Table Of ContentAdults living with stimulant abuse and
bipolar disorder: Experiences of service
users at treatment centres
by
Karina van Zyl
A mini-dissertation submitted in partial fulfilment of the
requirements for the degree
MASTER OF SOCIAL WORK (HEALTH CARE)
in the Department of Social Work and Criminology at the
UNI VERSITY OF PRETORIA
FACULTY OF HUMANITIES
Supervisor: Dr L.S. Geyer
February 2017
© University of Pretoria
DECLARATION OF ORIGINALITY
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ACKNOWLEDGEMENTS
‘For I know the plans and thoughts that I have for you’ says the Lord,
‘plans for peace and wellbeing and not for disaster, to give you a
future and a hope. Jeremiah 29:11
I would like to acknowledge and extend my appreciation to the following individuals:
To my supervisor Dr Stephan Geyer, for his guidance, advice, wisdom and time.
To my husband, mother and siblings for their support, patience and encouragement
throughout the study.
To all my friends and colleagues for their support and inspiration.
To all the staff and participants from the treatment centres involved. Thank you for
sharing your experiences and resources with me.
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ABSTRACT
Adults living with stimulant abuse and bipolar disorder:
Experiences of service users at treatment centres
Researcher: Mrs Karina Marié van Zyl
Supervisor: Dr L.S. Geyer
Degree: MSW (Health Care)
Institution: University of Pretoria
The goal of the study was to explore how adults living with stimulant abuse and bipolar
disorder experience treatment at treatment centres in the Gauteng Province. As the study
was aimed at gaining an in-depth understanding of the lived experiences of service users in
terms of treatment, a qualitative research approach was implemented. The research findings
were aimed at adding knowledge to the field of social work, which could contribute to the
development of treatment programmes and possible policy changes that could positively
impact the recovery of individuals living with a dual-diagnosis, specifically the dual-diagnosis
of bipolar disorder and stimulant abuse.
A phenomenological research design was used as it allowed the researcher to discover and
report on the details pertaining to the participants’ experiences in terms of the treatment they
received. The phenomenological research design also enabled the researcher to describe
the commonalities and discords expressed by participants in relation to the phenomenon.
The sampling process for the research study took place in three phases. In the first phase,
purposive sampling was implemented to select three substance abuse treatment centres in
the Gauteng Province, and more specifically the Tshwane Metropolitan Municipality. The
second phase of sampling was also purposive sampling, where inclusion criteria were
supplied to a social worker at each treatment centre who identified possible participants.
During the third phase of sampling, possible participants were approached and informed of
the study and ultimately four (N=4) individuals volunteered to participate in the study. Data
was collected through the use of semi-structured one-on-one interviews which were guided
by an interview schedule. Data gathered during the literature review and interviews were
analysed through the process of thematic analysis and aimed at answering the research
question “How do adults living with stimulant abuse and bipolar disorder experience services
at treatment centres in the Gauteng Province?”
The key findings indicate that admission to in-patient treatment programmes, for both
stimulant abuse and psychiatric care, was prevalent among all participants, but re-occurring
admissions to substance abuse treatment was more evident. Stimulants were primarily used
as a means of coping with moods and emotions, as unstable mood patterns and emotions
persisted regardless of the pharmacological treatment for bipolar disorder. The most helpful
component of treatment which aided participants in managing their mood was counselling.
When stimulants were not available and counselling was insufficient, other means of
achieving psychological relieve were employed by participants, such as exercise, nicotine
use, sweets and caffeine. The role of religion and spirituality in treatment is not clear, but all
participants believe that religion and spirituality should be included in treatment. The need
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for education in terms of bipolar disorder, addictive behaviours, lifestyle changes and coping
mechanisms were mentioned by most participants. In addition to education provided by
professionals, participants expressed a need for sharing experiences with individuals that
have managed to recover from bipolar disorder and/or stimulant abuse. When treatment
plans and goals are set participants believe that they and their family should be included, a
factor relevant to in-patient and reintegration services. With regards to in-patient treatment
programmes, the psychosocial-cultural environment created within the physical environment
was also mentioned as a component that needs to be considered.
In order to deliver services that allow for the effective treatment and reintegration of
individuals that abuse stimulants and are diagnosed with bipolar disorder the following
recommendations are made: 1) Interventions, including prevention and early interventions,
should be developed based on research findings focused on dual-diagnosis, to ensure that
concurrent treatment and reintegration is achieved and sustained, thus promoting recovery,
or the management, of both disorders. 2) Education in terms of stimulant addiction, cross-
addiction, bipolar disorder, lifestyle changes, coping skills, as well as the interplay between
these factors should be included in treatment programmes, however, education should be
expanded to service providers and extended to family members too. 3) The role of religion
and spirituality as part of dual-diagnosis treatment should be considered. 4) Treatment and
support groups that focus on the specific dual-diagnosis of stimulant use and bipolar
disorder, should be developed as part of in-patient treatment programmes, as well as
supporting out-patient programmes, which could improve long-term recovery. 5) The
physical and the psychosocial environments which are conducive to the recovery of dual-
diagnosis patients should be established, as these environments could possibly be
replicated, for example at home, and could ensure long-term recovery. 6) Service users and
their families should be included in decisions regarding treatment planning and reintegration,
as inclusion in this area of treatment could promote compliance to treatment. However, it
should be stated that many of these recommendations are dependent on governing bodies,
such as the Department of Social Development and the Department of Health, who are
responsible for changing, developing and monitoring policies guiding treatment, which has a
direct impact on the long-term recovery of individuals living with this dual-diagnosis.
Future research studies that can contribute to understanding this phenomenon can focus on
1) Repeating the study within other private and government based treatment centres across
South Africa in order to determine whether treatment needs differ or whether it presents the
same results. 2) Comparing studies from different centres and areas of South Africa in order
to establish treatment needs of individuals diagnosed with a dual-diagnosis. 3) Research
should be done to determine the actual prevalence of the dual-diagnosis of stimulant abuse
and bipolar disorder in South Africa, focused on admissions in both substance abuse
treatment centres and psychiatric treatment facilities. 4) Treatment programmes developed
from research findings should be implemented, and research should be conducted on the
effectiveness of treatment. 5) Research on different combinations of dual-diagnosis is
necessary to determine how treatment needs differ, as this will ensure the development of
appropriate treatment. Individuals working at treatment centres (for both substance abuse
and psychiatric disorders) should be aware of the needs of dual-diagnosis patients, and be
educated on this phenomenon. 6) It is recommended that research should be done with the
staff of psychiatric treatment centres, as well as staff at substance abuse treatment centres,
to determine their views and knowledge in terms of dual-diagnosis. 7) Research focussed on
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the costs of not treating dual-diagnosis should be conducted. When the actual costs of non-
treatment are established, government agencies and the private sector might be more prone
to support treatment strategies. 8) Intervention strategies focused on families of dual-
diagnosis patients should be implemented and the impact of these interventions on both
patients and families should be researched. 9) More research in terms of this dual-diagnosis
is necessary as this could allow for the development of effective treatment strategies that
could lower relapse and readmission rates.
Keywords:
Adults
Substance abuse
Stimulant abuse
Bipolar disorder
Dual-diagnosis
Service users
Treatment centre
Gauteng Province
Tshwane Metropolitan Municipality
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TABLE OF CONTENTS
DECLARATION OF ORIGINALITY ....................................................................................... i
ACKNOWLEDGEMENTS ......................................................................................................ii
ABSTRACT .......................................................................................................................... iii
TABLE OF CONTENTS ....................................................................................................... vi
LIST OF FIGURES ............................................................................................................ ix
LIST OF TABLES ............................................................................................................. ix
CHAPTER 1 ......................................................................................................................... 1
GENERAL INTRODUCTION ................................................................................................ 1
1.1 INTRODUCTION ......................................................................................................... 1
1.2 DEFINITION OF KEY CONCEPTS ............................................................................. 2
1.3 THEORETICAL FRAMEWORK .................................................................................. 3
1.4 RATIONALE AND PROBLEM STATEMENT .............................................................. 5
1.5 GOAL AND OBJECTIVES .......................................................................................... 7
1.6 OVERVIEW OF RESEARCH METHODS .................................................................... 7
1.7 CONTENT OF MINI-DISSERTATION ......................................................................... 8
CHAPTER 2 ....................................................................................................................... 10
LITERATURE REVIEW ...................................................................................................... 10
2.1 INTRODUCTION ....................................................................................................... 10
2.2 SUBSTANCE ABUSE ............................................................................................... 10
2.2.1 Categories and Types of Substance Abuse .................................................... 11
2.2.2 Causes of Substance Abuse ............................................................................ 12
2.2.3 Prevalence of Substance Abuse ...................................................................... 16
2.2.4 Effects of Substance Abuse ............................................................................. 19
2.2.5 Substance Abuse Treatment ............................................................................ 21
2.3 BIPOLAR DISORDER ............................................................................................... 26
2.3.1 Types of Bipolar Disorder ................................................................................ 27
2.3.2 Causes of Bipolar Disorder .............................................................................. 29
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2.3.3 Prevalence of Bipolar Disorder ........................................................................ 31
2.3.4 Effects of Bipolar Disorder ............................................................................... 32
2.3.5 Treatment of Bipolar Disorder .......................................................................... 35
2.4 DUAL-DIAGNOSIS ................................................................................................... 37
2.4.1 An Overview of Dual-Diagnosis ....................................................................... 38
2.4.2 Causes of Stimulant Abuse and Bipolar Disorder Dual-Diagnosis ............... 39
2.4.3 Effects of Stimulant Abuse and Bipolar Disorder Dual-Diagnosis ................ 40
2.4.4 Treatment of Dual-Diagnosis ............................................................................ 41
2.5 SUMMARY ................................................................................................................ 45
CHAPTER 3 ....................................................................................................................... 46
RESEARCH METHODS AND EMPIRICAL FINDINGS ...................................................... 46
3.1 INTRODUCTION ....................................................................................................... 46
SECTION 1: RESEARCH METHODS AND ETHICAL CONSIDERATIONS....................... 46
3.2 RESEARCH APPROACH ......................................................................................... 46
3.3 TYPES OF RESEARCH ............................................................................................ 47
3.4 RESEARCH DESIGN ................................................................................................ 47
3.5 RESEARCH POPULATION AND SAMPLING .......................................................... 48
3.6 DATA COLLECTION ................................................................................................ 49
3.7 DATA ANALYSIS ..................................................................................................... 50
3.8 TRUSTWORTHINESS IN QUALITATIVE RESEARCH ............................................. 52
3.9 PILOT STUDY ........................................................................................................... 53
3.10 ETHICAL CONSIDERATIONS ................................................................................ 53
3.11 CHALLENGES AND LIMITATIONS OF THE STUDY ............................................. 54
SECTION 2: RESEARCH FINDINGS AND DATA INTERPRETATION .............................. 56
3.12 BIOGRAPHIC PROFILE OF PARTICIPANTS ........................................................ 56
3.13 QUALITATIVE DATA AND INTERPRETATION ..................................................... 60
Theme 1: Me, Myself and I ......................................................................................... 61
Theme 2: Everything in moderation ......................................................................... 68
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Theme 3: Abundance Please! ................................................................................... 72
Theme 4: All for one, and one for all ........................................................................ 76
Theme 5: In the long run ........................................................................................... 82
3.14 SUMMARY .............................................................................................................. 87
CHAPTER 4 ....................................................................................................................... 89
CONCLUSIONS AND RECOMMENDATIONS ................................................................... 89
4.1 INTRODUCTION ....................................................................................................... 89
4.2 RESEARCH GOAL AND OBJECTIVES ................................................................... 89
4.3 KEY FINDINGS ......................................................................................................... 92
4.3.1 Key Findings from Literature Review .............................................................. 92
4.3.2 Key Findings from Empirical Study ................................................................. 93
4.4 CONCLUSIONS ........................................................................................................ 94
4.4.1 Conclusions Based on the Literature Review ................................................. 94
4.4.2 Conclusions Based on the Empirical Findings ............................................... 95
4.5 RECOMMENDATIONS ............................................................................................. 96
4.5.1 Recommendations for South African Treatment Centres that Admit Patients
with a Dual-Diagnosis of Stimulant Use and Bipolar Disorder ............................... 96
4.5.2 Recommendations for Future Research .............................................................. 98
REFERENCES ................................................................................................................. 100
APPENDIX A: INTERVIEW SCHEDULE .......................................................................... 112
APPENDIX B: PERMISSION FROM TREATMENT CENTRE .......................................... 114
APPENDIX C: PERMISSION FROM TREATMENT CENTRE .......................................... 115
APPENDIX D: PERMISSION FROM TREATMENT CENTRE .......................................... 116
APPENDIX E: INFORMED CONSENT ............................................................................. 117
APPENDIX F: ETHICAL CLEARANCE ............................................................................ 119
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LIST OF FIGURES
Figure 1.1: The Biopsychosocial Perspective ........................................................................ 4
Figure 3.1: Overview of Themes and Sub-Themes of Study ............................................... 61
LIST OF TABLES
Table 2.1: Primary and Secondary Drugs of Choice (stimulants) ........................................ 18
Table 3.1: Biographical Information of Participants ............................................................. 57
Table 3.2: Current Age, Age of Stimulant Abuse Initiation and Age of Bipolar Disorder
Diagnosis (in years) ............................................................................................................ 59
Table 3.3: Number of Participants Mentioning Childhood Risk Factors ............................... 60
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