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

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Similarly, findings suggest that persons from Black/African communities havesignificantly more affordability concerns than their Coloured counterparts. Forinstance, substance abusers earning less than R500 per month were five timesmore likely to be Black African than Coloured. In addition, Black Africansubstance abusers reported significantly more barriers relating to the affordabilityof treatment than their Coloured counterparts. While the affordability of treatmentwas a concern for all persons from HDCs, these findings highlight the need forinterventions that specifically target barriers relating to affordability amongwomen and Black/African persons with substance use disorders.6.2.4. Negative perceptions of treatmentAnother strong predictor of access to substance abuse treatment for HDCs iscommunity perceptions about existing substance abuse treatment services. Thisattitudinal-belief factor was indicated by the following variables: negativeperceptions of treatment effectiveness, concerns about treatment (i.e. whathappens within treatment facilities) and negative beliefs about the accessibility oftreatment.While only a weak effect was found for the former two variables, communityperceptions about the accessibility of treatment appears to have a strong effecton access to substance abuse treatment. For example, a one unit increase in the“community beliefs about access to treatment scale” was associated with a sixfoldincrease in the odds of not accessing treatment. In addition, increases in thisscale were associated with more delays in accessing treatment services. Whenconsidered together, these findings suggest that as negative beliefs about theaccessibility and availability of substance abuse treatment services increase,substance abusers are less disposed to seek and utilize these services.6.2.4.1. Factors underpinning negative perceptions of treatmentA possible reason for the relationship between realised access and negativeperceptions of treatment services may lie in the significant association between117
self-efficacy and negative perceptions about access to treatment. This studyfound that increases in the extent to which access to treatment services isnegatively perceived are associated with reductions in self-efficacy. Perceptionsthat existing treatment services are relatively inaccessible may result insubstance abusers having less confidence in their ability (i.e. self-efficacy) toaccess treatment; which may hamper treatment-seeking behaviour. The role ofself-efficacy in facilitating treatment-seeking behaviour has been welldocumentedby previous research (Appel et al., 2004).Findings (from the qualitative phase of the study) suggest that community beliefsthat treatment is inaccessible seem to relate to the accessibility of effectivetreatment services and appear to be underpinned by a limited awareness of whatconstitutes appropriate and effective treatment (an enabling factor). Morespecifically, HDCs tend to believe that only inpatient/residential substance abusetreatment services of a lengthy duration are effective - despite evidence to thecontrary (NIDA, 2000). These beliefs contribute to the perception that there are“no effective services available” and consequently hamper treatment utilizationas communities do not see the value of using existing treatment services whichare often outpatient programmes of limited duration. These claims are supportedby findings from international research which identified concerns about privacyand confidentiality in treatment and beliefs that treatment would be ineffective asconditions that interfered with linkage to substance abuse treatment (Appel et al.,2004; Grant, 1997; Simpson & Tucker, 2002; Tucker et al., 2004).In addition, findings from both phases of the study suggest that social supportand stigma contribute to negative perceptions about access to treatment; withthese variables being significant predictors of negative perceptions about accessto treatment. More specifically, low levels of social support and higher levels ofstigma towards substance abusers may contribute to views that treatment isinaccessible for persons from HDCs. These low levels of social support may beunderpinned by HDCs’ desire to transfer responsibility for supporting thesubstance abuser to the treatment system. This attempt to “transfer118
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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
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subjects earning less than R500 per
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and race (Table 16). This indicates
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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 and 116: salient for low-income groups who h
Page 117: diminishing self-efficacy and motiv
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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