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

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an over-representation of White South Africans in treatment facilities. Forexample, the proportion of Black/African clients declined from 12% in 2000 to 7%of all clients in treatment in 2004 (Myers et al., 2004) – despite the fact thatBlack/Africans comprise roughly 32% of the general population in the Cape Townmetropole (Smith, 2005). This is worrisome as the high levels of substance useamong Black/African and Coloured communities suggest that this pattern ofservice utilization reflects the limited extent to which black South Africans haveaccess to treatment rather than lower levels of substance use in thesecommunities (Myers et al., 2004; Myers & Parry, 2005).1.4.3. Access to treatment in Cape TownIn the Cape Town metropole, residential treatment is provided by approximately16 inpatient clinics, one of which is a specialized ward of a general statepsychiatric hospital and another of which is a state facility providing free services.The remainder of these facilities are either private non-profit facilities (n= 7)offering low-cost services (but requiring co-payment fees) or private for-profitfacilities charging high fees (n = 7). Outpatient treatment services are provided byfour agencies, one of which has several satellite offices. These facilities providelow-cost services, however clients are required to pay for each visit. Eventhough relatively affordable, the costs of these services can still be exorbitant formany indigent clients.Despite the apparent availability of substance abuse treatment in the metropole,for the uninsured, who are disproportionately represented by poor, black SouthAfricans (Goosen et al., 2003), the availability of affordable substance abusetreatment remains limited. The shortage of publicly-funded substance abusetreatment centres, together with the increased demand for treatment in HDCs,has given rise to a growing private non-profit treatment sector. Although many ofthese are professionally-run accredited facilities with solid treatmentprogrammes, in recent years several facilities have been started by well-meaningcommunity members with little knowledge of how to treat substance usedisorders and few resources. Often these community-based facilities operate11
illegally and are unregulated by the state. Although private non-profit facilities arerelatively more accessible to HDCs than for-profit services, the quality of servicesprovided by these facilities is often variable and waiting lists at the betterresourced facilities are often lengthy. In addition, many of the accredited nonprofitfacilities require clients to make some form of financial contribution towardstheir treatment (Myers, 2004b). Quality of services, waiting lists, and co-paymentfees may all restrict access to treatment for persons from HDCs.1.5. PRIOR RESEARCH AND THE WAY FORWARDTo date, planning and decision-making around substance abuse treatment in theCape Town metropole has been hampered by a lack of accurate information onsubstance abuse treatment need, patterns of service delivery, and patterns oftreatment utilization (Myers & Parry, 2005). Substance abuse treatment servicesresearch (which could address this issue) has been characterised by a largelydescriptive focus on (i) the extent to which treatment centres are used by clientsfrom historically disadvantaged population groups and (ii) the extent to whichtreatment facilities target factors thought to be barriers to service utilization(Myers, 2004a; Myers, 2004b; Myers & Parry, 2002). This early research hasseveral limitations. Firstly, as it has not compared recipients of services withcommunity-based samples of untreated substance users, it has been difficult toidentify factors that facilitate or restrict access to treatment. This has hamperedthe development of interventions to improve access for under-served groups.Secondly, previous studies have tended to extrapolate findings from developedcountries and apply them directly to the South African context. As the factorsthat enable and restrict access to substance abuse treatment among historicallydisadvantaged communities in South Africa have not been directly examined, thedegree to which findings from developed country settings can be extrapolated tothe South African context remains unclear. This is cause for concern as theidentification of locally-relevant environmental and contextual barriers is essentialfor the development of interventions that are theoretically sound, acceptable to,12
Page 1 and 2: Access to substance abuse treatment
Page 3 and 4: CONTENTSINTRODUCTION ..............
Page 5 and 6: 5.4. SUMMARY.......................
Page 7 and 8: al., 2004; Reddy et al., 2003; Shis
Page 9 and 10: 1.3. IS ACCESS TO SUBSTANCE ABUSE T
Page 11: 1.4.2. Racial disparities in the ne
Page 15 and 16: CONCEPTUAL MODELThis study’s conc
Page 17 and 18: presenting problems and ability to
Page 19 and 20: need for services is the most immed
Page 21 and 22: This study focuses specifically on
Page 23 and 24: METHOD3.1. STUDY AIMS & OBJECTIVESA
Page 25 and 26: the researcher to explore possible
Page 27 and 28: esidential areas from each of the s
Page 29 and 30: 3.3.2.4. Data collection: controlsF
Page 31 and 32: o Problem recognition, Desire for h
Page 33 and 34: Table 1.Domains and measures compri
Page 35 and 36: The 19-item MOS-SSS measures functi
Page 37 and 38: information on the accessibility of
Page 39 and 40: RESULTS: PHASE ONE4.1. VARIABLES AS
Page 41 and 42: efficacy to stop using drugs for mo
Page 43 and 44: (Table 6). Effect sizes were large
Page 45 and 46: were 2.4 times more likely to not a
Page 47 and 48: esteem scales (Table 9). Stigma als
Page 49 and 50: Table 10.Logistic regression coeffi
Page 51 and 52: 4.2.2. Model 2: Predisposing variab
Page 53 and 54: poverty scale, and the variable “
Page 55 and 56: of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: 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
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putting extra strain and pressure o
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The impact of availability and affo
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availability of affordable services
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completed a hospital-based detoxifi
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“I have thirty beds that are unus
Page 95 and 96:
“I don't see it amongst the bona
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going to be a good day. So, yes it
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in the fourth week they relapse, it
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esponses to treatment, in part, are
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• Awareness of appropriate treatm
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This perception is prevalent in Col
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substance abuse problem - without a
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o These community influences are lo
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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
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diminishing self-efficacy and motiv
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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
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To address these barriers, we argue
Page 133 and 134:
o To ensure objectivity, this needs
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egistration process should gather i
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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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