Developing an Inpatient Substance Use Disorder Program in a Middle-Income Country: The Experience of Sbrana Psychiatric Hospital, Botswana

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Background: The prevalence of substance use disorders (SUDs) is rising globally, significantly affecting public health. These disorders are associated with reduced quality of life, comorbid mental health conditions, and increased risk of infectious diseases such as HIV. This paper describes the development and implementation of group therapy as an intervention for SUDs in a resource-constrained setting. Program Description: An 8-week inpatient group therapy program was established at Sbrana Psychiatric Hospital in Botswana. The interdisciplinary team includes a social worker, psychologist, occupational therapist, psychiatric residents, and a psychiatrist. To date, 9 cohorts comprising 55 patients have fully participated. The average age was 35 years; most were males (61%), with alcohol being the most used substance, followed by crack cocaine. Of these, 21 have remained abstinent for at least 3 months and reintegrated into society, 11 have relapsed, and 23 are lost to follow-up. Program Insights: Challenges encountered include client dropouts, poor reintegration into the community, limited follow-up systems, and financial constraints. Key components contributing to the program's impact include peer support, relapse prevention, coping strategies, psychoeducation on triggers, and elements of the 12-step recovery model. Conclusion: Program improvement areas include strengthening follow-up through objective measures, such as urine drug testing, and incorporating structured wellness and recreational activities to support recovery.

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