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

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in the urbanized communities of the Cape Town metropole had a good grasp ofEnglish, the researchers decided not to translate the ATQ and instead employedtrained fieldworkers, who were fluent in at least two of the three official languagesof the region and could translate items where needed.3.3.2.2. FieldworkersAll fieldworkers employed in the study had extensive experience in conductingcommunity surveys related to substance use and had close ties to the targetrecruitment areas. This facilitated entry into these communities. Fieldworkersalso completed 40 hours of training in data collection procedures, such asrecruitment, quality assurance, screening and interview administration; researchethics; and alcohol and drug-related issues. In order to maintain data quality,fieldworkers were closely monitored by a fieldwork manager and by theresearchers.3.3.2.3. Data collection: casesResearchers contacted all inpatient and outpatient non-profit substance abusetreatment facilities in the Cape Town and described the study. Having obtainedthe support of these service providers, counselling staff were trained to identifyclients that met the study’s selection criteria. Prior to screening potential casesfor eligibility, counsellors obtained written informed consent from theseindividuals. All 440 persons screened met the study’s eligibility criteria. Onceeligibility had been established, locator information (e.g. residential address andcontact telephone numbers) was obtained so that fieldworkers could contactrecruits to arrange for an interview. Fieldworkers contacted recruits to obtainwritten informed consent to conduct an interview during which the ATQ would beadministered. Only 6 recruits refused to participate. This interview tookapproximately 90 minutes to complete and was generally conducted in recruits’place of residence.27
3.3.2.4. Data collection: controlsFieldworkers entered target communities by contacting community organizations,community leaders, and individuals in the community known to have interests inthe substance abuse field. Having explained the study’s goals and obtained thesupport of these community contacts, fieldworkers asked these key contacts toidentify potential recruits for the study. Key contacts were easily able to identifysubstance users within their communities- this is partly due to the social andpolitical structure of poorer South African communities where people live togetherin close confines and often depend on each other for financial survival. In suchcommunities, keeping issues such as drug use private is often a challenge.Fieldworkers contacted these potential controls and after explaining the aims ofthe study, obtained written informed consent to screen them for eligibility toparticipate in the study. The interviewer-administered brief screener tookapproximately five minutes to complete. Participants were given feedback fromthe results of the screener and those who did not meet the study’s eligibilitycriteria were thanked for their participation and given a resource list of substanceabuse-related services. Of the 559 participants screened, only 4 did not meet thestudy’s eligibility criteria. For the eligible participants, fieldworkers obtainedwritten consent to conduct a full interview. A time and place was arranged whereparticipants could complete the interviewer-administered ATQ in private. Thisinterview took approximately 90 minutes to complete. Although participants didnot receive financial incentives; fieldworkers did provide participants withrefreshments as well as feedback from their interview and referrals to substanceabuse treatment, mental health and social welfare-related services.3.3.3. Data collection tools3.3.3.1. The brief screenerThis tool determined eligibility to participate in the study. The screener collectsinformation on socio-demographic variables such as area of residence, gender,age, race, and legal income in the last 30 days. Controls were screened forcurrent substance use disorders (SUDS) using the Texas Christian University28
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 and 12: 1.4.2. Racial disparities in the ne
Page 13 and 14: illegally and are unregulated by th
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: esidential areas from each of the s
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
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 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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