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

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hospitals. These findings are in keeping with prior research which also reportsthat complex programme admission and eligibility criteria may hamper access tosubstance abuse treatment (Appel et al., 2004; Hser et al., 1998).Taken together, these barriers contribute to delays in accessing care, indicatedby lengthy waiting periods for affordable treatment slots. As mentionedpreviously, these waiting periods negatively affect access to treatment; withindividuals often abandoning attempts to access treatment services (Grant, 1997;Hser et al., 1998; Tucker et al., 2004). In addition, delays in accessing care alsocontribute to perceptions that treatment services are relatively inaccessible forpeople from HDCs - a factor which has been shown to limit access to treatment.These findings highlight the need for interventions that streamline the processof accessing treatment for persons from HDCs. These interventions shouldattempt to reduce delays in accessing treatment, not only by increasing theavailability of affordable treatment services but also by increasing the availabilityof affordable detoxification and psychiatric services. In addition, interventionstargeting delays in accessing treatment should attempt to develop a structuredreferral algorithm for individuals from HDCs that includes patient placementcriteria. Finally, interventions should also attempt to reduce the administrativerequirements for admission to non-profit treatment facilities. This could beachieved by limiting the number of reports required prior to patient placement.6.3.2. Resource-related barriers within the treatment systemFindings also suggest that resource-related factors limit the extent to whichsubstance abuse treatment facilities can provide affordable services to clientsfrom HDCs. More specifically, the state’s limited allocation of financial resourcesto non-profit substance abuse treatment facilities restricts the capacity of thesefacilities to provide affordable treatment services, by contributing to staffshortages, jeopardizing the sustainability of treatment, and hampering skillsdevelopment within treatment facilities.121
This study found that limited resources hamper treatment facilities’ capacity toexpand their staff contingent to meet the increased demand for services inHDCs. This negatively impacts on access to care by restricting the availability ofservices. The increased demand for treatment services coupled with staffshortages have also restricted the breadth of services that can be offered toclients, with detoxification and aftercare services generally not being provided.This negatively impacts on access to care by contributing to delays in accessingservices (due to the need for detoxification services) and by fueling communityperceptions that effective treatment services are generally not available.Limited financial resources also affect the financial sustainability of non-profittreatment services. As mentioned previously, concerns about financialsustainability often result in TSPs limiting the number of free and low costtreatment slots. This further restricts the availability of affordable treatment andtherefore access to care for persons from HDCs. Related to this, as many nonprofittreatment facilities end up competing for scarce financial resources, it isdifficult for treatment service providers to pool their resources and maximize theircapacity to deliver services to HDCs.Limited financial resources also affect the capacity of non-profit treatmentservices to provide effective treatment services by restricting the skillsdevelopment of the treatment team. Low levels of remuneration for treatmentstaff often lead to high levels of staff turnover, with treatment facilities strugglingto retain experienced counsellors. This erodes the treatment team’s body ofskills and experience and impacts negatively on treatment capacity.The impact of financial constraints on the knowledge and skills set of treatmentstaff is most obvious among small, community-based organizations (CBOs)which have emerged to meet the growing demand for substance abuse treatmentin HDCs. In these sectors of the substance abuse treatment system, there arefew resources for staff training and development and few resources to invest inup-to-date treatment models. In addition, as these organizations are often122
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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
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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 and 120: self-efficacy and negative percepti
Page 121: 6.3. TREATMENT SYSTEM FACTORS ASSOC
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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