Treatment outcomes for substance use disorders across the African continent: a systematic review

Abstract

Background: Substance use disorders (SUDs) are increasingly recognized as a significant public health concern in Africa, placing considerable strain on the economy, healthcare system, and society at large. Given the dual disease burden of both infectious and non-communicable diseases, African countries may not prioritize addressing the emerging epidemic of SUDs. There is a paucity of scientific literature on SUD treatment outcomes following their management across the African continent. Therefore, this systematic review aimed to address this gap. Methods: We conducted an electronic search of Web of Science, CINAHL, Embase, Medline (PubMed interface), Scopus, and PsycArticles. We included studies with participants who were diagnosed and treated for SUDs following internationally recognized diagnostic criteria in the African region as defined by geographical boundaries and had at least one treatment outcome measured and reported. Studies were assessed for risk of bias using the Joanna Briggs Institute critical appraisal tool. This systematic review was registered in the PROSPERO database (CRD42022362926). Results: Thirteen research studies were included across four African countries (South Africa − 8, Uganda − 2, Zambia − 2, and the Democratic Republic of Congo − 1). The treatment completion rates across all treatment modalities averaged 71.4%. A reduction in substance use was reported in nine of the 13 studies, with significant decreases observed in measures such as heavy drinking days and substance use severity scores. However, relapse rates ranged from 23 to 92%, with predictors including low recovery capital and poor social support. Substitution behaviours, such as increased alcohol or crystal methamphetamine use, were noted in some studies following abstinence from primary substances. Conclusions: The findings suggest varying levels of efficacy for SUD treatment modalities in Africa, including reductions in substance use in some studies and moderate treatment completion rates. However, the high relapse rates underscore the need for comprehensive, resource-adapted interventions. The limited geographical scope of the literature, with studies predominantly from South Africa, points to a critical gap in research from other African countries and emphasizes the need for expanded research across the continent to inform scalable, evidence-based solutions for SUD management.