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

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facilities have waiting lists, with an average of 6 clients waiting for an available treatmentslot. On average, the waiting period for a treatment slot / bed is 6 days. It should be notedthat none of the facilities in the Northern Cape reported using a waiting list.Despite the fact that these waiting periods are much shorter than those identified in otherprovinces, such as Gauteng and KwaZulu-Natal (Myers & Fakier, 2007), the presence ofwaiting lists is still worrisome as they may act as a barrier to accessing substance abusetreatment (Grant, 1997; Hser et al., 1998; Tucker et al., 2004). Timely access is importantfor facilitating treatment entry as many substance abusers are ambivalent about seekingtreatment and may have little tolerance for waiting for the next available treatment slot(Kaplan & Johri, 2000).Findings reflect that facilities in Mpumalanga have the lowest treatment occupancy rates,with these facilities operating, on average, at 38.3% of their capacity.4.1.3. Effective use of available treatment slotsIn this study, the effective use of available treatment slots is indicated by the degree towhich clients are retained in treatment. Client retention rates differ broadly acrossfacilities, with some facilities reporting retention rates as low as 30.0%. On average,facilities retain about 70.2% of their clients in treatment. The large variation in theseretention rates points to significant room for service improvement, especially as clientretention is an important proxy indicator of service effectiveness and positive treatmentoutcomes.4.2. RANGE AND DIVERSITY OF SERVICES PROVIDEDDespite growing evidence of an association between the availability of ancillarytreatment services (e.g. psychological and medical care) and treatment outcomes, andevidence-based practice guidelines that emphasise the need to integrate ancillary medicaland mental health services with core addiction services (Durkin, 2002; Lee et al., 2001),findings suggest that substance abuse treatment facilities in South Africa generally fail tomeet this standard. In Free State, Limpopo, Mpumalanga, North West and NorthernCape, clients are provided with ancillary medical and mental health-oriented servicesmuch less frequently than core addiction services. This is similar to findings from66
previous audits of specialist substance abuse treatment facilities in Cape Town (Myers &Parry, 2003); Gauteng (Myers, 2004) as well as Gauteng and KwaZulu-Natal (Myers &Fakier, 2007).4.2.1. Provision of ancillary mental health servicesIn all 5 provinces, substance abuse treatment facilities focus primarily on treating the coresubstance abuse problem and rarely provide ancillary psychiatric services that targetpsychiatric disorders and other mental health problems that are associated with, anoutcome of, and/or contributed to the development of the substance use disorder. Morespecifically, only 1 facility in Free State provides psychiatric services.In addition, only a minority of facilities assess clients for psychiatric disorders. Facilitiesin Free State (28.6%) are the only facilities assessing whether clients have co-occurringpsychiatric disorders. This remains a cause for concern; especially as internationalresearch points to the high prevalence of co-occurring psychiatric disorders amongindividuals with substance use disorders, which, if left undetected, negatively impact ontreatment outcomes (Teesson et al., 2005).Findings from previous research also suggest that individuals with co-occurring disordershave more complex treatment needs than persons with substance use disorders only(Durkin, 2002; Teesson et al., 2005). These findings suggest that in order to increase thechance of positive treatment outcomes for individuals with co-occurring disorders,psychiatric disorders need to be detected and managed during the course of treatment(Teesson et al., 2005). Despite this, findings from this study show that a smallerproportion of facilities offer counselling focused on mental health problems, relative tocounselling focused on substance abuse and/or family issues. In addition, only half of thefacilities provide clients with psychiatric medication to manage their co-occurring moodand/or anxiety disorders.The availability of speciality staffing resources may help account for the shortage ofmental health services in Free State, Limpopo, Mpumalanga, North West and NorthernCape. Prior research suggests that the availability of mental health services is stronglyassociated with the proportion of staff (employed by facilities) trained to deliver these67
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Alcohol & Drug Abuse Research UnitM
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3.1.2 Treatment facility profile by
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4.3 Targeting barriers to treatment
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EXECUTIVE SUMMARYA cross-sectional
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services to historically underserve
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use, reductions in criminal activit
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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 65: PART 4: DISCUSSION OF KEY FINDINGSW
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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