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

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equired to travel and the costs associated with travelling to treatment serviceslocated at permanent facilities.6.2.3. Availability of affordable treatmentThe availability of affordable treatment options also emerged as a significantpredictor of access to substance abuse treatment for people from HDCs. Duringthe quantitative phase of the study, the affordability of treatment services wasindicated by three variables: barriers relating to the affordability of treatment,monthly income, and competing financial needs. While only a weak effect wasfound for the former, stronger effects were found for the latter two variables. Forexample, individuals without competing financial needs were four times morelikely to access services than persons with competing financial needs. Thesefindings suggest that affordability considerations inform whether persons fromHDCS utilize substance abuse treatment services.6.2.3.1. Factors underpinning affordability barriersThe manner in which affordability considerations impact on access to substanceabuse treatment is revealed through findings from the qualitative phase of thestudy. In part, affordability barriers seem to be underpinned by contextual factors,such as the limited allocation of financial resources to the social welfare sectorresponsible for the provision of substance abuse treatment. While these limitedfinancial resources restrict the number of non-profit treatment facilities that areavailable; for non-profit treatment services that do exist, it also limits theircapacity to provide affordable (free or low-cost) services to clients from HDCs.This is partly due to the need for non-profit facilities to cross-subsidize freetreatment slots with paying clients, in order to remain financially sustainable.For substance abusers from HDCs, this limits the availability of substance abusetreatment by contributing to lengthy waiting periods for affordable treatmentservices. This is cause for concern as many substance abusers are ambivalentabout seeking treatment and may have little tolerance for waiting (Kaplan & Johri,2000). These lengthy waiting periods act as a barrier to treatment utilization by115
diminishing self-efficacy and motivation for treatment. Additional support for thisexplanation arises from findings (from the quantitative phase of the study) thataffordability barriers and competing financial needs are significantly associatedwith reductions in self-efficacy and motivation for treatment. Political decisionsregarding the allocation of resources to substance abuse treatment thus informthe organisation of substance abuse treatment resources (such as waitingperiods for treatment and the affordability of available treatment options) andconsequently substance abuse treatment utilization among HDCs.6.2.3.2. Socio-demographic differences on affordability of treatmentIn addition, female substance abusers from HDCs seem to have more barriersrelating to the affordability of treatment than their male counterparts. Forexample, substance abusers earning less than R500 per month were more thantwice as likely to be female than male. In addition, compared to males, the oddsof having competing financial needs tripled for female substance abusers. Thesefindings suggest that compared to men, women’s ability to afford substanceabuse treatment is significantly lower. Interventions that address barriers totreatment among women should therefore focus not only on the provision ofaffordable treatment options, but should also address factors that compete withwomen’s ability to pay for treatment, such as the provision of food and shelter fordependents.Interventions that enhance the provision of social support, particularly tangiblesupport provision (such as food, clothing or other basic necessities) for womenmay reduce the impact of competing financial priorities on substance abusetreatment utilization. The finding that higher levels of social support aresignificantly associated with fewer competing financial needs provides support forthis suggestion. Further support for this suggestion arises from previousresearch which has identified a lack of tangible support as an important barrier totreatment for substance abusers (Appel et al., 2004; Brown et al., 2004; Tuckeret al., 2004). Access to treatment could therefore be facilitated by the provisionof tangible support in the form of transport or economic assistance.116
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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
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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 and 114: informational support can improve a
Page 115: salient for low-income groups who h
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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