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

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speciality services (Durkin, 2002; Friedman, Alexander, & D’Aunno, 1999). Findingsfrom this study tend to confirm this explanation with only 43.8% of facilities employing apsychologist and 18.8% of facilities with a psychiatrist on staff.4.2.2. Provision of ancillary health servicesIn comparison to the proportion of facilities providing core addiction and aftercareservices, a smaller proportion of facilities provide ancillary medical and health services.Although this is in keeping with findings from previous audits of substance abusetreatment facilities (Myers & Fakier, 2007; Myers, 2004; Myers & Parry, 2003), thesefindings are cause for concern as many substance-abusing individuals experiencesubstance-related health concerns. The provision of ancillary health services (of both apalliative and preventative nature) is thus an important aspect of quality substance abusetreatment (Friedman, Alexander, & D’Aunno, 1999).Similar to findings from previous studies, facilities are more likely to conduct medicalassessments than provide clients with substitution medication and/or detoxificationservices. More specifically, less than 40.0% of facilities provide clients with access tosubstitution medication - despite the evidence that substitution medication isinternationally acknowledged to be a useful tool for limiting the harms of substance abuseand for retaining clients in treatment. The provision of substitution medication is alsointernationally recognised as one of the key principles of effective substance abusetreatment (NIDA, 2006). Similarly, only 56.3% of facilities report providing clients withon-site detoxification services. The limited availability of these services within treatmentfacilities is cause for concern as treatment facilities that do not provide detoxificationservices often require clients to have completed a hospital-based detoxification prior toentering treatment. This acts as a barrier to treatment entry due to the scarcity ofhospital-based detoxification services (Myers, 2007).Findings also show that only a small proportion of facilities conduct interventions toreduce the health risks associated with continued substance use. For example, a quarterof the facilities test for and conduct interventions to reduce the risks of substance-relatedinfectious disease (such as hepatitis) or conduct interventions to reduce the health risksassociated with injection drug use. While the latter may be due to the fact that only a68
small proportion of South African drug users are injection drug users (Dewing et al.,2006), injection drug users still face many health risks that can be ameliorated throughtimeous interventions. In addition, less than half of the facilities test for and conductinterventions to reduce the risk of HIV. This finding is of greater concern, especiallygiven the strong association between substance abuse and risky sexual practices(Wechsberg, Craddock, & Hubbard, 1998) and South Africa’s high HIV prevalence rate.4.3. TARGETING BARRIERS TO TREATMENT ENTRY, ENGAGEMENTAND RETENTION FOR CLIENTS FROM UNDERSERVED GROUPSInternational principles of effective treatment for substance use disorders (NIDA, 2006)and South African norms and standards for inpatient and outpatient treatment emphasisethat substance abuse treatment services should be (i) accessible to individuals who needand want services and (ii) appropriate for different cultural, age and gender groups.Despite these standards and widespread concern about the accessibility andappropriateness of existing treatment services for clients from historically underservedgroups (Myers & Parry, 2005), South African substance abuse treatment facilitiesgenerally fail to meet these standards. The following sections describe the accessibilityand appropriateness of substance abuse treatment services with particular reference tohistorically underserved population groups; namely Black/African substance users andwomen.4.3.1. The extent to which services are accessible to underserved groupsFindings show that in Free State, Limpopo, Mpumalanga and North West, Black/Africanclients continue to be under-represented in substance abuse treatment facilities. AlthoughBlack/African persons comprise about 84.0% of the general population of Free State(Statistics South Africa, 1998a), they comprise only 31.7% of the client population atsubstance abuse treatment facilities in this province. Similarly, while Black/Africanpersons comprise about 97.3% of the general population in Limpopo (Statistics SouthAfrica, 2006b), they comprise about 48.0% of the client population at substance abusetreatment facilities in this province. In Mpumalanga, Black/African persons compriseabout 92.4% of the general population (Statistics South Africa, 2006c) while only 48.5%of the client population are in treatment for substance abuse. Black/African personscomprise about 91.4% of the general population of North West (Statistics South Africa,69
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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
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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 and 66: PART 4: DISCUSSION OF KEY FINDINGSW
Page 67: previous audits of specialist subst
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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