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

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services. Environmental factors thus seem to shape barriers to accessingsubstance abuse treatment, including awareness of services.6.2.2. Geographical accessibilityGeographical accessibility of treatment services is another strong predictor ofwhether persons from HDCS utilize substance abuse treatment. During thequantitative phase of the study, this factor was indicated by two variables:travelling time to treatment and distance to nearest treatment centre. These twovariables were strongly correlated with each other, suggesting that travelling timeto treatment may be a proxy indicator of distance to treatment services. Morespecifically, findings indicate that the odds of accessing treatment were greaterfor persons who reported less travelling time to the nearest treatment facility; withevery one unit increase on the “travelling time to treatment” scale resulting in aneleven-fold increase in the odds of not accessing treatment. In addition, longertravelling times to treatment were associated with more delays in accessingtreatment services. These findings suggest that geographical accessibilitybarriers are strong impediments to substance abuse treatment utilization amongHDCs.6.2.2.1. Socio-demographic differences on geographical accessibilityFindings suggest that female substance abusers from HDCs experience greaterbarriers relating to the geographical accessibility of treatment services comparedto their male counterparts. For example, for every one unit increase in the“Travelling time to treatment” scale, the odds of being female doubled. A possibleexplanation for this lies in the finding that female substance abusers havesignificantly lower incomes and higher levels of competing financial needs thantheir male counterparts. This may limit women’s ability to afford public transportto substance abuse treatment and may increase the time it takes for women totravel to treatment. This explanation is supported by the finding that affordabilitybarriers were strongly associated with travelling time to treatment. Findings fromthe international literature that geographical access barriers are particularly113
salient for low-income groups who have less access to private transportation(Allard, Tolman, & Rosen, 2003) also corroborate this claim.Similarly, findings suggest that persons from Black/African communities havesignificantly longer travelling times and distances to travel to treatment comparedto their Coloured counterparts. For instance, for every one unit increase in the“Distance to nearest treatment centre” scale, the odds of participants beingBlack/African increased by a multiplicative factor of 3.4. This suggests thatgeographical accessibility barriers are significantly higher in Black/Africancommunities than Coloured communities in the Cape Town metropole. Thesesocio-demographic differences highlight the need for interventions that addressgeographical accessibility barriers among women and Black/African persons withsubstance use disorders especially.6.2.2.2. Factors underpinning geographical access barriersPolitical and systemic factors appear to contribute to these geographicalaccessibility barriers. More specifically, findings from the qualitative phase of thestudy suggest that the state’s failure to assess the substance abuse treatmentneeds of HDCs and gaps in treatment service coverage has led to an unevendispersion of treatment resources; with Black/African communities beingparticularly underserved. This has resulted in persons from Black/Africancommunities having greater distances to travel to treatment than theircounterparts from other communities. This reveals one way in which the politicalcontext informs the dispersion of treatment resources and consequentlygeographical barriers to accessing care.Given these findings, a starting point for developing interventions that addressgeographical accessibility barriers would be a mapping of treatment need andexisting treatment services in the Cape Town metropole. Other innovative lowcostinterventions could include the use of mobile outpatient clinics located withinBlack/African communities. These mobile units would reduce both the distances114
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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
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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 and 110: o These community influences are lo
Page 111 and 112: 6.2.1. Awareness of substance abuse
Page 113: informational support can improve a
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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Access to substance abuse treatment in the Cape Town metropole ...

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