POST TRAUMATIC STRESS DISORDER
Post Traumatic Stress Disorder is the label contemporary psychiatry gives to what was known as 'shell shock' during the Second World War. [I have referred to it in 'Grensvegter?', Chapter 6]. In the First World War, it was regarded as cowardice amongst common soldiers, who might be shot, and 'Lacking Morale Fibre' amongst the officers, who were sent back to England to recuperate. (Reference: Thomas Szass interview.)
The disorder, the symptoms of which include a critical incident;
* "The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone ..."
* "The traumatic event is persistently re-experienced ..."
* "Persistent avoidance of stimuli associated with the trauma, or numbing of general responsiveness ..."
* "Persistent symptoms of increased arousal ... hyper- vigilance ... exaggerated startle response ..."
* "Duration of at least a month ..."
- DSM III - R pp. 247 - 251.
The model followed in treating people suffering from Post Traumatic Stress Disorder used in the SAMS was that developed in Israel and documented by Gabriel (1982). This focuses on preventing the disorder from developing fully by debriefing people who had experienced traumatic events, as soon after the event as possible (Immediacy) and as close to where the event had happened as possible (Proximity). Particular difficulties were found where military sufferers were removed from the battleground.
The technique, as described by Gabriel, included:
"Letting the soldier sleep or have an uninterrupted rest for a few hours, feeding him with good food, and outfitting him with a fresh uniform - especially if he had blood on him. Once awake, he was kept active, usually by a psychologist who walked with him while talking to him about what happened. The soldier was pressed to recount his experiences in exact detail."
"In the retelling of his story, the psychologist would support him at points of obvious stress by touching him, holding him, letting him cry, telling him he was not so different. The object was to rebuild the soldier's self-image by making him go over his story repeatedly, each time purging more and more of the fear and horror that had induced the shock."
Gabriel, 1982, p. 42
Unfortunately, by the time people reached us at 1 Mil, we were reduced to the technique of the repeated retelling of the traumatic events.
I assessed one chap, from a farming family, who seemed to have had more than his share of bad luck. He had accidentally burned down a building. Shortly after that, during a family dispute his drunken brother-in-law had staggered out of the door. The patient had jumped into one of the pickups to go and look for him, but it was a dark night, and he didn't see his brother-in-law passed out in a dip in the track, and rode over him, killing him. He was charged with manslaughter, but acquitted, but he reached us with many confused emotions about all of this. He seemed to benefit from being debriefed.
"Patient Johannes referred by Dominee Jan B.. He was involved in a vehicle rolling during which he was injured. He has had recurring nightmares of the accident where he has seen himself burned or paralysed. I found that he had been aware of both these fears during a brief phase of consciousness immediately following the accident. Intervention with Dominee B.. I did controlled relaxation exercises and guided imagery with Johannes and Jan worked with the image and left the message that God was with him, caring for him. (Why did I later pick up so much flack from the Dominees?)"
I met a youngster who had been exposed to a very traumatic event when he was a teenager. His mother had separated from his father, and his father found out that she was living with another man. He and his son, my patient, dressed up with masks and took sticks along and went to go and beat up the woman's new boyfriend. This went according to plan, until during the assault, my patient's father pulled out a pistol and shot the man dead. There was a court case, and the patient's father was sentenced to a very long prison term, if not life. I think my patient was on probation for several years. I think he was a mislead innocent - he had gone along at his father's insistence, and had been completely surprised to see that his father had taken a firearm along. (Or was I just buying into his story?) He was 'notorious', as he showed me an article in the Afrikaans Magazine 'Huisgenoot', in which the story was reported, which included a photograph of him.
I saw a young national serviceman who had been the subject of attempted rape by a number of women. The incident happened in Voortrekkerhoogte, and his genitals had apparently been cut and scratched, but he would not suffer permanent damage. He was a very pleasant lad, with a conservative upbringing, and had found difficulty defending himself because he adhered to the philosophy he had brought up with, that 'boys must not hit girls'.
Glenn saw a patient who had been present at the murder by his tracker of a little shepherd boy somewhere in the operational area. They must have been 'special forces' of some description. The tracker had used the patient's knife to slit the boy's throat. They had buried the boy's body in an unmarked shallow grave, which was to be a source of much guilt to Glenn's patient.
Glenn focussed attention on getting the patient to yield the knife up to him. When he was successful, Glenn showed the knife to us with the comment; "This knife has actually killed someone".
"Do you still use it?" Glenn asked the patient.
"Sometimes," the patient admitted, "When I'm carving biltong." ['Biltong' is a Southern African delicacy of dried meat. Having cut off slices, the man would eat them.]
I saw a young National Service officer or NCO who had been involved in some public relations work 'trying to win the hearts and minds of the people' of Namibia. He had a vehicle and trailer at some little village, and had just finished a demonstration, or some 'good turn', and when they drove away, there was some accident in which some of the children were killed by the trailer. He had a great deal of guilt to work through as a result of this.
Robin was a couple of months older than me, and bore a striking resemblance to American comedian Robin Williams. He had completed his initial two years service in 1979.
His platoon had been ambushed in Angola and they were pinned down by rocket and mortar fire, and half the squad was killed. A sergeant was killed next to him. The sergeant had been hit in the back of his head, and died as Robin tried to save him, leaving blood, bone, brain and flesh on Robin's shoulder and chest.
He was trained as a medic and a radio operator, a strange combination of jobs. The fact that he was a radio operator meant that it was his job to call for airborne support, and delays in its arrival would illogically be seen as his fault. His role as 'medic' meant that he was expected to save lives, no matter how badly people were injured. People died, and he blamed himself, and he got the feeling that the survivors of the platoon felt that 'he could have done more'.
They had returned to base, only to be sent on another patrol the next day, which involved a fire-fight, but casualties were not as severe. Robin was very resentful at having been sent out again so soon, without the opportunity to rest sufficiently, or come to terms with what had happened to them. (Though they were treated as Gabriel would have advocated - return to combat status as soon as possible!)
After his initial two years, Robin kept being called up for camps, and receiving notification of these brought forward many symptoms of PTSD. He had nightmares, and his relationship with his girlfriend deteriorated. He would get his camp call-ups postponed, but they would just add his name to the list for the next camp to be organised.
Unfortunately his employers tried to get him to work in the eastern Transvaal, terrain which he found very similar to that in which the ambush had occurred, and he did everything he could to avoid such assignments. The company he worked for objected to his avoidance of this work, and started to discriminate against him, and eventually laid him off. He started to have financial problems.
While we were seeing him, an ANC bomb blew up a church (?) in the suburb in which he lived. He asked, why, after all that he had gone through, had the trouble followed him to his neighbourhood.
He had suffered with the problem for more than five years. I arranged for him to be seen by Commandant P. who recommended that he be medically exempted from any further military duties, and that he receive financial compensation for his suffering. But we didn't remove his suffering.
I have met someone who has done his two years national service, and has been rocketed in southern Angola, has tried to save the life of someone who had half his head shot away, all to no avail. He comes home to find that the war has followed him, and churches in his own neighbourhood are being bombed. How do you explain it to him, that what he has gone through was all for nothing? How would you explain that to anyone? All that he has gained from his two years is a psychiatric diagnosis of "Post Traumatic Stress Disorder" (which means 'shell shock'), and a hatred for the people with whom hopefully we will one day be working in harmony with.
There was a big thug-like chap on Ward 9, called David, who was diagnosed as suffering from Post Traumatic Stress Disorder. He had adapted to being on the ward too well, and walked around as though he owned the place. He was one of Commandant P.'s patients, and as such was above the law that governed the rest of us, as he waited to be medically discharged. I was asked to take him with me when I went to the Quartermasters Store to get items of uniform. Beside as, as we were driving along, a car backfired. He showed what is euphemistically called an 'exaggerated startle response' - he almost leaped out of his seat, and shook the whole car with the movement. He went on to become a TV star in a South African soap opera, and I read a Huisgenoot article in which he described his experiences at 1 Mil.
Late in 1987, I saw a patient who had Post Traumatic Stress Disorder after his Ratel armoured vehicle was rocketed by a Soviet 'Mig' fighter. Several of his crew had been killed. This was before it was general knowledge, even in the military, that we were getting heavily involved in Angola, and it was the first time that I envisaged South African troops facing enemy jet fighters.
He also said that he felt cheated when they had been informed by intelligence that they were being sent into a base in which there were only five tanks. They went in to find thirteen tanks waiting for them. He vowed that he would never trust intelligence reports again, but he felt that they had not been wrong; that intelligence had actually lied to them.
For more information relating to combat related Post Traumatic Stress Disorder in the SADF, have a look at the following two articles. Both are relatively obscure to the international community interested in combat related PTSD, so I have taken the liberty of reproducing them here, but will removed them immediately when asked to do so by the publishers. `Coming Home' and Shattered by Fear. The actual debriefing procedure that I used, and that I learned while in the SADF is presented as Debriefing Traumatised People.
In 1987, questions were asked in parliament about the number of attempted suicides amongst conscripted national servicemen. This was a sensitive area, reflecting as it did, disenchantment with the national service system. I think that even before this, it was SADF policy that all attempted suicides had to be investigated by a board of inquiry, and such suicide attempters had to be referred to the Department of Psychiatry for evaluation.
As a result of this, we saw in the department, many people who had made unsuccessful suicide attempts. Some of the people we saw were genuinely depressed, but others were just making suicidal gestures in the hope of being discharged from the army or transferred to another unit. Some are quite blatant about this. Seeing so many manipulative attempts did make staff rather blaze towards feeble suicide attempts, but I am sure that we did respond compassionately to people who really had severe problems.
An indicator of the severity of an attempted suicide's intention was the extent to which he took precautions that he would not be disturbed, and possibly rescued, before he was dead. A person who tried to hang himself in a deserted farm building while his family were away for a week would be taken more seriously than someone walking around a dormitory drawing attention to himself as he tried to 'overdose' one tablet at a time. Similarly, people who tried to shoot themselves were taken more seriously than people who 'scratched' their wrists, or ingested a handful of tranquillisers. I think this paragraph refers to mental health services in general, and not just to the SADF.
Here is a note from a youngster who went on to cope well:
"MR. FOWLER URGENT!"
"Dear Mr. Fowler, This is very difficult for me to tell you seeing that I don't want to hurt your feelings. I am very confused and depressed. However it seems you think I am beginning to adapt. I feel that I am picking up negative vibes because I am not able to tell you how I feel. The things I told you about me are minor, and I don't know what is actually bothering me. I've been thinking about committing suicide because I think that seeing that I don't get a solution its the only way out. To die. I would like you to refer me to Dr. Jackson if it is possible as soon as possible. PLEASE HELP ME !!! Pte. [Identity withheld]"
One person I saw had shot himself through the chest with an R5 rifle. He had aimed for his heart, but missed. He was still around to have to try and explain why he tried to kill himself. He wasn't sure. ("It had seemed like a good idea at the time"?)
I 'lost' a patient in 1986, but he wasn't seeing me at the time. I received a message from one of the doctors in the department saying that the patient had been found gassed in his car, in an isolated place on his family farm. Out of a morbid curiosity, I looked through his file. In it were my notes, concluding with the recommendation that he be granted some 'recovery leave' to sort himself out (steps to which I had detailed elsewhere in the file), to visit his father's grave, and come to terms with the death of his father. Three months later he killed himself.
Extracts from case notes:
"Attempted suicide 5 times previously. Blames the army for loss of mother, and girlfriend with child."
"Trivial attempt. He has a sleep out pass. There are two DD1's (Military disciplinary charges) against him for not doing his clerical duties. Summarily charged for not standing the second half of his guard duty. When told of this he went into another room and started to cut his wrists. A friend came in and confiscated the blade. He found another one and continued to cut. The friend came back with others and prevented him from further attempts. He dislikes being in the army, dislikes standing guard, doesn't like 'Rank' or being told what to do. Disregards discipline and authority."
"Psychiatric Panel Recommended: "The patient was warned that he has no excuse for attempting suicide (no signs of depression) and that further attempts may be disciplinarily dealt with. No follow up treatment was deemed necessary."
"Patient drank half a bottle of ant poison, containing potentially lethal organic-phosphates. Reported vague reasons including his belongings being stolen and clothes not fitting. He went to hardware store specifically to buy the ant poison - yet he said it was an impulsive act. He made the attempt only days before he was due to start work at Wits Command." [Seen as a comfortable posting.] This chap was referred on by the consultation team for further evaluation and treatment.
One of the most gruesome cases I saw was a thirty five-year-old father of two, apparently happily married, a concerned father, and popular at work (according to him) who went home one evening, and shot himself through the head. The bullet went through his frontal lobes, hit the other side of his head, bounced back, and lodged itself above his right eye. He can still do an amazing number of things - walking and talking - considering the amount of damage he could so easily have done to his brain.
Mondays were always potentially heavy days at work, as people had the whole weekend (with the prospect of a return to work on Monday) in which to make their suicide attempts, and about two thirds of the cases I saw while working on the Psychiatric Consultation Team were suicide attempts.
I had a shock one Monday to discover that one of the nursing sisters that worked on our ward had taken an overdose. We had known that she was unhappy, and seemed to have more than her fair share of bad luck. She was back at work in the same week, but it was worrying when things like that happen with the people you work with. (I have since noted that mental health professionals either treat each other as patients, or else show an amazing lack of awareness of the mental distress of their colleagues.)
One of my favourite patients was a young lad who reached me after having made two suicide attempts. He was Afrikaans, and called himself 'Frank' though his real name was something more exotic. He was about eighteen.
His history revealed a string of disasters; His father, to whom he had been particularly close, had died five years previously, of a brain tumour, which had led to some bizarre and embarrassing behaviour, including allegations that he had sexually interfered with some little girls. Young Frank had to come to terms with this reputation being associated with his beloved dead father.
To make matters worse, his house was burned to the ground two year later, and in the fire Frank lost all the mementoes he had of his father, as well all the trophies of his sporting career - which he had to discontinue following a knee injury. One of his most prized possessions was his Northern Free State Schoolboy rugby jersey, his entry into the team of which he considered to be his biggest achievement.
It got worse:
"He has a poor self concept and girlfriend is 39 and suffers from leukaemia (stable) - presumable a one- down relationship. His brother is in prison and his mother and sister say that he will go the same way. Girlfriend is now rejecting him as being a weakling. Two suicide attempts in the last week - he sees no use in carrying on as he will hurt the people he loves. Rugby injury may prevent him from playing again - was very good at rugby at school. Good functioning before his fathers death - some evidence of a mourning process."
"He has an active fantasy life which he seems able to distinguish from reality and therefore lacks a delusional quality. He has imaginary buddies in an imaginary rugby team. One gets a sense of deep hurt talking to him."
"He has been active at occupational therapy, reminiscent of activities he did with his father. We discussed Seligman's theory of learned helplessness - aim at setting small tasks that he can master, and I helped him to decide on such tasks."
"Complicated relationships that he has had with his mother and father and how this has led to his present feelings of inferiority and desire that other people make decisions for him. He reports being able to socialise better from experiences that he has gained on the ward. Panel decision to GT him and let him go back to school." ('GT' - temporary discharge.)
"He is smiling and making plans for the future. He will not try to get back to his older woman, but intends to re-establish relationships with girls his own age. It is very pleasant to see such an improvement."
"Frank's mother phoned to say that she is worried that Frank will not go to school as is the intention with his GT. She says that he "is a psychopath because he has two personalities and she has no control over him." She wants us to ensure that he goes to school. I told her that we cannot do that."
"Discussed problems that Frank has with his credibility, and how chances that he takes may hamper him further."
I suppose I was aware of the possibility that he was 'having us on'. He was immature, and seemed to develop from therapy.
A year after he was discharged, he phoned me at work out of the blue, asking if I remembered who he was. Yes, I did! He reported to me that he had gone back to school, and that he was lodging with the school principal, and that he was doing well at school. He was phoning because he thought I would like to know how things were going - which I did!
I couldn't resist asking him what specifically he had found most helpful of the work I had done with him. I shouldn't have asked!
He told me that what had impressed him most was that I had pointed out that he always seemed to look at the dark sides of things, and that he should 'always try to look on the bright side of things.' Six years of my training, and that was what had helped him most?!
Dr. Leslie K. had a patient who was a fairly senior officer, who had just been caught embezzling vast amounts of money, and his whole life lay in ruins around him. While Leslie was trying to get him to his office, the man made an attempt to throw himself down the stairwell, and Leslie had to physically intervene, and for a few moments it was touch and go as to whether Leslie would be able to stop him, as he was a big man, and Leslie is small and lightly built.
There was apparently another case where a patient appeared to be about to throw himself down the stairwell, but was stopped by the domestic staff. Afterwards it appeared that their concern was not so much with saving his life, but to try and prevent the mess that they would then have to clean up.
I have notes which indicate that I saw two children below the age of fourteen, dependants of military personnel, who had made suicide attempts, but I did not record the details.
There was a NSM doctor on Ward 9 who was so fascinated with death that Rene was sure that he was bound to take his own life. There was the notion that he might cope if he was allowed, encouraged to play golf every day, and was given great support.
While part of the Psychiatric Consultation team, I was asked to assess a badly disabled NSM who was self mutilating in a feeble attempt at suicide - the best that he was capable of. Nothing in my training (until then) had equipped me to attempt to help a person in such a situation, and I knew that if I was in the same situation, I would probably do all that I could to finish myself off. Wimpie briefed me about how he might be helped, which I had not previously been aware of.
NOTES ON 'Suicide' [From a lecture given at various units]
Suggestion on how to handle someone who threatens suicide:
* Refer them to the Dominee or social worker
* Possibly inform them that successful suicide attempts cause much suffering and guilt to their families and loved ones.
* Possibly inform them that unsuccessful suicide attempts often lead to physical or mental damage, paralysis, collapse of vital organs, permanently damaged muscles, and brain damage.
* A suicide attempt is an offence, and a person attempting suicide can be charged with attempt to evade National Service for which a person can be sentenced to five years in a civilian jail.
I gave a lecture on `Suicide in the SADF' to the Ordnance Base at Wonderboom, North of Pretoria, and the difficulty I had getting there, but Fred managed to get one of his drivers to take me there. The officer commanding was Portuguese; a very friendly chap who came up to me afterwards to continue to chat about aspects of the lecture that had interested him. We talked about the modern reversal of Darwin's theory; as in the `Battle of Britain', the cream of the British youth became fighter pilots with life expectancies measured in terms of hours, where the sick, weak and lame were exempted from military service, and stayed at home and bred.
'Substance Abusers' or drug users tend to be an unpopular group to work with for most mental health professionals. Psychodynamic theories suggest that drug users use drugs to replace unpleasant lives, and usually the absence of meaningful human relationships. A difficulty for therapists working with drug abusers is to try to find ways in which life without drugs can be meaningful and pleasurable.
Commandant P., the Psychiatrist in charge of the department, had a psychodynamic approach, and a strong interest in working with drug users. As mentioned earlier, he and his team toured the country running workshops on how unit welfare committees could deal with their drug abusers within the unit.
He ran groups with drug users, many of whom were kept on Ward 9 so that they could attend the groups. These patients were seen as very manipulative, and as the Commandant's personal patients were quite arrogant. They were very unpopular with the ward staff. Smoking tobacco was seen as successful, and all of the drug addicts chain-smoked tobacco when they were in the group, and the room was always thick with smoke.
The drugs referred to here were mostly cannabis, referred to in South Africa as 'dagga'. 'Heavier' drugs were usually handed over to the police, who would lay criminal charges.
One patient I met early on, Marco, came from a Permanent Force family. He was a painter in the permanent force - sort of - with a problem of heavy cannabis abuse. The main element of his problem was that he would become psychotic each time he smoked dope, and he would take days to recover from this effect, whereas a cannabis 'trip' usually only lasts a couple of hours. (Am I sure of this?)
I evaluated a 19 year old drug user, Brett, who claimed that he was keen to give up smoking dope. ("Well why don't you just stop?" I would have liked to have asked, believing that cannabis is not addictive, but that certain personality types develop a dependence on it.) In one session, about why he smoked dope, he said that the only way he could make me understand why he smoked dope would be if we were to smoke dope together. He also spoke quite smugly about ways of avoiding being 'busted' smoking dope - like smoking far away from other people, with plenty of time to drop the 'skyf' ['joint'], and stomp it into the ground. Cannabis traces can apparently be detected in urine and the bloodstream for two weeks after use, but apparently this is inadmissible evidence in court. I'm sure the lad was having me on, and that he had no real desire to give up smoking dope. He would be manipulative, developing tremendous insights into himself to give me the feeling that I was doing meaningful work with him:
"Brett is being self punitive for having smoked dope last night after having 'gone straight' for about ten days. He told the Commandant this morning that he had been straight and the Commandant shook his hand, and now he has the feeling that he has betrayed the Commandant's trust."
I think I sent him on his way fairly soon.
Brendan was a much more interesting person - whom I liked, and enjoyed talking to. He was bright and very pleasant, but came from a strange family who rejected him, and his mother clung to the idea, which she ascribed to a psychologist that they had taken him to see; that he was 'born bad', and consequently his involvement with drugs and other criminal activities was not their fault at all.
I phoned his mother for background information, and she told me what a bad lad he was and had always been, and what a hard time he had given them. Eventually she had had her say, and then wanted me to tell her what trouble he was now in, probably so that she could store this to use as ammunition against him in the future. I explained that I could not give her that sort of information, which irritated her, and she started to rant and rave about how unfair I was being to withhold information from her after all the information I she had given me. But Brendan was over eighteen, and legally I could give her no information without his permission, which I was sure that he would not give.
I didn't see him for long, as he seemed to be coping fine in the Air Force - which is generally seen as milder than anything the Army had to offer.
He came back to me, in what he admitted was a vain hope of getting me to help him when he had been busted for drug usage, and what he described as having 'technically' stolen a car. He already had a suspended sentence following his previous drugs bust, and faced to possibility of going to prison, but I don't know if he did. Cannabis use is widespread in South Africa.
He was a 'likeable rogue', with many creative ideas about the films he wanted to make, which of course appealed to my interests.
PEOPLE YOU KNOW
I met someone I used to know socially who was now a psychiatric patient. He used to be a pupil at the Sunday School I taught at when I was in high school. He was only in my class a couple of times, while I was filling in for someone else, but I knew who he was - it was a small community - and he was someone that I wanted to invite along on my camping group, but we never did.
He now had a severe drug problem, which seems to have effected his memory, so he can't remember much of the time that I knew him. He had been a nice kid. I was sorry to have met up with him again under such circumstances.
He was in Commandant P.'s Drug Group, and consequently lived on Ward 9. The group was run on a token economy system - patients returning from a weekend's leave had their urine tested for evidence of cannabis use, and when these tests were positive, they were refused permission to have a weekend pass the next weekend.
(Remember, while all this was going on, other youngsters were walking patrols in the Operational Area - and the experience counted as national service for both of them.)
I remember very vividly, this lad complaining that he was being kept in because he had failed his drug test, which meant that he would miss his girlfriend's twenty first birthday party. He demanded to see the Commandant, in tears, and talking of 'agreements being broken'. Not so; he had known the rules, and had chosen to break them.
But he saw the Commandant, and they had a long heart-to- heart, and eventually the lad was granted a weekend pass. This did nothing for the morale of the staff on the ward, and they felt that they had been undermined completely.
I was in the secretary's office when a drug patient arrived at the department, having been escorted by a young Lieutenant from 5 SA Infantry Battalion. It was unusual for a Lieutenant to be doing escort duties, as this was usually done by a Military Police (MP) corporal at most. They were about the same age, and as the escorting Lieutenant said farewell to the patient, they shook hands in a manner which suggested deep intimacy. I was to experience similar intimacy with a patient I escorted down from the Border the following year.
We became aware of some very sinister and vicious drug subcultures which developed at some units. Informers were likely to be beaten up or have their faces slashed, and former drug users reporting for treatment were suspected of identifying other hardened drug users. Many people seemed to be fearful or returning to former units after (?)successful treatment for their drug problems, and were much happier about being discharged if they were sent to a new unit.
Some people do incredible things to get 'high'. People spike (inject) the most amazing things, including mayonnaise. ("Spike on mayonnaise and become a vegetable!" Not far from the truth!)
I was amused to attend a barbecue at which several of the staff of Commandant P.'s touring 'Drug Management Team' attended. Over a couple of beers, conversation turned to their own experimentation with drugs. This sounded very hypocritical, but, as one of the doctors pointed out, 'for us its not a problem!'
There was a fundamental hypocrisy in the SADF - and in the wider society; that cannabis usage was a criminal offence, whereas alcohol - considered by many professional people to be at least as dangerous - was positively encouraged by being part of Army life, and drinks being sold at ridiculously low prices.
There was almost a generational conflict involved, where the dagga users tended to be teenage conscripts, and this was seen as a severe problem, often linked to the communist plot to undermine the moral fibre of the South African youth - and such cases would often be dealt with by NCOs and Officers some of whom could easily be diagnosed as having alcohol-related substance abuse disorder.
Additional information regarding the treatment of drug problems, from a different perspective, is provided in RESISTER magazine.