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

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1998b) and comprise only 31.0% of the client population at substance abuse treatmentfacilities. In contrast, White South Africans continue to be over-represented in substanceabuse treatment facilities, relative to the demographic profile of the general population.These findings are in keeping with findings from previous audits of treatment facilities inGauteng and KwaZulu-Natal (Myers & Fakier, 2007), Gauteng (Myers, 2004) and CapeTown (Myers & Parry, 2003).As substance abuse treatment need has not been properly investigated in South Africa, itis unclear whether there are disparities in the need for substance abuse treatment servicesamong the racially defined social groups. Despite this gap, emerging evidence suggeststhat poor Black/African communities may be especially vulnerable to substance usedisorders, due to the psychological stress associated with rapid urbanisation, poverty,neighbourhood social dysfunction, and a lack of basic infrastructure (Flisher & Charlton,2001; Kalichman et al., 2006; Latkin, Williams, Wang, & Curry, 2005) - factors thatoften characterise these communities. Anecdotal reports of increasing levels of substanceuse among Black/African communities also suggest that this pattern of service utilisationreflects the limited extent to which Black/African South Africans have access tosubstance abuse treatment rather than lower levels of substance use by these raciallydefined social groups (Myers et al., 2004; Myers & Parry, 2005).In terms of gender, findings show that women are also under-represented in substanceabuse treatment facilities. Although women comprise at least half of the generalpopulation (Statistics South Africa, 2005), on average less than 30.0% of the recipients ofsubstance abuse treatment services in Free State, Limpopo, Mpumalanga, North West andNorthern Cape are women. This finding is in keeping with findings from previous auditsof substance abuse treatment facilities in Cape Town; Gauteng as well as KwaZulu-Nataland Gauteng (Myers, 2004; Myers & Parry, 2003; Myers & Fakier, 2007) andinternational research which points to the under-representation of women in treatment(Schober & Annis, 1996; Zule, Lam, & Wechsberg, 2003). However, this pattern oftreatment service utilisation by women probably reflects the limited extent to whichwomen have access to substance abuse treatment rather than lower levels of substanceuse by women; especially given research which suggests that similar proportions of menand women drink at risky levels in South Africa (Parry et al., 2005) and that points to70
high levels of substance use among women in Cape Town (Sawyer, Wechsberg, &Myers, 2006).4.3.2. Access to treatment: Targeting barriers to treatment entrySeveral studies have identified barriers that hinder access to treatment for clients fromunderserved groups. In South Africa, these barriers include awareness of treatmentservices; logistic barriers including access to transport; affordability barriers relating tothe costs of services; and linguistic barriers, relating to the language in which services areprovided (Myers, 2007). These barriers, if unaddressed, may negatively impact ontreatment-seeking behaviour (Beardsley et al., 2003; Joe et al., 2002). This studyexamined the extent to which substance abuse treatment facilities address these keybarriers to treatment entry for clients from historically underserved groups.Awareness-related barriers to treatment entryLimited knowledge and awareness about where to seek help for substance use disordersand how to access help inhibits entry into substance abuse treatment (Hser et al., 1998),particularly for poor Black/African substance users (Myers, 2007). Less than half offacilities attempt to address this barrier by conducting routine awareness campaigns (atleast once a month) that provide information about substance abuse treatment options.Just over half of facilities report routinely distributing information and materialspertaining to substance abuse and available treatment options. Over 80.0% of facilitiesroutinely conduct outreach among vulnerable groups and conduct outreach indisadvantaged areas. In comparison, the inner city areas are relatively neglected, with justover 50.0% of facilities routinely targeting these high-risk areas.The important role that outreach can play in addressing awareness-related barriers amongunderserved Black/African communities (and in facilitating treatment entry) is reflectedin findings that facilities which conduct outreach activities in disadvantaged areas treatsignificantly more Black/African clients than facilities without these services.Logistic and affordability barriers to treatment entryAffordability and other logistic barriers (such as access to transport) also hamper entryinto treatment for South African substance abusing populations (Myers, 2007). For71
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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
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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 and 68: previous audits of specialist subst
Page 69: small proportion of South African d
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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