South Africans are among the world's heaviest drinkers. A 2011 World Health Organisation report estimates that we consume an average of 9.46 litres of pure alcohol per adult every year, which is more than a third higher than the African regional average of 6.2 litres of pure alcohol. 

According to a 2014 South African Medical Journal article, alcohol is the most abused drug in the country and alcohol abusers account for more than half of all patients being treated for substance addiction.

The Western Cape and the Northern Cape provinces have the highest levels of binge and harmful drinking in the country, according to the Human Sciences Research Council. Studies have shown that alcohol abuse has an effect on all aspects of life. Alcohol abuse is often associated with unemployment, risky sexual behaviour and violent crimes. 

Bhekisisa travelled to De Aar and Upington in the Northern Cape – both towns with excessively high levels of drinking – to witness the devastating effects of alcohol abuse.

Violence  
Frances April stands in her front yard, watching protectively over her grandchildren, who are among the group playing in the sun-baked sand of the wide street in De Aar in the Northern Cape.

"When they are in primary school we don't have any problems with the children. But when they start going to high school and attending school functions, that is when their drinking starts." She shakes her head wistfully. "The youth drink so much."

Leading the way into her small living room, April says not all of De Aar's young people drink excessively. Some youngsters do it for "relaxation" and don't go overboard. "They just hang out at somebody's house where they all sit together and have drinks."

The problem, however, comes about when youngsters who have not been invited to these parties force their way in, become confrontational and cause fist fights. "These brawls happen every weekend," April says, shrugging her gaunt shoulders.

She walks to the adjacent kitchen to check up on the vetkoek she is frying. She then returns to the living room and wipes her hands on her apron before seating herself on the old sofa.

"The girls here do drink but they do it where people can't see them and they don't get out of control when they are drinking.

"But we have a big problem with our boys. The police have their hands full because the boys talk back and sometimes even fight with the police," she says, reaching under her wide-brimmed hat to wipe her perspiring forehead as if to wipe the strain from her wrinkled face.

Being a single parent, April struggles to discipline her son (20) and nephew (18), who both live with her. Just that morning she had to rush to the hospital because her sister's child was involved in a violent altercation that nearly cost him an eye.  

Alcohol-related violence is something that has become so common in her home that April has had to get a protection order against her own son – if he becomes violent towards his mother he will be sent to jail. 

"I've tried speaking to him nicely; I've called the church people. I've even gone as far as giving him an ultimatum but that fell on deaf ears." 

April, her grandchildren and neighbours have all been victims of his violent, alcohol-related outbursts. 

"A few months ago, while I was at work, I got a call from my neighbour. My son had arrived home drunk and started a squabble with them. I called the police from work and they came here and spoke to him. Although I asked that they lock him up, the police just spoke to him and gave him a warning." 

Intimidated by her son's increasingly violent behaviour, April applied for a protection order. "Since I was granted the interdict he has been behaving himself," she says with a toothless smile. 

Although he still lives under her roof, the order sets out strict rules for him to abide by. "He is not allowed to come into my yard drunk because when he is drunk he picks fights with me. He is not allowed to shove the [neighbours'] children and grandchildren around and swear and shout at them like he used to."

But sometimes April fails to follow these rules herself and ends up protecting her son when he violates the stipulations of the interdict.

The real problem, she says, is the lack of recreation for young people in De Aar – and booze is readily available.  

"Things get really bad here on weekends, there are a lot of murders and assaults," she says, remembering that, earlier that day, a pregnant woman had been raped and assaulted and left for dead in a nearby field. 

"I wish there was no such thing as weekends. Our children behave themselves during the week because their friends who have the money to buy drinks are at work. But when Friday comes we don't get any sleep because they run this place on weekends." 

Teen pregnancy 
It is almost midnight on a Monday and, for the most part, the central Karoo town of De Aar is fast asleep, except for some of the town's young people who are hanging out at Trudy's  tavern where the music can be heard from a few blocks away, disturbing the otherwise peaceful night.  

Not too far from the lively music booming from the tavern, a lone dog strolls across the deserted, dimly lit street. A woman with a young body but a face that looks significantly older,  carrying a brown beer bottle, staggers out of the darkness towards a small house with a neat yard. 

Inside the house an indistinct foul smell filters into the barren, dirty kitchen from the dark, smoke-filled living room. 

Dressed in a silky red nightgown thrown over leather tights, 18-year-old Jovinda Pieterse is preparing to join her 18-month-old son Jovandre who has just dozed off in the adjacent bedroom. 

The room is small and crowded. The glaring light from the globe on the low ceiling only adds to the heat in the room.  In the middle of one double bed that engulfs most of the space in the room, the ?tiny baby boy tosses restlessly. Two beds – divided by a small dressing table, and a wardrobe – are all jammed into the already crammed space. 

This is where he and his 18-year-old mother have been living for some time now. 

 "This is my cousin's house; I actually live with my sister and her boyfriend. But my sister and I haven't been seeing eye to eye since my mom died," says Pieterse, waving the flies away from her sleeping baby. 

"I fell pregnant when I was 16. My mom passed away when Jovandre was five months old and I've been raising him on my own since," she smiles shyly. 

Without any adult relatives nearby, Pieterse has fallen under the influence of her older cousins and admits to drinking whenever the opportunity arises and loves "to have a jol". 

"I do have a drink every now and then, but I drink responsibly and I don't drink every day. I'll drink whatever is available but if there is nothing then I won't drink," she says, nursing the now sleepless baby.

"I did actually drink a little when I was pregnant but it was difficult to do [so] because my mother was very strict. She didn't know ?about the days that I did drink because I would do it behind her back."  

According to a 2012 University of Cape Town study published in the South African Medical Journal, alcohol abuse can lead to risky behaviour in adolescents. It often results in unprotected sex and consequent teenage pregnancies, as well as increasing the risk of contracting sexually transmitted infections such as HIV. 

Pieterse was in grade 10 when she fell pregnant and says she had to drop out of school. Even after giving birth she couldn't bring herself to go back because she "didn't have a passion for learning".

"My mom really wanted me to go back to school, but she understood how I felt. I've been applying for jobs in town but at the moment things are too difficult for me – and I have to look after him [she gestures to the nursing infant in her arms].

"That is why I haven't started looking for work yet, but I am busy with it. I'm working on it but he is still very small."

Jovandre is dozing off once again in his mother's arms.  "It is hard to be a mother while I'm so young. I am sad that I couldn't finish my school but I don't blame my baby. I made a bad choice and I am prepared to take the punch."

Unemployment
"Every Monday it's the same thing; we have to conduct breathalyser tests [to measure blood alcohol content] on workers before they can go on site and every week I have to write warning letters and fire people because some are still drunk from the night before," says a Pretoria-based civil engineer who is currently working on the construction of several solar panel plants in Upington in the Northern Cape. 

The engineer, who asked not to be named, says he struggles to find local people to employ for the construction of the plant as it was difficult to keep them off the bottle. 

"A construction site is very dangerous and we have to keep to stringent safety regulations to make sure that nobody gets injured on duty. We all get reckless when we are under the influence," he says, shaking his head in frustration.  

Increased investment into renewable energy has meant that young people in towns such as Upington and De Aar now have employment opportunities – even if that employment is temporary and will only last until after the solar plant is up and running. 

But the engineer says that it seems as though the extra income may do more harm than good in the communities where he works. 

"Alcohol has taken over this place. Giving people jobs isn't a good enough solution because this simply means they have more money to buy drinks. That's all they live for." 

Anneline Jonas, a field worker for the Foundation for Alcohol Related Research in De Aar, says that in many of the families she works with there is a daily battle between buying bread or alcohol.

"Our community is poor. For most, social grants are the only source of income. Alcohol is readily available and is as cheap as 50 cents for a mug of homebrewed beer," says Jonas. 

"Some of these smokkelhuise [illegal shebeens] give people alcohol on credit so by the time their next grant payment is due they are already in the red."

                            Jovinda Pietersen is a mother at the age of 18 (Madelene Cronjé)

South Africa's addiction 

• Alcohol is the most widespread drug of abuse in South Africa.
• Alcohol is the third-largest contributor to death and disability (after unsafe sex and sexually transmitted infections and interpersonal violence).
• Alcohol abusers account for 65% of patients at drug treatment centres in the Free State, Northern Cape and North West.  
• 29% of  school-age adolescents misuse alcohol. 
• An estimated R9.68-billion is incurred in response to crime including police and correctional services and legal costs.
• The cost of alcohol-attributable worker absenteeism ranges from R140.6-million to R447.7-million a year
• South Africans  spend an estimated 13% of their disposable income (money left after you've paid your essential expenses) on alcohol. – Sources: South African Medical Journal, Volume 104, No 2, 2014, Medical Research Council, 2009