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

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number of known treatment centres. Weaker influences included support forabstinence, self efficacy and distance to treatment• Number of known treatment centres: The strongest influences on numberof known treatment centres are desire for help and anxiety. Other significantfactors include social trust, social support, and relative deprivation, withhigher levels of social trust and social support and lower levels of deprivationpredicting more known treatment centres• Competing needs: Improvements in self-efficacy and social support seemassociated with reductions in competing financial needs. Competing financialneeds are also associated with barriers relating to awareness of services.• Time to treatment (Geographical accessibility): The most powerful factorsunderpinning travelling time to treatment include distance to treatment,followed by affordability barriers; with higher levels of these variablespredicting longer travelling times. In contrast, greater levels of abstinence selfefficacy and greater number of known treatment centres predicted shortertravelling times.• Community views about access: The most powerful factors underpinningnegative perceptions about access and availability of treatment includegreater neighbourhood disadvantage, greater community stigma, and barriersrelated to delays in accessing treatment due to gatekeepers. In contrast,greater social support and abstinence self-efficacy predicted more positiveperceptions about the availability of treatment.77
RESULTS: PHASE TWODuring qualitative data analysis, three themes were identified: political andsystemic influences on access to treatment, treatment system dynamics, andcommunity dynamics. The first two themes relate primarily to theexternal/contextual environmental domain, while the third relates to thepredisposing and enabling variable domains of the BHSU.5.1. THEMES RELATED TO BROAD SYSTEM DYNAMICSWe identified two broad systemic influences on substance abuse treatmentutilization: provincial government’s responses to substance use and theprovincial government’s allocation of resources to substance abuse treatment.5.1.1. Provincial government’s responses to substance abuseProvincial government’s responses to substance use indirectly hamper treatmentutilization by shaping the organization of the treatment sector and communityresponses to government initiatives.5.1.1.1. The first influence on government’s responses to substanceabuse revolves around information.More specifically, government tends to develop strategic plans and responseswithout assessing the needs of HDCs and gaps in current service delivery:“You (government) say research is not available, so how do you make yourdecisions?” [LDAC]“…even to identify needs and gaps (in service delivery) because often, thedepartment will take the initiative and say, okay they want some training here orthey identify certain needs but I know they don't have very good needs analysisin the province…” [TSP]This hampers government’s ability to appropriately allocate resources fortreatment. For instance, it has contributed to an uneven dispersion of resources;with some communities being relatively over-served while others remainunderserved, despite similar needs. In addition, it has led to service duplication,78
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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
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: • In historically disadvantaged c
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
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• While the affordability of trea
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To address these barriers, we argue
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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. (
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First, MB; Spitzer, RL; Gibbon, M;
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Myers, B., & Parry, C.D.H. (2005).
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Ross, M.W., Williams, M.L., Timpson
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