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

example, several studies report that “lack of transportation” is a barrier to substanceabuse treatment entry (Hser et al., 1998), especially for low-income groups who have lessaccess to private transportation and who may not be able to afford public transport(Allard, Tolman, & Rosen, 2003). Although research indicates that providing clients withtransport increases substance abusers’ use of treatment services (Booth et al., 2000;Friedmann, Lemon, & Stein, 2001; Hser et al., 1998), only12.5% of facilitiesparticipating in this study routinely provide clients with transport to their treatmentfacility. Similarly, 12.5% of facilities routinely provide clients’ families with transport totheir facilities. This lack of transportation may limit the extent to which poorer familiesare able to participate in the treatment process. This is cause for concern as familyparticipation in treatment is an essential ingredient of effective treatment, particularly foradolescent clients (NIDA, 2006) and because a lack of participation may limit theirknowledge of how to provide a supportive social environment to their family member – akey ingredient for positive treatment outcomes (Joe et al., 2002).Affordability factors have also been identified as significant obstacles to substance abusetreatment entry (Hser et al., 1998; Myers, 2007; Tucker, Vuchinich, & Rippens, 2004).These factors include the direct costs of treatment as well as indirect costs associated withtransport to treatment facilities, replacement of wages, and child care (Myers, 2007;Tucker, Vuchinich, & Rippens, 2004). Cost barriers seem highest for substance userswithout health insurance (Sturm & Sherbourne, 2001), which in South Africa consistslargely of Black/African persons (Goosen, et al., 2003). Findings from this study showthat few treatment facilities address the cost barriers that restrict poorer clients fromentering treatment. Although more than half of facilities report routinely offering indigentclients reduced fees, often these reduced fees are still unaffordable to indigent clients.Three quarter of the facilities routinely have free treatment slots available for clients whocannot afford to pay for treatment. In terms of the indirect costs of entering treatment,less than half of the facilities have child care services available to clients participating intheir treatment programmes. As affordability considerations are one of the mostimportant predictors of treatment entry among South African substance abusers (Myers,2007), it is vital that facilities consider innovative ways in which the costs associated withtreatment can be reduced for clients from underserved groups; particularly as addressing72