Rehabilitation of heroin and cocaine abusers managed in a Nigerian psychiatric hospital.

Eighty patients, managed primarily for heroin and cocaine dependence at the Drug Rehabilitation Unit of Psychiatric Hospital, Yaba, Lagos, were followed up monthly for a period of 12 months post-discharge and assessed with regard to continued substance use, employment status and illegal activities. The management package included full assessment, detoxification, treatment of associated physical conditions, group therapy sessions, occupational and vocational rehabilitation. The sample was predominantly male (91%), young adults (mean age 29.1 years; SD 5.99) and single (58%). Although 95% had some formal education, many were school drop-outs, and only 31.3% were gainfully employed. The majority (84%), used a combination of heroin and cocaine, almost all on a daily basis, mainly by smoking and "chasing the dragon" (95%). Other substances reportedly used preadmission were alcohol (22.5%), cannabis (76.3%) and tobacco (97.5%). Less than one half (43.8%) completed the minimum one month required for inpatient treatment. Only seven (8.7%) attended the follow-up clinic regularly, but all defaulters were assessed in their homes. The level of heroin, cocaine and cannabis use, as well as report of illegal activities, dropped sharply from the first month post-discharge, but started to rise again (albeit slowly) by the second half of the follow-up period. There was only a slight insignificant gain in employment status of patients during the follow-up period. The community-based management approach is strongly advocated as a way of addressing the several factors identified in this study as militating against the successful management of substance abusers.