Access to substance abuse treatment in the Cape Town metropole ...

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money is given for people to go and do work in that area. But it's very much atop-down approach and your outcomes are a lot less in that scenario.”According to key informants, this has implications for the implementation and useof public substance abuse services, with community willingness to supportsubstance abuse initiatives diminishing:“Well I think that is important… It's to start with your community, to start with theirneed, to identify who the community leaders are and to involve them right fromthe very beginning, and not just coming in with your own plans and ideas… Ithink that is very important, otherwise you will not get the buy-in and the supportfrom the community and you cannot change a community without thecommunity's own taking partnership, taking ownership of any project.” [TSP]This reflects how social capital, particularly social trust, is informed by broadersystemic influences. Community barriers to treatment utilization thus interactwith political and treatment system factors to influence substance abusetreatment utilization in HDCs.5.4. SUMMARY• Both political and treatment system factors influence access to care.o Political strategies for addressing substance abuse in HDCs interactwith the state’s allocation of resources for substance abuse to affectthe availability of substance-related services, treatment systemdynamics, and community responses to both state and TSPinterventions.o The organization of, and resource distribution within, thetreatment system affects access to care directly and indirectly byhindering treatment capacity and by shaping communityperceptions about the effectiveness of services.o The lengthy process of accessing treatment (specifically unclearreferral pathways and multiple gatekeepers) hampers access toservices.• Community dynamics directly influence access to treatment.107
o These community influences are located within both the predisposingand enabling variable domain of the BHSU.o Awareness of when, where and how to access treatment impedestreatment utilizationo Unrealistic expectations of TSPs creates negative perceptions oftreatment services and hampers service use.o Social capital (specifically collective efficacy and social trust)negatively affect treatment utilization.o Low levels of social capital are underpinned by neighbourhooddisadvantage, poverty and the normalization of drug use withinHDCso Socio-demographic differences were found on community enablingresources; with Black/African communities being less aware oftreatment than Coloured communities, and Coloured communitieshaving lower levels of social capital than Black/African communities.• Contextual/environmental factors influence both predisposing andenabling resources- suggesting that access to substance abuse treatment ismultiply determined.o These multiple influences on access, together with constraints ontreatment capacity in the substance abuse treatment system, highlightthe challenges of delivering substance abuse treatment in resourcepoorsettings.108
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Access to substance abuse treatment
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CONTENTSINTRODUCTION ..............
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5.4. SUMMARY.......................
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al., 2004; Reddy et al., 2003; Shis
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1.3. IS ACCESS TO SUBSTANCE ABUSE T
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1.4.2. Racial disparities in the ne
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illegally and are unregulated by th
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CONCEPTUAL MODELThis study’s conc
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presenting problems and ability to
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need for services is the most immed
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This study focuses specifically on
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METHOD3.1. STUDY AIMS & OBJECTIVESA
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the researcher to explore possible
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esidential areas from each of the s
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3.3.2.4. Data collection: controlsF
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o Problem recognition, Desire for h
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Table 1.Domains and measures compri
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The 19-item MOS-SSS measures functi
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information on the accessibility of
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RESULTS: PHASE ONE4.1. VARIABLES AS
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efficacy to stop using drugs for mo
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(Table 6). Effect sizes were large
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were 2.4 times more likely to not a
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esteem scales (Table 9). Stigma als
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Table 10.Logistic regression coeffi
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4.2.2. Model 2: Predisposing variab
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poverty scale, and the variable “
Page 55 and 56:
of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: and R1000 per month than their fema
Page 61 and 62: subjects earning less than R500 per
Page 63 and 64: and race (Table 16). This indicates
Page 65 and 66: were 3 times more likely to earn le
Page 67 and 68: (which are higher for Black/African
Page 69 and 70: substance use or remain abstinent d
Page 71 and 72: monetary needs rise, subjects repor
Page 73 and 74: with improved awareness of services
Page 75 and 76: 4.4.4.4. Predictors of “community
Page 77 and 78: • In historically disadvantaged c
Page 79 and 80: RESULTS: PHASE TWODuring qualitativ
Page 81 and 82: 5.1.1.3. Government’s responses t
Page 83 and 84: “Part of the government's agenda
Page 85 and 86: putting extra strain and pressure o
Page 87 and 88: The impact of availability and affo
Page 89 and 90: availability of affordable services
Page 91 and 92: completed a hospital-based detoxifi
Page 93 and 94: “I have thirty beds that are unus
Page 95 and 96: “I don't see it amongst the bona
Page 97 and 98: going to be a good day. So, yes it
Page 99 and 100: in the fourth week they relapse, it
Page 101 and 102: esponses to treatment, in part, are
Page 103 and 104: • Awareness of appropriate treatm
Page 105 and 106: This perception is prevalent in Col
Page 107: substance abuse problem - without a
Page 111 and 112: 6.2.1. Awareness of substance abuse
Page 113 and 114: informational support can improve a
Page 115 and 116: salient for low-income groups who h
Page 117 and 118: diminishing self-efficacy and motiv
Page 119 and 120: self-efficacy and negative percepti
Page 121 and 122: 6.3. TREATMENT SYSTEM FACTORS ASSOC
Page 123 and 124: This study found that limited resou
Page 125 and 126: 6.4. RECOMMENDATIONSBased on study
Page 127 and 128: • As findings suggest that female
Page 129 and 130: • While the affordability of trea
Page 131 and 132: To address these barriers, we argue
Page 133 and 134: o To ensure objectivity, this needs
Page 135 and 136: egistration process should gather i
Page 137 and 138: REFERENCESAday, L.A., & Awe, W.C. (
Page 139 and 140: First, MB; Spitzer, RL; Gibbon, M;
Page 141 and 142: Myers, B., & Parry, C.D.H. (2005).
Page 143 and 144: Ross, M.W., Williams, M.L., Timpson
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