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

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esponsibility” may arise from (i) limited awareness of the role that communitiescan play in facilitating access to treatment and positive treatment outcomes and(ii) from limited capacity to provide a supportive community environment.Interventions that address these negative perceptions as a means of improvingtreatment utilization should focus not only on addressing these perceptionsdirectly, but also focus on factors that contribute to these perceptions. Forinstance, interventions could attempt to (i) increase awareness of the value ofcreating a drug-free community environment that is supportive of abstinence and(ii) improve social capital and community capacity so that environments can beprovided. These interventions would enhance social support for and reducestigma towards substance abuse treatment-seeking behaviour in HDCs.6.2.4.2. Socio-demographic differencesSubstance abusers from traditionally Coloured communities seem to have morenegative perceptions about treatment than their Black/African counterparts. Forexample, a one unit increase in the “Community views about access totreatment” scale resulted in the odds of respondents being Coloured increasingmore than eight-fold. In addition, Coloured respondents reported significantlyhigher levels of “treatment concerns” and more negative beliefs about theeffectiveness of existing treatment services than their Black/African counterparts.These findings suggest that compared to Black/African respondents, Colouredrespondents hold more negative views about access to and availability oftreatment facilities, are more concerned about what happens in treatment, andare more likely to believe that treatment is ineffective.These findings highlight the need for interventions that target negative beliefsabout treatment and the availability of services among Coloured persons,specifically. Given these negative beliefs and concerns about treatment, it is notsurprising that many respondents do not attempt to access treatment.119
6.3. TREATMENT SYSTEM FACTORS ASSOCIATED WITH ACCESS TOSUBSTANCE ABUSE TREATMENTAlthough treatment system factors were not examined during the quantitativephase of the study, these factors emerged as significantly associated withtreatment utilization during qualitative data analysis. Key informants highlightedthe way in which both organizational barriers and resource allocation within thetreatment system limit access to treatment in HDCs.6.3.1. Organisational barriers to accessing substance abuse treatmentFindings suggest that there are several organisational factors within thesubstance abuse treatment system that act as barriers to accessing treatment forpeople from HDCs. These barriers all relate to the process of accessing nonprofittreatment. One such barrier is the lack of a clear, structured referralpathway; with persons from HDCs often referred to several non-profit treatmentservices before they are able to obtain help. For persons from HDCs this oftendelays entry into the treatment system. Administrative requirements forobtaining a free or low-cost bed at a non-profit treatment facility also delay theprocess of accessing treatment. In order to access affordable treatmentservices, persons from HDCs often need reports from social workers and healthprofessionals that document their need for treatment, their levels of motivation,and their medical and psychiatric history. Given that many of the agenciesresponsible for collating these reports have high caseloads and staff shortages,these administrative requirements often take several weeks to complete.Complex eligibility requirements (such as the need for adequate levels ofmotivation and the need for detoxification to have occurred prior to admission)also delay entry into the treatment system for persons from HDCs. For example,many non-profit facilities do not admit clients into their treatment programmeunless they have completed a hospital-based detoxification programme.Although this eligibility criertia arises from facilities’ lack of capacity to providedetoxification services, an unintended consequence is that treatment entry isoften delayed due to the limited availability of detoxification services in state120
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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
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(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 and 118: diminishing self-efficacy and motiv
Page 119: self-efficacy and negative percepti
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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