cannabis or injected, depending on its form. Whoonga is highly addictive, and a user can become addicted even after only using it once (Mokwena, 2015). The long-term effects of whoonga have been linked to a variety of psychiatric and health disorders (Modisane, 2010). The withdrawal symptoms of this drug are severe body pains, which include severe headaches, stomach pains and muscle spasms (Ghosh, 2013).

• Shebeen- In South Africa it is defined as an informal, unlicensed establishment or private house selling of alcohol place in a township and typically regarded as slightly disreputable where a lot of unlawful activities take place usually selling, exchange and distribution of illegal drugs (Faull, 2013).

RESEARCH METHODOLOGY

This thesis used a qualitative literature review for its methodology. A literature review is vital and an indispensable apparatus in research methodology. A literature review is defined as a written argument that presents a logically argued case founded on a comprehensive understanding of the current position of knowledge about a topic of study. This case then establishes a convincing thesis to answer the study´s question (Machi & McEvoy, 2009, p.4).

Qualitative literature review

This study chose a qualitative literature review for the purposes of reviewing the materials in this study. The purpose of having a literature review in a qualitative study is to gain valuable insight into the phenomenon under investigation. More so, the qualitative literature review provides the researcher with an opportunity to identify any gaps that may exist in the body of literature and to provide a rationale for how the proposed study may contribute to the existing body of knowledge (Gay et al., 2006).

A qualitative literature review also helps the researcher to refine the research questions and entrench them in guiding hypotheses that provide possible directions the researcher may follow (Machi &McEvoy, 2009, p.12). A computerized search of databases was conducted to find peer-reviewed and journal articles pertaining to South African illegal drug use between 1994 and April of 2019. This study used the Boolean query to frame the database search. A Boolean query is a type of search allowing researchers to combine keywords with operators such as “AND”, “NOT” and “OR” to further produce more relevant results (Machi &McEvoy, 2009, p.39). This study focused the query and narrowed it to the specific area, which is the illegal drug use in South Africa and the research questions thereto. A combination of the following keywords were used to search for published articles in the Malmö

University library database: “illegal drugs in South Africa,” “illicit drug markets,” “drug-related crimes,” “drug use and treatment,” “illegal drug prices,” “most affected drug use in South Africa,” “drug abuse patterns,” “and drugs and crime.” (including related terminology for illegal drugs such as “marijuana,” “cocaine,” “opioids, ” and whoonga).

The initial search of the databases from Malmö University´s online library database and Google Scholar yielded a total of 625 journal articles. Several of these articles were overlapping between these two databases. Eliminating unnecessary articles across databases yielded a final number of 197 exceptional, non-overlapping articles.

In addition to using library databases, specific journals that have published articles on illegal drug use in South Africa were also examined over the period mentioned above for potential articles (that is, International Journal of Drug Policy, Science Direct, and EBSCO databases). This type of search yielded no new or exceptional articles outside of the 197 articles extracted from the library databases.

The inclusionary criteria

As the search produced articles published in non-peer-reviewed literature or journal articles, several articles were automatically excluded for review, bringing the total number of journal and peer-reviewed articles to 147. Primarily, abstracts were read to see if the article mentioned illegal drug use as a primary or secondary finding. If so, the full contents of articles were screened to ensure the sample consisted of broad South African illegal drug use and included findings that were specific to the South African population.

For this study the articles need to have either, or the following factors ; (i) reported findings of different demography like adolescence and women samples, (ii) included a sample about different regions or province use of illegal drug use, (iii) reported a sample about illegal drug use in urban or rural environments, (iv) included a sample of illegal drugs as a primary or secondary use variable, (v) included findings pertinent to people living in South Africa as a predominant focus of this analysis, and (vi) described samples of illegal drug use which were in line with criminological focus and did not focus on other fields like medicine or economics studies.

Many articles did not meet criteria (#vi) because they were centred in other social sciences fields like medicine, anthropology or economics and did not focus on the criminological relevance or examination. After examining and evaluating the 147 articles based on the inclusionary criteria, a total of 42 articles were identified as relevant to the review of this study. The initial list of 42 articles was then authenticated through review and or discussion with the preponderance of research concentrated on South Africa and its illicit drug use over the past 25 years, and this operated as a validity check for the inclusiveness of the literature search. Within this validity check, it became evident that several relevant articles were buried within other topic areas (e.g. school misconduct, adolescent dating violence, community tolerance, and suicide) and were not initially revealed by using the initial search terms.

In addition, they were an outcome from articles that focused on South Africa and illegal drug use which were buried within articles focused on other topic areas, this

led to the determination whether these articles should be included based on the details described in their results section. For example, one article described that illegal drug use correlated to suicide but did not include any names of illegal drugs and its specific results. This article did not meet criteria #iv, hence it was not included in the review.

Conversely, other articles included illegal drug use as a correlate to suicide, but also reported illegal drug use-specific results for South African demography and were therefore included as part of the analysis. This way of validity check yielded 10 articles that met the inclusionary criteria and were not part of the original search of the library databases.

Accordingly, a total of 42 articles were reviewed as part of this research. Once selected, each article was reviewed based on the sample size, analytic approach, demographic composition of the sample, and location and type of study that is in relation to illegal drug use in South Africa.

Ethical Considerations

There was no application for ethical approval from Malmö University’s academic committee. This is so, because, this research employed desktop research and focused on content that is available online. In addition, there was no interaction with sensitive materials that necessitated the application of ethical approval.

RESULTS

A total of 42 peer-reviewed articles met the criteria for inclusion in this review and are referenced in the appendix. This section presents the main themes and sub-themes which were identified in the 42 articles, which are imperative for the results of this study. These themes are composed of socio-cutural and demographically appropriate factors that the literature analyzed and found to be the most paramount in criminological relevance.

1. Socio-Cultural Factors

Berghetto and Karwowski (2017) define sociocultural factors as useful insights that provide correlation into factors including perceptions, and environmental support of people and communities. Furthermore, he explains that in criminological lens these go far to include customs and practices within cultures and societies that affect the thoughts, feelings, socio-economic factors and behaviours of its citizens. 1.1 Availability of Illegal Drugs

Many of the articles reviewed in this thesis allude to the widespread, easy availability of illegal drugs in South Africa (Van Zyl, 2013; Meghdadpour, 2012; Faull, 2013). The policing of illegal drugs in many urban and rural areas has been little and, in many regions, non-existent (Faull, 2013). The study by Peltzer et al. (2010) revealed that adolescents, youths and adults alike considered the accessibility of drugs as a reason for drug abuse amongst their respective age groups.

According to Dada and colleagues (2018), they comment that the policing of illegal drugs has hardly changed as the easy availability of illegal drugs is the same as it

was two decades ago. This is connected to the infamous apartheid period where different communities and races were left by the system. In present-day, South Africa, nothing has changed as the police do not do enough to curb drug-related crimes (Faull, 2013).

Furthermore, Florence and Koch (2011) allude that secondary adolescents school learners, aged 14 to 16 years, could obtain illegal drugs directly from legal public outlets and shebeens. In addition, a study by Neser et al. (2001) found that access to drugs was predominant in the majority of male adolescents involved in their research, undertaken in Pretoria. This study by Neser et al. (2001) indicated that a third of 2 281 secondary school learners in secondary schools could acquire drugs easily from local shops, shebeens, and butcheries.

Peltzer et al. (2010) and Ghuman et al. (2012) reported easy access to illegal drugs in the rural context. The above studies indicated the majority of the adolescents living in rural areas could acquire illegal drugs from local shops, butcheries and shebeens. Myers et al. (2004) argue that the proliferation and easy availability of illegal drugs and drug use in various communities may also heighten adolescents´ and youths´ as perpetrators of violence, although, there is no confirmation to such assertion.

1.2 Weak Parental Control

Inadequate role modelling by parents and guardians has been eulogized as problematic in the plague of illegal drugs in South Africa. The literature dissected review that adolescents consider their parents and guardians as being the most influential people in their lives (Ghuman et al.2012; Amoateng et al., 2006). This view concurs with the findings that adolescents and youths are likely to have used illegal drugs and binged on drinking respectively if they have often observed their parents or guardians being high on drugs or drunk (Ladikos et al., 2003; Judith et al., 2006; Faull, 2013).

Moreover, studies conducted in South Africa with regards to parental behaviour on their children, Amoateng et al. (2006) and Morejele et al. (2006) account that parents who use drugs may be less protective of and less likely to monitor their children’s behaviour. More so, a study done by Meghdadpour et al. (2012) consisting of 11 904 South African youths between 15 to 24 years of age showed that family supervision was important in curbing drug use among this demography. In addition, this study revealed that family supervision reduced the chances of male youths’ prediction and the use of illegal drugs by 38%.

Furthermore, Morojele et al. (2006) indicate that the imitation of parental behaviour by the younger ones was partly responsible for drug use. This research by Morejele further mentions that a positive parent-child relationship and parental monitoring of the adolescent’s activities are vital in avoiding the use of illegal drugs. In this regard, Olalade and Mndzebele (2017) also note that the modelling of illegal drug use behaviour by guardians and significant others constitute important categories of social-influence variables in the adolescence´ critical point in life and strain of such variables in life will lead to the use of illegal drugs more significantly.

1.3 Illegal drug use and Violence

There is a scarceness of data on the extent of drug use among the general population in South Africa. The literature analyzed exposes an interchange between violence

and juvenile drug use in South Africa (King et al., 2003; Smith, & Bautz, 2000) extensively.

An extensive research project headed by Mncube and Harber (2013) at secondary schools in the provinces in Kwazulu-Natal, North West Province, Western Cape, Limpopo Province, Gauteng and Mpumalanga revealed that youths respondents from these provinces which consisted of 192 interviews and 1200 questionnaires considered drug use to be a key reason for perpetrator violence, which manifested, among others, in physical abuse geared towards teachers and the damaging of school property. However, there have not been scientific studies towards perpetrator violence noted in this review.

There have been several studies reviewed in this thesis that textualize on illegal drug use and victimization. These studies examined the role of substance use in predicting adolescents’ experiences of victimization and drugs among adolescents in South Africa (King et al., 2004; Swart et al., 2002). The study by King et al. which consisted of 2 946 learners studied illegal drug use, sexual activity and anti-social behaviour as predictors of sexual victimization among 8th and 11th graders in Cape Town. In this study, they found that having peers, particularly those who engage in anti-social or drug use behaviours, are associated with an increased risk of the adolescent being victimized.

Moreover, Schreck and Fisher (2004) concurring with the above point argue that adolescents who spend time with delinquent friends are more likely than their peers without such friends to be victimized. These juveniles will more often be in closer proximity to motivated offenders, without capable guardianship by parents, friends or others, and more likely to appeal as attractive targets of an attack. It is imperative to note that research has shown an increased risk of adolescent victimization in neighbourhoods where drugs are more widely available, and crime is pervasive (Van Dorn, 2004). However, to the best knowledge of this study, there have not been studies about adolescence, drug use, and perpetrators.

Furthermore, Mokwena (2015) argues that illegal drug is present in different social classes, that is low, middle and high class. However, the drugs used just differed. Alcohol was, however, a main reason for many violent crimes in all the classes (Dada et al., 2018), why drug use was not so predominant in rich communities could be attributed to the availability of recreational facilities, as opposed to unemployment and poverty in needier communities (Mokwena, 2014; Mokwena, 2015; Swart et al., 2002).

1.4 Illegal Drug Use and Community tolerance

According to the study undertaken by King and colleagues (2003) they report that the impact of socio-criminological factors on adolescence and adults drug use alike is associated through exposure of illegal drugs on television and drug availability in the neighbourhood as key environmental factors that have been found to be correlated to illegal drug use amongst this group (Swart et al., 2002). Furthermore, the study by Szabo which chronicles on the potential role of illegal drugs, violence on television and in other media outlets, showed the role of illegal drugs and its link to youth violence and victimisation in South Africa (Szabo, 2003).

In addition, a noteworthy relationship between drug use and community tolerance was shown by Parry et al. (2004) who indicated correlations between adolescents

who had been high on drugs and communities where drugs like whoonga could be obtained easily and where the law enforcement failed to respond on youths’ use of illegal drugs. A qualitative investigation was undertaken by Onya et al. (2012) which focused on the effect of illegal drugs from neighbourhood watchers, this study indicated that different ethnic backgrounds of Xhosa, Venda and Afrikaans speaking communities all blamed community tolerance for the prevalent selling and use of drugs in their neighbourhoods.

Furthermore, Onya et al. (2012) comment that there are many reasons adolescents and youths use illegal drugs, and this includes the desire for new experiences, an attempt to deal with problems or perform better in school, and simple peer pressure. These researchers further allude that adolescents are ´biologically wired´ to seek new experiences and take risks, as well as to shape out their own identity.

In this context, they further mentioned that the environmental background is important for such restraint and it is the community’s duty to ensure that young people are made aware of this behaviour and the severe long-term consequences illegal drugs have on their health and developmental gain. In addition, other findings report that the scourge of community tolerance is widespread and very high to the extent of caregivers facilitating drug use among the population by providing money to the users (Onya et al., 2012). Most of them become addicted, and the caregivers do not want them to go through the “hell” of withdrawal symptoms (Mokwena, 2015). Mokwena (2015) argues that the above point can only be attributed to the lack of information by the society and alludes that the government has to do more to help such disadvantaged communities in South Africa.

In addition, there are even views that whoonga may be South Africa's worst drug, mainly because of its addiction and effects (Wegner & Fisher, 2009). The uniqueness of the drug whoonga lies in its demographic popularity in that it is used almost exclusively by black people, although, the health consequences of whoonga use are not widely known, (Thomas & Velaphi, 2014). Mokwena (2015), Morejele et al. (2006) and Wegner and Fisher (2009) are in agreement that the native drug of whoonga and its consequences on the health of the users, their families, their communities and the country at large have been reported widely by many researchers.

1.5 Poverty and Unemployment

It has long been known that poverty is associated with poor health and health-compromising behaviours like the use of illegal drugs (Ewart & Suchday, 2002). Poverty and unemployment are an indicator of illegal drug abuse since it may serve as a means of coping with the daily pressure of not having a job. This assessment is concurrent with the study of Ladikos et al. (2003) who found that indicators of illegal drug problems showed a significant association with lower socioeconomic status, no school education and being adults mainly older than 25 years of age. Furthermore, drug use by adults, aimed at escaping despair, was held to be adding influence on adolescents who pursue adulthood to display similar behaviour. This would, in turn, negatively influence their peers, causing an increased reduction in chances of obtaining employment and turn to the more easy and accessible illegal drugs (van Zyl, 2013). The prevailing high unemployment rate of among 19 to 29-year old’s, was reported by the study of Pienaar and Savic (2016) which is a critical

analysis of South Africa´s national drug problem, this review provides an explanation for the widely experienced poverty in South Africa, and it alludes that: “Many communities are distressed due to diverse socio-economic challenges which include poverty, joblessness and consequently, the problem of illegal drug abuse is heightened”.

Moreover, the relationship between drug use and poverty was also accentuated by the SAIRR report (2011), which concluded that:

“poverty and unemployment and the lack of any recreational facilities leave young people with a feeling of hopelessness and worthlessness. If they see no prospect of ever getting a decent job and enough income to live a normal life, seeking oblivion through drugs and/or other substances becomes a tempting escape route”.

Poverty and unemployment have been held to be unique to South African townships and most prevalent among young and unemployed black people who live in socio-economically depressed areas (Venter, 2014; Mokwena, 2015). However, people in this backdrop mainly abuse native drugs like whoonga and bushman’s tea (Madi et al., 2003). In turn, the use of whoonga and other illegal drugs in these townships takes over the lives of the users, they drop out of school or lose their jobs because all they think of and pursue is getting the next fix (Swart et al., 2002).

2. Socio-Demographic Factors

Socio-demographic factors are important background information about the population of interest, such as age, sex, race, educational status, income, and geographic location. These factors are regarded as explanatory because they help make sense of the results of analyses (Walters, 2005).

2.1 Illegal drug use amongst adolescents and youths

The major concern in the South African illegal drug context is the growing problem of drug abuse among adolescents and youths in South Africa (this group includes boys and girls below or the age of 25), a challenge that is denying this population group full participation in the socio-economic development of the country and seeing an increase in drug-related crimes (Rehm et al., 2013).

A majority of studies reviewed in this thesis presented statistics on illegal drug abuse among this population group (van Zyl, 2013; Reddy et al., 2010; Maghdapour et al., 2012; Peltzer & Mafuya, 2018). A study was done by Phaswana-Mafuya (2018), consisting of 26 453 individuals (52.0% women and 48.0% men) aged 15 years and older were analysed. Male adolescents were found to have been using two times the drugs as opposed to their female counterparts, and for females, it was found that their rate of illegal drug use declined with age and education. More so, peer pressure has been noted as a major contributing factor to why people under the age of 25 abuse drugs. Research conducted by Parry et al. (2004), which is a qualitative study of nine respondents, revealed peer pressure as a major reason for drug use amongst those interviewed. In this regard, it was found that youths’ social approval by their peers is highly valued. Moreover, Morejele et al. (2006) comment that the adolescents’ central explanation of their peers’ drug use was that it was confidently reinforcing. They believed it resulted in pleasurable

consciousness states, heightened attention, an enhanced status, and excused their socially unacceptable behaviour.

Other explanations for the illegal drug use among this group were that drugs increase sexual arousal, decrease inhibitions and tenseness especially to the male partners who cited masculinity as a core part to why they use illegal drugs, especially during sexual activities. The males would then exploit the intoxicated and “high on drugs” females whom they consider to be opportune targets of their sexual advances (Myers et al., 2008).

In addition, findings from Ololade and Mndzebele (2017) concluded that the adolescence in South Africa was more prone to peer pressure than other African nations because most of the people in their generation attended parties regularly or occasionally where illegal drugs are freely available. However, the majority of these peers who reported drug use admitted that the main source of getting drugs was through their friend´s influence.

The study by Judith et al. (2006) also established the connectivity of peer influence resulting in an additional 13% adjustment in illicit drug use among adolescents. Furthermore, research done by Neser et al. (2001) amongst learners in middle school district schools in Pretoria revealed the tremendous effect of peer pressure on drug use was: 91,4% of white learners, 77,5% of Indian learners, and 59,1 % of black learners who used illegal drugs attributed this behaviour to their friends’ examples.

2.2 Illegal drug use by women

The extensive literature reviewed in this thesis shows little evidence and revealed some major gaps in the availability of credible and reliable information of illegal drug use by women mainly because there have not been many gender studies being produced in South Africa in relation to this subject. However, it is imperative to note that the majority of adolescence studies reviewed in this thesis focus on both genders.

Intimate partner violence and its connection with victimization for women have been mentioned in several of the studies (Peltzer & Ramlagan, 2010; Meghdadpour et al. 2012) as the leading mutual factor to illegal drug use by women. According to Myers (2007), women abuse drugs as a coping mechanism of the sexual and physical violence perpetrated against them.

Also, women become vulnerable because they are in a phase of peer pressure from friends; they are unemployed, have no income, among other things (Parry et al., 2012). This finding is corroborated by Ololade and Mndzebele (2017) whose interviews with respondents from Cape town, reported that women use drugs in order to escape the misery associated with the stressful environment and stressful situations surrounding them.

In addition, findings by Dada et al. (2018) and Myers (2007) alludes that in South Africa, illegal drug use such as cannabis, whoonga and cocaine are widely used among women. A study conducted by Myers (2007) revealed that levels of cannabis use among men and women were very similar but different in any other drug use. In addition, many women either reported cocaine or cannabis as their primary

illegal drug. Furthermore, findings also point to more women accessing treatment for cocaine and heroin-related problems in the Western Cape (Myers et al., 2008). However, Dada et al. (2018) and Myers and Wechsberg (2016) notes that more studies of women illegally abusing drugs have been prominent in the province of Western Cape than any other region, so it is difficult to generalize and come with an accurate statistics regarding this epidemic towards gender studies. The review also noted that over half of the patients reporting cannabis use as their primary drug abuse were girls younger than 18 years and were students or learners. Also, women using abusing heroin were on average younger and white (Greenfield et al., 2010; Morojele et al., 2011).

2.3 Illegal drug use through geo-locality factors

In the past decades, South Africa has experienced an increase in the amount and types of illicit drug use and distribution (Mokwena, 2016). The patterns of illegal drug use have been linked to regional and provincial variations, socio-economic status, racial and geographical differences. Whoonga has been held as some of the designer or cocktail drugs commonly used in black townships and has been in circulation for more than ten years (Mokwena & Huma, 2014).

It is important to note that several studies pointed out in this research which has alluded to areas high prevalence of illegal drug use, renowned as socio-economically deprived, with high unemployment rates, pockets of poverty and easy availability of the drugs within different regions in South Africa (Mokwena & Huma, 2014; Mokwena, 2016 ; van Zyl, 2013; Ramgalan et al., 2010). These places have been found to share the same drug attributes regardless of geo-locality of drug use, that is whether its rural or urban location.

These studies mentioned above, make observations that illegal drug use is observed everywhere within South Africa and the experiences of drug users are consistent across all areas, regardless of urban or rural spheres. However, (Ramlagan et al., (2010) and Thomas &Velaphi, (2014) have presented findings that illegal drug use is more prevalent in the urban areas than rural areas mainly because in urban areas the population can afford some of the expensive unlawful drugs like cocaine and heroin, whilst cannabis was more available in both the urban and rural dwellings. According to the studies of Modisane (2010) and Morebudi & Mukhari (2014), these researchers mention that whoonga is popular among lower income groups in the townships surrounding big cities like Johannesburg, Cape Town, Durban and Pretoria, whose areas are already facing high unemployment and poverty. More so, they argue that in the black townships evidence suggests that nyaope and other native drugs may be the drugs most frequently used. On the other hand, Dada et al. (2018) allude that cocaine and heroin are the most commonly used in white communities. Although, there are currently no recognized or formal comparative studies to support these views.

DISCUSSION

Issues pertaining to the socio-cultural, socio-demographic and their association with illegal drugs in South Africa have been noted and argued in this thesis. It is

important to examine and discuss the methodological approach, which has led to the obtained result. As such, the discussion of this study will be divided into two parts. The first part will discuss the method, and the second part will discuss the results section.

Method Discussion

This study used a qualitative literature review and focused on 42 peer-reviewed and journal publications to examine the extent of illegal drug use in South Africa. This method was chosen in order to perceive the state of the current research and identification of gaps that may exist in the body of literature. The knowledge extracted helped to disseminate ways for future research and policy development in order to curb the vast illegal drug use scourging South Africa.

The overall objective of this research was to assess the prevalence of illegal drug use, to explore the socio-demographic and socio-cultural characteristics that are associated with the influence and use of illegal drugs in South Africa. However, it should be noted that the methodology chosen in this study has its advantages and disadvantages. On one hand, conducting a literature review has benefits in discovering new angles that need further exploration by reviewing what has already been written on a topic (McEvoy et al., 2009).

On the other hand, a literature review makes it difficult to identify all related themes and their association with illegal drug use. There is no set method to guarantee that all the literature on a topic was considered. Thus, the chances of the review being biased increases (McEvoy et al., 2009). Some important and potential articles which might have made a difference were neglected or were not published altogether. In addition, the inclusion criteria used was very exhaustive in trying to redact articles that did not meet the criminological relevance of this study. In turn, some articles in other fields of social sciences like epidemiology and psychology, which had a potential relevance in this study might have been overlooked.

Regardless of the disadvantages associated with the methodology chosen, carrying out a primary study to evaluate factors related to illegal drug use in South Africa gained immensely from the methodology selected. The qualitative literature review was perfect in giving a clear, concise picture, and yield results with a stronger foundation.

Results Discussion

This study is founded on three research questions. Firstly, delineate the existing research, factors, and practices regarding perceptions of illegal drug use in South Africa, secondly, to assess the prevalence of illegal drug use through sociodemographic, sociocultural, criminal and health characteristics that impact the use of illegal drugs in South Africa. Finally, the third aim is to draw conclusions and make recommendations regarding future research´s direction. The analysis of these factors found several features and themes which are important and worth noting in this study.

With regards to socio-cultural factors, the complexity of the drug problem in South Africa has been compounded by patterns of drug availability and easy accessibility, distribution, violence victimization, poor social relationships, poverty, and unemployment. These results show that there has been a decrease in social and economic ties which make people, especially the young, more exposed and likely

to engage in drug use and drug-related risk-taking behaviour (Peltzer et al., 2010). However, it should be noted that the majority of the literature reviewed in this thesis focused on young learners, especially adolescents in high school.

Furthermore, South African law enforcement initiatives primarily subscribe against large-scale busting distributors and illegal drug trafficking syndicates, whilst local police hardly focus upon secondary level distributors. Very little time is dedicated to curbing small-time drug exchanges between sellers and buyers of illegal drugs in public places, and this has led to the scourge of widespread availability of illegal drugs in the country.

In addition, several studies reviewed alludes to the correlation between illegal drug use and its association with violence victimization. However, there is a lack of existing data on studies of drug use and violence-perpetration. These assertions should be supported by substantial research to be conducted on the use of illegal drug use and its association with violence perpetration as a major factor in South Africa.

To continue, sociodemographic factors were also analysed. The studies reviewed suggests that a major section of South Africa's adults finds themselves in a social environment conducive to drug use, that is, an environment in which there is a rational degree of social support for drug use, exposure to such use, and restricted judgment against it (Peltzer, 2007). These social factors seem to be generally wired by certain psychological factors, namely peer pressure, poverty, unemployment and community tolerance to illegal drug intake. However, as much as these contentions are crucial, such examinations should also be investigated to adults above the age of 30 years for more concrete results which can be generalized.

More so, the prevalence of illegal drug use reviewed in this study shows that South African adolescents and youths are the most affected population group of drug use. Men follow in this hierarchy and finally, women. This is so, because, the majority of the literature analysed in this study is premised on factors affecting juveniles and youths.

In addition, women or gender studies have been few, and most of these studies examined in the current research were executed in Western Cape province. Cocaine and heroin were reported to be the most abused illegal drugs to this population due to intoxication, made women look more attractive among men, coupled with low self-esteem and economic factors like working as prostitutes or being unemployed. However, the literature assessed were all in agreement that women were the least population affected by drug use and that illegal drug use declined with education among female learners (Morejele et al., 2013). Also, several studies mention that black Africans, appear to have the highest prevalence rates of illegal drug use apart from other races. This is so, because, many of the studies have been conducted in socially and economically strained societies where many black Africans reside. Also, black Africans have been noted with their association with native drugs like nyaope and bushman´s tea.

Furthermore, Venter (2014), mentions that black Africans assemble in public places where they spend their day smoking drugs or making plans to get the next. This behaviour, however, as well as the grooming of the users, is yet to be understood, explained or researched intensively in an academic manner (Conway-Smith, 2013).

This assertion, however, is derived from a media article. Also, there have not been many studies in other races and social classes. It is crucial to note that cannabis use among black Africans is lower than in Whites and coloureds.

Although some of the data reviewed in this research allude to the experiences of drug use is consistent across all areas in South Africa, it should be noted that South African major cities are the most urbanized in the whole of sub-Saharan Africa (Dada et al., 2018). The three major cities of Johannesburg, Cape Town and Pretoria, are characterized by high rates of urbanization, they also have the highest rate of drug use, and most of the studies reviewed were conducted in those cities. Thus, to equate such prevalence of drug use in urban centres together with rural locations, and without many studies to support this assertion is misleading and unethical.

Research Limitations

Because the findings are limited to material published between 1994 and April 2019, the study´s primary limitation is the relative lack of coherent and substantial information available on illegal drug use in South Africa. In addition to that, this study´s origins lie in the literature reviewed. It was necessary and important to do a literature review of illegal drug use in South Africa, yet, there could be cultural or political bias in the data collection process and perhaps even the publication process that is limiting.

Furthermore, most of the studies were done in major cities like Cape Town and Johannesburg; this could be limiting and not representative of the whole country. In addition, this study has proved that most of the available information on illegal drug use has come from cross-sectional research studies frequently conducted in a single location and easily accessible populations (e.g., black populations in the townships and high school learners).

It is also imperative to interpret the results of this study in light of the methodology selected. This thesis relied exclusively on a literature review that is subject to intentional distortion and bias. Also, depending on where funding originated from either from educational institutions or non-governmental organizations, the research reviewed may have originally been written with political and cultural agendas in mind.

In terms of a more macroscopic limitation, the relationship between illegal drug use and aspects of gender, ethnicity, religion and other important demographic characteristics were not discussed at length in this study for it to be generalized and used on a national context. However, the research studied will pave the way for future research.

A final limitation of this study is that literature was selected on the basis of thematic review and was then analysed according to those themes. It should be noted that selection based on themes and recent findings were also subject to the author's interpretation of their relevance to the research aims. While objectivity was placed as an adamant principle in the collection and review phase, some underlying bias may exist.

Future Implications

This research evaluated existing research on illegal drug use in South Africa and has recognized gaps in literature and possibilities for future practical research. The missing link in the blight of illegal drug issues confronting South Africa is the need for policymakers to carefully convey policy responses and interpretations that deal with this pressing issue. Already, South Africa has legislation which controls and punishes illegal drug use. This legislation is regulated by the Drugs and Drugs Trafficking Act and Prevention of Treatment for Substance Abuse Act.

This research proposes for the delivery of ‘evidence-based approaches’ which focuses more on the delivery of evidence-based strategies and policies that are designed to meet the clear needs of communities. This is essential in supporting the legislation, and for the country to have comprehensive, accurate and up-to-date data on the nature, extent, and consequences of illegal drugs in South Africa.

Furthermore, in South Africa, there is very little existing, accurate and detailed statistical evidence of the drug problem and its effect on populations, therefore the need for comprehensive and precise research on the subject. Also, much additional information would be needed to have more scientifically long-range trends research of illegal drug use to provide for improved data, starting at the local level. In addition, the South African government has no agencies that provide sustained funding to specifically support research projects studying illegal drug usage. This lack of certain services and agencies, coupled with the non-existence of financing for groundbreaking research has led, in effect, to the mishandling of available resources and the failure to secure other grants and aids with regards to illegal drug use.

Moreover, this review indicates that there are very few studies on the notion of unlawful drug use in South Africa. South Africa has poorest communities that exist without, or have limited, governmental services like drug user treatment centres, health care facilities, statistical data, and basic outreach programs. Such governmental services and resources are necessary and should be commonly placed towards the low and middle-class communities.

In addition, the majority of the available research which has studied prohibited drug usage for the last 25 years has mainly focused on adolescents, illegal drugs and their use of alcohol.There is a need for more studies to be conducted recording illegal drugs as an independent variable. Also, currently, there are no studies about the life course and health-related aspects of illegal drugs and their association with communities. Future research should address and focus on the understanding and developmental advancement of illegal drug use in South Africa. Finally, South Africa should implement longitudinal research about drug user life histories. The advantage of conducting this type of research is that it allows researchers to observe changes over time.

CONCLUSION

This study reviewed evidence from 42 peer-reviewed and journal articles of illegal drug use and its interrelatedness with socio-cultural and socio-demographic factors between

1994 and April 2019 in South Africa. Results showed that socio-cultural factors

included easy access and availability of drugs, weak parental control, poverty, and employment. Furthermore, illegal drug use within gender and illegal drug use through geographical spheres were thoroughly discussed in socio-demographical themes.

Within the research conducted, there are significant gaps that were noted. In the study, the literature reviewed indicated that much of the studies focused on the adolescents and youths´ associations with illegal drug use than any other age groups and most of the studies were carried out in major cities and this has prevented this study to be generalized to the whole of South Africa. As a result, there is a need to support research on the notion of illegal drugs as its core value. Furthermore, future drug prevention programs should be steered towards longitudinal studies, and national treatment services and centres should be more accessible for communities that are distressed by the scourge of illegal drug use in South Africa.

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APPENDIX

Author Year Title

Amoateng, A.Y., Barber, B.K. & Erickson, L.D

2006 Family predictors of adolescent substance use: the case of high school students in the Cape Metropolitan Area, Cape Town.

Brook, S., Morojele, N.K., Pahl, K. & Brook, D.W.

2006 Predictors of drug use among South African adolescents.

Dada, S., Harker ,N., Laubscher, R., Parry, C., Myers, B.

2018 Alcohol and other drug use among women seeking substance abuse treatment in the Western Cape.

Degenhardt, L.,

Whiteford, H., A,Ferrari A. J,

2013 Global burden of disease attributable to illicit drug use and dependence in South Africa.

Ewart, Craig K., Sonia, Suchday

2002 Discovering How Urban Poverty and Violence Affect Health: Development and Validation of a Neighbourhood Stress Index.

Faul, A. 2013 Policing taverns and shebeens:

observations and experiences. Flisher, A., Parry, C.D.,

Evan, J., Muller, M. & Lombard, C.

2003 Substance abuse by adolescents in Cape Town Prevalence and correlates.

Ghuman, S., Meyer-Weitz, A. & Knight, S.

2012 Prevalence patterns and predictors of alcohol use and abuse among secondary school students in southern KwaZulu-Natal, South Africa: demographic factors and the influence of parents and peers.

Fellingham, R., Dhai, A., Guidozzi, Y., & Gardner, J.

2012 The ‘war on drugs’ has failed: Is decriminalisation of drug use a solution to the problem in South Africa?

Judith, S., Brook, J.S., Morojele, N.K., Pahl, K. & Brook, D.W.

2006 Predictors of drug use among South African adolescents.

King, G., Flisher, A.J., Mallett, R., Graham, J. & Lombard, C

2003 Smoking and drugs in Cape Town: community influences on adolescent tobacco use.

King, G., Flisher, A. J., Noubary, F., Reece, R., Marais, A., & Lombard, C.

2004 Substance abuse and behavioural correlates of sexual assault among South African adolescents.

Ladikos, A., Prinsloo, J.

& Neser, J. 2003 An opinion survey on teenage substance abuse indicators: an application of the Child analysis.

Leggett, T. 2002 Drugs and crime in South Africa: a study in three cities.