Audit of Substance Abuse Treatment Facilities in ... - SA HealthInfo

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PART 1:BACKGROUND1.1. THE NEED FOR SUBSTANCE ABUSE TREATMENTIn South Africa, changes in the pattern of substance use over time highlight the need foraccessible treatment services. During the apartheid era, the country’s physical andeconomic isolation, strict monitoring of external borders, and stringent internal controlsrestricted access to and availability of most kinds of illicit drugs, with locally cultivatedcannabis, Mandrax tablets, and prescription drugs being the only drugs widely availableto South Africans. However, changes in global drug markets, such as improved drugsupply- and demand-reduction strategies in Europe and the USA, have forced traffickersto seek alternative routes and markets. South Africa, due to its geographical location, is aconvenient trans-shipment point for illicit drugs from drug-producing countries to drugmarkets. Socio-political changes that followed the collapse of apartheid, such as thereduction in internal and external border controls, the increase in land and air travel,increased trade, and the poorly resourced law enforcement agencies; together with thecountry’s advanced banking, transport, and communication systems have also made thecountry an attractive new market for drug cartels. With these changes South Africansnow have access to a broad range of illicit drugs (Parry et al., 2002a). Supply anddemand indicators suggest that the domestic drug market is expanding, with drug pricesdecreasing, availability increasing, and treatment demand for substance-related problemson the rise (Parry et al., 2002a/b). This expansion of the domestic drug market has placedsubstance abuse treatment facilities under increased pressure to provide effective andaccessible treatment services.1.2. THE VALUE OF SUBSTANCE ABUSE TREATMENTYet, there is strong evidence that substance abuse treatment helps reduce the harmsassociated with substance abuse and benefits both the individual and broader society.Although few treatment outcome studies have been conducted in South Africa,international research, conducted across a variety of treatment settings and clientpopulations, has provided considerable evidence of the benefits of substance abusetreatment (e.g. Gossop, Marsden, Stewart & Teacy, 2001; Simpson, Joe & Brown, 1997).In general, these studies reported positive outcomes, including reductions in substance10
use, reductions in criminal activity, improvements in physical and psychological health,and improvements in social functioning.In developing countries in general (Arif & Westermeyer, 1998), and South Africa inparticular, few treatment outcome studies have been conducted. Despite methodologicallimitations (such as low follow-up rates), preliminary evidence points to the benefits ofsubstance abuse treatment in these settings. For example, De Silva, Peris, Samarasinghe andEllawala (1992) reported that 36% of 234 patients attending a treatment centre in SriLanka were abstinent two years post-treatment. In addition, significant reductions insubstance use were reported among patients in treatment centres in Thailand, with 50% ofpatients abstinent from amphetamine-type substances and 27% abstinent from opiates 6months post treatment (Perngpam & Porncharoen, 2001). Only two substance abusetreatment outcome studies have been conducted in South Africa. Coetzee (2001) reportedan abstinence rate of 55% among 58 patients attending an outpatient substance abusetreatment centre in 2000. In the second study of 89 patients attending a private inpatientfacility, Coetzee (2004) reported an abstinence rate of 48% one year post-treatment. Thisemerging evidence points to the potential value of substance abuse treatment services inSouth Africa.1.3. SUBSTANCE ABUSE TREATMENT SERVICES IN SOUTH AFRICAAnecdotal reports from treatment service providers and communities point to anincreased demand for substance abuse treatment services, with waiting lists for treatmentslots increasing and communities mobilising around drug-related issues. This increaseddemand has placed treatment facilities under pressure to increase their coverage andprovision of services to a greater number of users. Despite this pressure, little is knownabout the structure and functioning of the substance abuse treatment system in thecountry. This study attempts to address this gap in knowledge by examining substanceabuse treatment services in the Free State, Limpopo, Mpumalanga, North West andNorthern Cape.Free State is the fourth largest province in South Africa (Statistics South Africa, 2006a)and constitutes about seven per cent of the population of South Africa (Statistics SouthAfrica, 1998a). In line with the national pattern, Black/Africans 1 form the largest11
Page 1 and 2: Alcohol & Drug Abuse Research UnitM
Page 3 and 4: 3.1.2 Treatment facility profile by
Page 5 and 6: 4.3 Targeting barriers to treatment
Page 7 and 8: EXECUTIVE SUMMARYA cross-sectional
Page 9: services to historically underserve
Page 13 and 14: Despite high levels of substance ab
Page 15 and 16: Despite the apparent availability o
Page 17 and 18: treatment services provided. At pre
Page 19 and 20: use disorders whose physical and em
Page 21 and 22: delivery, treatment retention, and
Page 23 and 24: audit substance abuse treatment fac
Page 25 and 26: 2.8.3. Further data considerations
Page 27 and 28: Figure 1. Inpatient intensity of ca
Page 29 and 30: Since there is a large overlap betw
Page 31 and 32: the total client population (χ = 4
Page 33 and 34: Figure 7.Comparison of race profile
Page 35 and 36: services per month ranges from 13 t
Page 37 and 38: 3.4.1. Characteristics of staff at
Page 39 and 40: supervision. In contrast, a much sm
Page 41 and 42: In terms of client record-keeping,
Page 43 and 44: Core findings:• Compared to the p
Page 45 and 46: using 12-step approaches, 75.0% rep
Page 47 and 48: Figure 16. Proportion of treatment
Page 49 and 50: 3.7. ADDRESSING BARRIERS TO TREATME
Page 51 and 52: Table 11. Proportion of facilities
Page 55 and 56: Figure 20.Proportion of substance a
Page 61 and 62:
3.9.2. Monitoring of clients’ pro
Page 63 and 64:
Table 16. Proportion of facilities
Page 65 and 66:
PART 4: DISCUSSION OF KEY FINDINGSW
Page 67 and 68:
previous audits of specialist subst
Page 69 and 70:
small proportion of South African d
Page 71 and 72:
high levels of substance use among
Page 73 and 74:
these barriers appears to significa
Page 75 and 76:
appropriate services for Black/Afri
Page 77 and 78:
clients progress post-treatment, an
Page 79 and 80:
• The number of state facilities
Page 81 and 82:
• Another way of ensuring (indire
Page 83 and 84:
• The age appropriateness of serv
Page 85 and 86:
REFERENCESAllard, S.W., Tolman, R.M
Page 87 and 88:
Myers, B., & Fakier, N. (2007). Rep
Page 89:
Zule, W.A., Lam, W.K., & Wechsberg,
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