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

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Drug Screen (TCUDS-II, Knight et al., 2002). As cases were known to have alifetime diagnosis of substance dependence, they were not screened for SUDS.The TCUDS had good internal reliability, with this study obtaining a coefficientalpha of .88.3.3.3.2. The Access to Treatment Survey Questionnaire (ATQ)The ATQ, designed to examine access to substance abuse treatment amongSouth African populations, is a 45-page questionnaire that collects self-reportinformation on several domains, including factors thought to predispose personsto seeking treatment, factors thought to enable or restrict access, need fortreatment variables, and utilization of substance abuse services. The ATQconsists of scales that were constructed for the purposes of this study andexisting standard questionnaires. The following sub-sections summarise thedomains and measures comprising the ATQ in more detail (see Table 1).• Utilization of substance abuse treatment servicesThe dependent variable for this study is realized access or utilization oftreatment. This was assessed by the question: “Have you ever gone anywhereor seen anyone for help with alcohol and/or drug-related problems? “• Need for substance abuse treatmentThe ATQ assesses perceived and evaluated need for substance abuse treatmentas well as severity of SUDS - with greater severity indicative of more treatmentneed. Perceived need is examined by the following questions: “Do you think youhave an alcohol or drug problem?”, “Do you think you need help to change youralcohol and/or drug use?”, and “Have other people suggested that you need helpto change your use of alcohol/drugs?” The Substance Use Disorders module ofthe Structured Clinical Interview for DSM-IV-TR (SCID-I, First et al., 1997) isused to objectively evaluate need for treatment. The following scales alsoexamine perceived need:29
o Problem recognition, Desire for help and Treatment readinessThe 9-item Problem Recognition (PR) scale measures the extent to whichparticipants’ perceive problems related to their substance use. The 6-item Desirefor Help (DH) scale examines intrinsic need for change and interest in gettinghelp. The 8-item Treatment Readiness (TR) scale assesses commitment levelsand expectations about how helpful substance abuse treatment will be (Knight,Holcom & Simpson, 1994). This study obtained Cronbach alpha coefficientsof.86 for the PR scale,.86 for the DH scale, and .68 for the TR scale.o Readiness to changeThe Stages of Change, Readiness and Treatment Eagerness Scale(SOCRATES, Miller & Tonigan, 1996) measures readiness to change substanceuse; with higher scores indicating greater readiness to change. This scale hasgood internal reliability, with alpha coefficients of .91 and .95 being obtained forthe pilot and main study, respectively.• Predisposing factors for access to treatmentThe ATQ contains several variables thought to be predisposing factors for accessto substance abuse treatment. These include demographic and social structuralfactors; beliefs and attitudes related to substance abuse treatment; and socialcognitive factors including readiness to change substance use, self-efficacy,problem recognition, desire for help, and treatment readiness.o Demographic and social-structural factorsThe ATQ includes the following socio-demographic variables: age, gender,race/ethnicity, education, marital status, employment status and deprivation. Arelative deprivation index was constructed for the study, with higher scoresindicating relatively less socio-economic deprivation.o Beliefs about substance abuse treatmentThe 12-item “Community beliefs about substance abuse treatment” scalemeasures community beliefs about the effectiveness of substance abuse30
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 and 28: esidential areas from each of the s
Page 29: 3.3.2.4. Data collection: controlsF
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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