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

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DISCUSSION AND RECOMMENDATIONS6.1. IS ACCESS TO SUBSTANCE ABUSE TREATMENT EQUITABLE?Findings show that access to substance abuse treatment for historicallydisadvantaged communities in the Cape Town metropole is not equitable. Morespecifically, when substance abuse treatment need is considered in the light ofpredisposing and enabling/restricting variables, findings show that access isdetermined predominantly by the extent to which barriers to treatment areexperienced and negative views about treatment are held, with need fortreatment having little effect on treatment utilization. This highlights the need forinterventions that address barriers to accessing substance abuse treatment aswell as negative perceptions about treatment services.6.2. FACTORS THAT PREDICT ACCESS TO SERVICESAlthough a range of variables were significantly associated with access tosubstance abuse treatment for people from historically disadvantagedcommunities in the Cape Town metropole, many of these were weak predictorsof access to treatment. For instance, while some indicators of perceived andevaluated need for substance abuse treatment significantly predicted treatmentutilization, when considered together with indicators on the enabling andpredisposing variable domains, their effect on treatment utilization was relativelyweak.In contrast, the strongest predictors of access were located in theenabling/restricting variable domain. These predictors included: awareness oftreatment, geographical accessibility of treatment (indicated by travelling time totreatment) and affordability of treatment (indicated by competing financialpriorities and income). Negative perceptions about access to treatment, anattitudinal-belief variable located in the predisposing variable domain, wasanother strong predictor of whether persons accessed treatment. The followingsub-sections describe these predictors.109
6.2.1. Awareness of substance abuse treatmentOne of the strongest predictors of access to substance abuse treatment isawareness of substance abuse treatment services. Findings from the qualitativephase of this study not only confirm this finding, but also suggest that awarenessof substance abuse treatment is often multidimensional, with several dimensionsneeding to be present to facilitate access to treatment. More specifically, keyinformants noted that for access to occur, persons need to be aware of where toseek help, to know when help is needed, and to know how to access services.Furthermore, persons also need to know what constitutes appropriate treatmentfor substance use disorders. This study found that knowing how to accessservices is strongly related to the organisation and functioning of the substanceabuse treatment system, a factor that predicts access to services (discussed insection 6.3). In contrast, knowing what constitutes appropriate treatment forsubstance use disorders seems to underpin HDCs’ perceptions of treatmentanotherfactor strongly associated with access to services (see section 6.2.4).During the quantitative phase of the study, this first dimension, knowing where toseek help, was indicated by two variables: awareness of alcohol and drugtreatment services, and number of known treatment centres. For the former,findings indicate that the odds of accessing treatment were ten times greater forpersons who knew where to go for alcohol and drug-related help compared topersons who were not aware of where to go for help. In addition, the odds ofaccessing treatment were greater for individuals who knew of more treatmentfacilities; with every one unit increase on the “number of known treatmentcentres” scale resulting in a five-fold increase in the odds of accessing treatment.These findings from the quantitative component of the study highlight the strongeffect that awareness of where to seek help has on substance abuse treatmentutilization.6.2.1.1. Socio-demographic differences on awareness barriersRelated to this, both qualitative and quantitative findings suggest that personsfrom Black/African communities are significantly less likely to know where to110
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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 “
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of the model increased significantl
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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 and 108: substance abuse problem - without a
Page 109: o These community influences are lo
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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