The present study reports a higher prevalence of past-year use of psychoactive substance use in comparison to 4.1%, 4.4%, and 5.5% for the general population in the Eastern Cape, South Africa, and globally, respectively . Several other studies have similarly reported a higher prevalence of lifetime and past-year substance use in individuals with mental illness in comparison to the general population . Our study shows that the prevalence of lifetime, past-year, and risky alcohol use was higher among males than females. This trend is similar to previous studies carried out in the Eastern Cape, nationally in South Africa, and globally . Males also had a higher prevalence of past-year use of psychoactive drugs than females . Similar observations were made in studies done nationally in South Africa , Nigeria , the United Kingdom , and the Netherlands . The World Health Organisation Report found a lower prevalence of lifetime abstinence from alcohol in males in comparison to females . The differences in alcohol use can be attributed to the influence of gender-related socio-cultural factors, which in themselves vary between different ethnic and cultural groups .
In addition to the traditional gender roles and societal norms, which set the acceptable standards of behavior for both sexes, these complex dynamics influence alcohol and substance use at the population level, especially among women.The important issue regarding differences in substance use between the sexes is that, while men are more likely to use substances and have substance use disorders, women are more susceptible to negative health and psychosocial outcomes of alcohol and drug use and face more obstacles in accessing treatment for substance use disorders , thus highlighting the need for prevention and intervention programs aimed specifically at this vulnerable group. Younger individuals with mental illness were more likely to engage in risky alcohol and psychoactive substance use than their older counterparts. This finding is consistent with global trends .The reasons for this are multi-factorial and can be seen at the individual, familial and societal levels. On an individual level, there is cognitive development happening in the young brain. This is a critical period that lends itself to particular vulnerability to stressors and risk-taking behaviors.
Individuals might have undiagnosed, untreated mental illnesses for which they self-medicate with substances . Individuals with family problems, such as ongoing conflict, physical or mental illness, and substance abuse, are also more likely to use substances as a coping mechanism. Unemployment and poverty can result in individuals using substances to escape or becoming part of the supply chain to earn money to survive . Youths also use substances due to peer pressure, the need to belong, bullying , and, in some instances, as a result of gang affiliations. Therefore, younger individuals with mental illness should be categorized as a high-risk sub-population that requires targeted intervention programs at the community level. Employed individuals with mental illness were more likely to engage in risky alcohol and psychoactive drug use in comparison to those receiving social grants. There are several plausible explanations for this result. Employed individuals have more resources at their disposal to secure alcohol and psychoactive drugs in comparison to those with social assistance , who tend to prioritize basic needs over substance use . Individuals who are receiving social grants must have fulfilled a set of criteria that suggest that they were incapable of obtaining employment or generating income to support themselves. In addition, the results from this study also show that the majority of participants live with family members.
The money from the social assistance grants is often used to support not just the individual but also the family members with whom they live. Interestingly, it was observed that unemployed individuals also engage in risky alcohol and psychoactive drug use in comparison to those receiving social grants. Besides the underlying mental illness precluding the patients from securing and keeping a job, it is also plausible that alcohol and psychoactive drug use impact negatively on the underlying mental illness and consequently lead to poor functioning. Evidence suggests that unemployment can be a psychosocial stressor that leads to increased use of substances by unemployed individuals . Often, the source of money for procuring alcohol and psychoactive drugs remains an important question, despite being unemployed. Unemployed individuals resort to borrowing, theft, robbery, extortion, and other illegal activities in order to access substances . Anecdotally in this setting, unemployed individuals share substances with friends or family members who buy them or perform occasional piece-work or resort to crime. This could be an area for future research in this population. In this study, individuals living in urban areas were found to have a higher prevalence of both alcohol and psychoactive substance use than those living in rural areas. Similar trends have been observed in national studies in South Africa and China.