Patterns of extra-medical drug use in South Africa: results from the South African Stress and Health Study.

Background. Historically data on substance abuse in South Africa has been limited. This paper describes patterns of substance use based upon recent, nationally representative data. Methods. Data were derived from the 2002-2004 South Africa Stress and Health Study (SASH). A nationally representative household probability sample of 4351 adults was interviewed using the paper and pencil version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Data are reported for lifetime use, socio-demographic correlates of use, and age of cohort predicting lifetime use for four classes of drugs. Results. The estimate for cumulative occurrence of alcohol use was 38.7%; tobacco smoking, 30.0%; cannabis use, 8.4%; other drug use, 2.0% and extra-medical psychoactive drug use, 19.3%. There were statistically significant associations between male gender and alcohol, tobacco, cannabis and other drug use. Coloureds and Whites were more prone to have used alcohol, tobacco and other drugs compared to blacks. Clear cohort variations existed in the age of initiation of drug use; these were most marked for other drugs and for extra-medical drug use. Use of all drug types was much more common in recent cohorts, with a similar cumulative incidence of tobacco, alcohol and cannabis use across age cohorts. Conclusions. These epidemiological patterns of alcohol, tobacco, cannabis, other drugs and extra-medical drug taking provide the first nationally representative data. New findings on race and exploratory data on time trends provide a foundation for future epidemiological work on drug use patterns across birth cohorts and population subgroups in South Africa.