REHABILITATION OF HEROIN AND COCAINE ABUSERS MANAGED IN A NIGERIAN PSYCHIATRIC-HOSPITAL

Eighty patients, managed primarily for heroin and cocaine dependence a t the Drug Rehabilitation Unit of Psychiatric Hospital, Yaba, Lagos, w ere followed up monthly for a period of 12 months post-discharge and a ssessed with regard to continued substance use, employment status and illegal activities. The management package included full assessment, d etoxification, treatment of associated physical conditions, group ther apy sessions, occupational and vocational rehabilitation, The sample w as predominantly male (91%), young adults (mean age 29.1 years; SD 5.9 9) and single (58%), Although 95% had some formal education, many were school drop-outs, and only 31.3% were gainfully employed. The majorit y (84%), used a combination of heroin and cocaine, almost all on a dai ly basis, mainly by smoking and ''chasing the dragon'' (95%). Other su bstances reportedly used preadmission were alcohol (22.5%), cannabis ( 76.3%) and tobacco (97.5%), Less than one half (43.8%) completed the m inimum one month required for inpatient treatment. Only seven (8.7%) a ttended the follow-up clinic regularly, but all defaulters were assess ed in their homes. The level of heroin, cocaine and cannabis use, as w ell as report of illegal activities, dropped sharply from the first mo nth post-discharge, but started to rise again (albeit slowly) by the s econd half of the follow-up period. There was only a slight insignific ant gain in employment status of patients during the follow-up period. The community-based management approach is strongly advocated as a wa y of addressing the several factors identified in this study as milita ting against the successful management of substance abusers.