Stigma, treatment beliefs, and substance abuse treatment use in historically disadvantaged communities

Women and opioid use disorder treatment: A scoping review of experiences, use of patient-reported experience measures, and integration of person-centred care principles

BACKGROUND

Patient-reported experience measures (PREMs) are an important aspect of assessing and improving women's experiences of person-centred care during treatment for Opioid Use Disorder (OUD). This scoping review aimed to 1) examine the extent, type, and characteristics of evidence regarding women's OUD treatment experiences, and 2) describe the extent to which PREMs and person-centred care principles are incorporated within research methods.

METHODS

Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a scoping review to identify peer-reviewed articles on women's OUD treatment experiences. Data were extracted from 39 included studies and synthesised based on study design, method of assessment/analysis (including use of PREMs), key findings, and the integration of person-centred care principles.

RESULTS

Analysis of included studies revealed a predominance of qualitative research focused on women's experiences of pharmacological OUD treatment (methadone and/or buprenorphine) in Western countries. Women in these studies reported predominantly negative or mixed experiences of treatment. Few studies used validated PREMs and there was a lack of direct assessment or focus on recognised person-centred care principles. However, common categories of outcomes/findings identified in results across studies broadly aligned with person-centred care principles (e.g., fast access to reliable healthcare, effective treatment by trusted professionals), emphasising their applicability to women's experiences of treatment.

CONCLUSIONS

Although there has been an increased focus on women's experiences of treatment for OUD in recent years, results highlighted room for improvement regarding the systematic and comprehensive assessment of women's experiences across different contexts. Given the often negative or mixed experiences reported by women, an increased focus on assessing service provision through a person-centred care lens (including utilising PREMs) may allow for service improvements or adaptations targeted towards the needs and experiences of women.

Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review

BACKGROUND

With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries.

METHODS

A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services.

RESULTS

This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients.

CONCLUSION

There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.

Identity Construction in Recovery from Substance Use Disorders

Long-term recovery from substance use disorders has been described as a process of identity construction, through which the stigma of being a substance user is replaced by a new identity of a non-user. Identity construction has been widely acknowledged as a significant factor in different pathways of substance use cessation, such as self-change and treatment-change. However, almost no articles have discussed the role of identity construction in desistance and recovery among both self-changers and treatment-change. The aim of this narrative review was to explore this subject in the two groups. Based on the recovery capital approach and the social identity model of recovery, I posited that self-changers and treatment-changers undergo different processes of identity construction. Moreover, the prospects for successful identity construction depend upon personal and social resources (recovery capital) that provide identity-building materials such as relationships, attitudes, and role models. This article contributes to the field by presenting the different identity constructions in the process of long-term recovery from SUDs.

Lay counsellors' experiences of administering the AUDIT-C as a brief screening tool in a South African township

BACKGROUND

South Africa presents one of the riskiest patterns of alcohol consumption, with per capita consumption above the African regional average. Globally, there has been an increased focus on the potential of appointing lay counsellors to administer alcohol intervention strategies in resource-limited contexts. Given the increasing need for relevant and efficient intervention strategies in response to high-risk alcohol consumption, screening instruments such as the AUDIT-C have gained increased attention.

METHODS

This paper explores the experiences of 15 lay counsellors in response to the training received on how to administer the AUDIT-C instrument, as well as provide interventions such as brief advice or an appropriate referral, in the resource-limited South African township of Alexandra, Johannesburg. A focus group was facilitated for this purpose and, thereafter, a thematic content analysis was applied to identify the themes most central to the lay counsellors' experiences.

RESULTS

The research findings suggest that the lay counsellors perceived the training to be adequate in preparing them for administrating the AUDIT-C and for providing any relevant interventions, and that their confidence in administering the instrument developed as the project progressed. However, recruitment and administration challenges were experienced in primary healthcare and community settings, and lay counsellors perceived home visits to be more appropriate with respect to issues related to confidentiality and stigmatisation.

CONCLUSION

Overall, while lay counsellors feel that the training they received on the tool and the tool itself is useful for effectively implementing the AUDIT-C in low-resource communities, the availability and efficiency of alcohol treatment services in Alexandra Township need to be improved.

Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention

BACKGROUND

Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a "Medication First" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients.

METHODS

This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions.

RESULTS

White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients.

CONCLUSION

In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.

"It's all about asking from those who have walked the path": Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa

BACKGROUND

South Africa has the highest number of people with HIV (PWH) globally and a significant burden of co-occurring substance use disorder (SUD). Health care worker (HCW) stigma towards SUD is a key barrier to HIV care engagement among PWH with SUD. Support from peers-individuals with lived experience of SUD-may be a promising solution for addressing SUD stigma, while also improving engagement in HIV care. We evaluated the perceived acceptability of integrating a peer role into community-based HIV care teams as a strategy to address SUD stigma at multiple levels and improve patient engagement in HIV care.

METHODS

Patients and stakeholders (N = 40) were recruited from publicly-funded HIV and SUD organizations in Cape Town, South Africa. We conducted a quantitative assessment of stigma among stakeholders using an adapted Social Distance Scale (SDS) and patient perceptions of working with a peer, as well as semi-structured interviews focused on experiences of SUD stigma, acceptability of a peer model integrated into community-based HIV care, and potential peer roles.

RESULTS

On the SDS, 75% of stakeholders had high stigma towards a patient with SUD, yet 90% had low stigma when in recovery for at least 2 years. All patients endorsed feeling comfortable talking to someone in recovery and wanting them on their HIV care team. Three main themes emerged from the qualitative data: (1) patient-reported experiences of enacted SUD and HIV stigmas were common and impacted HIV care engagement; (2) both patients and stakeholders considered a peer model highly acceptable for integration into HIV care to support engagement and address SUD stigma; and (3) patients and stakeholders identified both individual-level and systems-level roles for peers, how peers could work alongside other providers to improve patient care, and key characteristics that peers would need to be successful in these roles.

CONCLUSIONS

Findings from this formative work point to the promise of a peer model for reducing SUD stigma among patients and HCWs within community-based HIV care teams in SA.

Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa

BACKGROUND

Despite HIV and problematic drinking often co-occurring in South Africa (SA), limited research has examined how HIV stigma relates to alcohol outcomes, how alcohol stigma relates to HIV outcomes, and moderators of these associations. This study examined the intersection of HIV and alcohol stigmas on HIV and alcohol outcomes, and the role of avoidant behavior in moderating these relationships in SA.

METHODS

We assessed biomarker-verified measures of antiretroviral therapy (ART) adherence, HIV viral load (VL), and alcohol consumption, and self-reported measures of internalized HIV/alcohol stigmas, avoidant behavior, ART adherence, and problematic drinking-alcohol use that will likely lead to health or other problems-cross-sectionally among people with HIV (PWH) and problematic drinking (N = 64). We conducted regression analyses with interaction terms.

FINDINGS

A significant relationship was found between internalized alcohol stigma and VL suppression, with higher levels of alcohol stigma associated with a lower likelihood of suppression (OR=1.68, 95%CI[1.11-2.65], p = .02). Avoidance significantly moderated the relationship between internalized HIV stigma and problematic drinking; higher HIV stigma was associated with lower problematic drinking only at low levels of avoidance (b(SE)= -1.92(.85), p = .03).

CONCLUSIONS

This study is the first to examine associations between HIV and alcohol stigmas, avoidance, and both HIV and alcohol outcomes in SA. Findings contribute to our understanding of how alcohol stigma relates to biological HIV outcomes, and the role of avoidance in the relationship between internalized HIV stigma and problematic drinking. Findings may inform future clinical interventions aiming to address the impact of stigma on HIV treatment outcomes and alcohol use among PWH in SA.

HCV communication within ego-centric networks of men and women who inject drugs

INTRODUCTION

Leveraging interpersonal communication among social networks of people who inject drugs (PWID) may be an innovative strategy to increase awareness and access to hepatitis C (HCV) care. However, little is known about HCV communication patterns among PWID and if these patterns vary by gender.

METHODS

Egocentric network data collected at baseline from HCV-infected PWID enrolled in a randomized HCV treatment intervention trial in Baltimore, Maryland were analyzed. Logistic generalized estimating models were conducted to identify predictors of HCV communication.

RESULTS

Among 227 PWID, the mean age was 43.8 (SD=10.3), 28.2% (n = 64) were women and 71.8% (n = 163) were men. Female participants reported 516 dyadic relationships and male participants 1139 dyadic relationships. While there were significant gender differences based on socio-demographics, risk behavior and network composition, there were few differences in HCV communication patterns. Both men and women had increased odds of HCV communication with alters who are currently enrolled in drug treatment (AOR 1.7, 95% CI: 1.3-2.4), alters with whom participants share drug preparation equipment (AOR 3.0, 95% CI: 1.9-4.6), alters who are sex partners compared to kin (AOR 3.0; 95% CI: 1.9-4.9) and alters with whom respondents have increased trust (AOR 1.1; 95% CI: 1.11.2) and daily/weekly interactions (AOR 1.7; 95% CI 1.3-2.1).

CONCLUSION

PWID engaged with trusted alters about HCV disclosure and information, highlighting the important role network interventions could play in this vulnerable population.

Outcomes of Implementing in the Real World the Women's Health CoOp Intervention in Cape Town, South Africa

Women in South Africa living with HIV who use alcohol may not adhere to ART, affecting the country’s 90-90-90 targets. The Women’s Health CoOp (WHC), a woman-focused HIV intervention, has shown efficacy in numerous trials with key populations of women in South Africa who use alcohol and drugs. In a hybrid implementation effectiveness study, the WHC was implemented in usual care clinics by healthcare providers in a modified stepped-wedge design. We present the outcomes of alcohol use and ART adherence with 480 women, with a 95% 6-month follow-up rate across 4 implementation cycles. Compared with the first cycle, women in the fourth cycle were significantly less likely (OR = 0.10 [95% CI 0.04, 0.24]) to report alcohol use disorder risk and were 4 times more likely (OR = 4.16 [95% CI 1.05, 16.51]) to report ART adherence at 6-month follow-up. Overall, acceptability and satisfaction were extremely high. The WHC intervention was successful in reaching key populations of women to reduce alcohol use and increase ART adherence, which is essential for South Africa to reach the 90-90-90 goals.

Priorities for addressing substance use disorder in humanitarian settings

Background

Populations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings.

Methods

UNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies.

Results

Participants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical ‘do no harm’ approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings.

Conclusions

Results from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00407-z.

The Role of Acceptance and Change in Recovery from Substance Use Disorders

Long-term recovery (LTR) from substance use disorders (SUDs) has been described as a complex process. It has been proposed that psychological mechanisms can influence the resolution of problematic substance using behaviors and may explain how and why a recovery process works. The aims of this narrative review were to (a) examine acceptance and change as an underlying mechanism in LTR from SUDs; (b) examine the practice of acceptance and change in the Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) programs; and (c) present a conceptual model of self-acceptance and change in LTR from SUDs. Based on dialectical behavioral philosophy and mindfulness-based intervention, I posited that self-acceptance is an underlying mechanism that addresses the cyclical nature of shame, guilt, and SUDs; improves emotion dysregulation; psychological well-being; and activates a change process of recovery from SUDs. This article contributes to the field by presenting the opposing forces of acceptance versus change and their synthesis in promoting LTR from SUDs, and by discussing the practice of acceptance and change in the AA and NA programs.

Substance abuse among high school learners in a rural education district in the Free State province, South Africa

BACKGROUND

In South Africa, many studies conducted on substance abuse among in-school youth focus on urban areas. However, anecdotal evidence suggests that rural areas are experiencing an increase in substance abuse, though there is dearth of studies in these areas.

METHODS

This study used a quantitative design to collect data from 629 high school learners who were in Grades 10 and 11 in public schools in rural Free State Province, to determine the prevalence of, and factors associated with substance use.

RESULTS

The sample consisted of 46% males and 54% females. Their ages ranged from 14 to 20 years, with a mean of 16.9 years. The prevalence of substance abuse was 47% (n = 295) with alcohol consumption, cigarette and dagga smoking being the most common substances used. Socio-demographically, age and gender were significantly associated with substance abuse. While behavioural variables of physical fights, serious problems with parents and friends, poor academic performance, trouble with police, having sex without condom, and having sex and regretted the next day were significantly associated with substance abuse (p = 0.05).

CONCLUSION

The prevalence of substance abuse is very high for this rural school community, which highlights the need to pay attention to rural schools regarding substance abuse challenges.

Current Interventions for People Living with HIV Who Use Alcohol: Why Gender Matters

PURPOSE OF REVIEW

Alcohol is the most misused substance in the world. For people living with HIV (PLWH), alcohol misuse may impact ART adherence and viral suppression. This review of the most recently published alcohol intervention studies with PLWH examines how these studies considered gender in the samples, design, and analyses.

RECENT FINDINGS

Three searches were conducted initially, and 13 intervention studies fit our criteria with alcohol outcomes. In general, most studies did not consider gender and had used small samples, and few demonstrated significant efficacy/effectiveness outcomes. Five studies considered gender in their samples or analyses and/or were woman-focused with larger samples and demonstrated significant outcomes. It is essential for women who misuse alcohol to not only be well represented in alcohol and HIV research but also for studies to consider the barriers to reaching them and their contextual demands and/or co-occurring issues that may affect participation and outcomes in intervention research.

'Special death': Living with bereavement by drug-related death in Ireland

This paper explores the impact of complicated grief on the family system following the drug-related death of a family member. Drug-related deaths are rife with moral stigmas, and those left behind often carry an emotional burden laden with shame and guilt. 17 bereaved family members were interviewed using semi-structured interviews and transcripts were analyzed using reflexive thematic analysis. Three core themes were generated: Renegotiation of Relationships; Experiencing Complex Emotions; and Adjusting to a New Reality. The findings demonstrate that this population experience great difficulty in processing their grief as they struggle with family breakdown, navigating supports and stigma.

The intersection of gender and drug use-related stigma: A mixed methods systematic review and synthesis of the literature

BACKGROUND

Substance use-related stigma is a significant barrier to care among persons who use drugs (PWUD). Less is known regarding how intersectional identities, like gender, shape experiences of substance use-related stigma. We sought to answer the following question: Do men or women PWUD experience more drug use stigma?

METHODS

Data were drawn from a systematic review of the global, peer-reviewed scientific literature on substance use-related stigma conducted through 2017 and guided by the Stigma and Substance Use Process Model and PRISMA guidelines. Articles were included in the present analysis if they either qualitatively illustrated themes related to the gendered nature of drug use-related stigma, or quantitatively tested the moderating effect of gender on drug use-related stigma.

RESULTS

Of the 75 studies included, 40 (53 %) were quantitative and 35 (47 %) were qualitative. Of the quantitative articles, 22 (55 %) found no association between gender and drug use-related stigma, 4 (10 %) identified women who use drugs (WWUD) were more stigmatized, and 2 (5 %) determined men who use drugs (MWUD) were more stigmatized. In contrast, nearly all (34; 97 %) of the qualitative articles demonstrated WWUD experienced greater levels of drug use-related stigma.

CONCLUSION

The quantitative literature is equivocal regarding the influence of gender on drug use-related stigma, but the qualitative literature more clearly demonstrates WWUD experience greater levels of stigma. The use of validated drug use-related stigma measures and the tailoring of stigma scales to WWUD are needed to understand the role of stigma in heightening the disproportionate harms experienced by WWUD.

Intention to initiate and uptake of PrEP among women who injects drugs in a demonstration project: an application of the theory of planned behavior

Some women who inject drugs (WWID) would benefit from pre-exposure prophylaxis (PrEP), yet there are few studies of issues related to uptake in real-world settings. In this study, participants (n = 95) were offered PrEP and responded to items measuring PrEP-related attitudes, norms, and perceived behavioral control based on the Theory of Planned Behavior. We tested associations with intention to initiate PrEP and uptake. Most WWID (88%) intended to initiate PrEP and 78% accepted a prescription. Compared to WWID who did not express PrEP intentions, those who did were less concerned about attitudinal and perceived behavioral control constructs such as temporary (75% vs. 36%, p = 0.01) and long-term (63% vs. 27%, p = 0.05) side effects, negative interactions with their birth control (93% vs. 38%, p < 0.01), their ability to take a daily pill (80% vs. 36%, p < 0.01), and the cost of PrEP (87% vs. 36%, p < 0.01). WWID who went on to take PrEP had fewer concerns with subjective norms constructs such as talking to health care providers about sex (91% vs. 65%, p < 0.01) and drug use (88% vs. 55%, p < 0.01) compared to those who did not. Attitudes and perceived behavioral control influenced intention while subjective norms had a greater impact on actual uptake.

Affective relations and treatment adherence for HIV and problematic drug use (Argentina, 2014-2016)

The article analyzes interactions between therapeutic experiences and affective relations in the history of patients with chronic health conditions: persons with problematic drug use receiving therapeutic care in religious devices and persons with HIV under clinical care and antiretroviral therapy. The article uses a qualitative methodology based on in-depth interviews. The hypothesis is that the treatments (pharmacological or psychological) usually prove insufficient to provide adequate therapeutic responses to these two chronic conditions. Both groups acknowledged the central importance of affective dimensions for adherence to the proposed treatment regimens and a comprehensive (and thus more effective) approach to HIV and drug addictions. The article concludes by presenting a notion of adherence that extrapolates individual behavior involving mere compliance with prescribed treatments. Adherence is less a personal than a collective experience, in which family, peer networks, and professionals and other therapeutic reference persons play a central role.

On my own terms: Motivations for self-treating opioid-use disorder with non-prescribed buprenorphine

INTRODUCTION

The opioid overdose crisis in the United States has prompted an expansion of treatment services, including pharmacotherapy with buprenorphine. However, many people who use illicit opioids (PWUIO) self-treat their opioid-use disorder (OUD) with non-prescribed buprenorphine (NPB) in lieu of attending formal treatment. The present study aims to qualitatively understand motivations of people who are self-treating their OUD with NPB.

METHODS

Qualitative study designed to supplement and contextualize quantitative findings from natural history study of buprenorphine diversion, self-treatment, and use of substance use disorder treatment services. Interviews were audio-recorded, transcribed, systematically coded and analyzed via Iterative Categorization.

STUDY SETTING

The Dayton, Ohio metropolitan area in the midwestern United States; a site previously characterized as high impact in the national opioid overdose crisis.

PARTICIPANTS

Sixty-five individuals (35 men and 30 women) who met the DSM-5 criteria for OUD (moderate or severe) and had used NPB at least one time in the six months prior to their intake interview.

RESULTS

Participants described four key motivators for self-treating with NPB: perceived demands of formal treatment, the desire to utilize non-prescribed buprenorphine in combination with a geographic relocation, to self-initiate treatment while preparing for formal services, and to bolster a sense of self-determination and agency in their recovery trajectory.

CONCLUSIONS

Use of NPB is a recognized self-treatment modality among PWUIO, with some PWUIO transitioning into sustained recovery episodes or enrollment in formal treatment. Understanding the motivations for opting out of treatment is crucial for improving forms of care for people with OUD.

Social and public health implications of the legalisation of recreational cannabis: A literature review

BACKGROUND

After many years of legal struggles for the legalisation of recreational use of cannabis, the Constitutional Court of South Africa ruled in favour of the applicants in September 2018. Although the ruling issued caution regarding the social challenges accompanying this legalisation, it did not address how the country would deal with the societal consequences of this ruling.

AIM

The aim of this article was to discuss the social and public health implications of the legalisation of recreational cannabis on South Africa.

METHODS

Literature review on the social, health and legal impacts of legalisation of cannabis, considering experiences of other countries that have legalised cannabis.

RESULTS

The legalisation brings a range of significant negative consequences, which include an expected increase in the number of users and the subsequent undesirable effects on the physical, mental and social health of communities.

CONCLUSION

In terms of financial, infrastructural and human resources, South Africa cannot afford the consequences of the legalisation of recreational cannabis. Poor communities, children and the youth will carry the brunt of the scourge of cannabis use.

Help seeking behavior for problematic substance uses in north-West Ethiopia

Background

Substance miss use and neuro-psychiatric conditions are a growing public health challenges, but 76 to 85% of people with those disorders in low and middle-income countries did not receive treatment. The aim of this study was to see help seeking behavior and determinant factors in residents with problematic substance uses.

Methods

A total of 2400 participants had screened for problematic substance uses and 548 participants were found positive for problematic substance uses. Then, we had interviewed 548 participants for help seeking behavior by pre-tested modified General Help Seeking Questionnaire. Logistic regression with its corresponding p-value < 0.05; Adjusted odds ratios (AOR) and 95% confidence intervals (CI) have been used.

Results

Among five hundred and forty-eight participants with problematic substance use, only one hundred and sixty-eight (30.7%) with 95% CI (27, 35%) had sought help. Age above 35 years [AOR = .47 95% CI (.25, .90)], who had common mental disorders [AOR = 4.12, 95% CI (2.7, 6.3)], who had comorbid medical condition [AOR = 3.0, 95% CI (1.7, 5.3)], and grand-families’ history of substance use [AOR = 2.18, 95% CI (1.4, 3.4)] were significantly associated with help seeking behavior.

Conclusion

Help-seeking behavior was infrequent in people with problematic substance use. Advanced age was a barrier to seek help while medical illnesses, common mental disorders and history of substance use in grand families were found to enforce to seek help.

To what extent is Fetal Alcohol Spectrum Disorder considered in policy-related documents in South Africa? A document review

BACKGROUND

South Africa is considered to have the highest prevalence of fetal alcohol spectrum disorder (FASD) globally. Nevertheless, the extent to which the South African government has responded to the high FASD prevalence at the policy level is unclear. Herein, we aimed to identify targeted and generic clauses that could be attributed to the prevention and management of FASD in relevant South African policy documents.

METHODS

We conducted a search of two search engines (PubMed and Google) and the websites of South African national and provincial departments from January to April 2018. A total of 33 policy documents were included in this review. Using content analysis, we sought documents that mention the terms 'fetal alcohol syndrome' and 'fetal alcohol spectrum disorder'. The Framework method was also used to thematically identify specific and generic clauses attributed to the prevention and management of FASD in South Africa.

RESULTS

The content analysis indicated that 12 policy documents contained the searched terms. Findings from the thematic analysis showed that targeted and generic clauses for FASD exist in various policy documents. Some of the generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of persons with mental and educational challenges. Specific clauses focused on creating platforms to improve the awareness, screening, identification and support for individuals with FASD.

CONCLUSIONS

There is a noticeable increase in the number of policy documents that considered elements of FASD enacted in the last decade. Although this study revealed the existence of targeted and generic clauses that could be attributed to the prevention and management of FASD, the sustained high prevalence of FASD in South Africa, as reported in the literature, calls for more holistic and comprehensive approaches to tackle the FASD problem in South Africa.

A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa

BACKGROUND

Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town.

METHODS

Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted.

RESULTS

Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital.

DISCUSSION

The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers.

CONCLUSIONS

Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

Perceived discrimination, racial identity, and health behaviors among black primary-care patients who use drugs

Blacks who use drugs are at heightened risk for health problems. Discrimination experiences may contribute to these risks by influencing health behaviors. This study examined associations between discrimination, racial identity, and health behaviors (alcohol use, cigarette smoking, low physical activity, and unprotected [condomless] sex) in a sample of 203 Black primary-care patients who reported current drug use. Logistic regression analyses did not find direct effects of discrimination or identity on outcomes. Hypothesized moderation of discrimination by racial identity was not observed in expected direction for the outcome of unprotected sex.

"Not human, dead already": Perceptions and experiences of drug-related stigma among opioid-using young adults from the former Soviet Union living in the U.S

BACKGROUND

Young people from the former Soviet Union (FSU) in the U.S. are engaging in opioid and injection drug use (IDU) in substantial numbers, paralleling nationwide trends. Yet opioid-using FSU immigrants face distinctive acculturation challenges, including perceived stigmatisation as drug users within their immigrant communities, which may exacerbate the negative health and psychosocial consequences of such use.

METHODS

This qualitative study draws on semi-structured interviews with 26 FSU immigrant young adults (ages 18-29) living in New York City who reported opioid use in the past month and/or were currently in treatment for opioid use disorder. Interviews probed youths' drug use histories, immigration/acculturation experiences, family and peer relationships, and service utilisation. Interviews or focus groups were also conducted with 12 FSU mothers of opioid-using youth and 20 service providers familiar with the FSU population. In a content-based thematic analysis, verbatim transcripts were coded for salient themes.

RESULTS

All three participant groups emphasized that stigma towards drug users within the FSU community is pervasive and acute, in contrast to the cultural acceptance of heavy drinking, and is rooted in punitive Soviet-era drug policies, fostering widespread ignorance about drugs and addiction. Young adults and service providers reported instances in which anticipation of community stigmatisation deterred youth from accessing drug treatment and harm reduction services. Similarly, stigma contributed to parents' failure to recognize early signs of their children's opioid problems and their reluctance to seek drug treatment for their children until opioid use had become severe. Young adults described how drug-use stigma is frequently internalized, leading to shame and loss of self-esteem.

CONCLUSION

Findings indicate an urgent need for community-wide education about drugs within FSU immigrant communities, and suggest specific service modalities that may be less stigmatizing for youth, such as peer-delivered syringe exchange and harm reduction education, and technology-based interventions that can be accessed privately and discreetly.

African American women and sexually transmitted infections: The contextual influence of unbalanced sex ratios and individual risk behaviors

This study uses data from 564 African American women to examine the correlates of lifetime prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions about the availability of African American males, five partner characteristics, and drug history. At the bivariate-level, women with an STI diagnosis were significantly more likely to have dated a man who was married, older, had sex with another man, involved in concurrent partnerships, and had been incarcerated. About half of the participants stated it was difficult to find an eligible African American male and attributed the limited pool of same-race partners to drug trafficking, a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug use during sex were positively associated with ever having an STI. Individual and contextual implications are addressed.

What the recovery movement tells us about prefigurative politics

The concept of prefigurative politics has re-emerged following recent worldwide uprisings, such as the Occupy movement, to which this concept has been applied. In applying a contemporary analysis to prefigurative politics, we explore the contribution of community-based recovery groups to the recovery movement, a socio-political movement in the fields of mental health and addiction treatment. We argue that collective action in recovery groups is derived from the formation of an opinion-based social identity and results in alternative approaches to unmet needs, creatively addressing these identified needs through the utilisation of personal, social and collective resources within an emerging recovery community. To illustrate our argument, we provide examples of community-based recovery groups and the approaches they use in addressing the identified needs of their recovery community. We conclude with an analysis of what community-based recovery groups and the wider recovery movement can contribute to a contemporary understanding of prefigurative politics.

"Not on the agenda": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa

BACKGROUND

Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women's use of health services.

METHODS

We conducted four focus groups with young women (aged 16-21) who used AODs and were recruited from two township communities in Cape Town. We also conducted 14 in-depth interviews with health and social welfare service planners and providers. Discussion topics included young women's use of health services and perceived influences on service use. Qualitative data were analysed using a framework approach.

RESULTS

The findings highlighted structural, contextual, and systemic influences on the use of health services by young women who use AODs. First, young women were absent from the health agenda, which had an impact on the provision of women-specific services. Resource constraints and gender inequality were thought to contribute to this absence. Second, gender inequality and stigma toward young women who used AODs led to their social exclusion from education and employment opportunities and health care. Third, community poverty resulted in the emergence of perverse social capital and social disorder that limited social support for treatment. Fourth, the health care system was unresponsive to the multiple service needs of these young women.

CONCLUSION

To reach young women who use AODs, interventions need to take cognisance of young women's risk environment and health systems need to adapt to respond better to their needs. For these interventions to be effective, gender must be placed on the policy agenda.

The Effects and Stigma of Mental Illness in Turkey

This study was planned to determine internalized stigma of patients who were monitored in the psychiatry clinics due to mental problems. It was determined that there was significant difference between the patients' mean internalized stigma total scores between subscale scores and their gender, job, the place that the patient was raised in, educational status, working status, income level, the period spent after the diagnosis, hospitalization status, the hospital monitoring the patient and the diagnosis. It is suggested that counseling services should be planned in order to identify negative impact of the factors that influence coping with internalized stigma.

Development and psychometric validation of a novel patient survey to assess perceived quality of substance abuse treatment in South Africa

BACKGROUND

A hybrid performance measurement system that combines patient-reported outcome data with administrative data has been developed for South African substance abuse treatment services. This paper describes the development and psychometric validation of one component of this system, the South African Addiction Treatment Services Assessment (SAATSA).

METHODS

First, a national steering committee identified five domains and corresponding indicators on which treatment quality should be assessed. A decision was made to develop a patient survey to assess several of these indicators. A stakeholder work group sourced survey items and generated additional items where appropriate. The feasibility and face validity of these items were examined during cognitive response testing with 16 patients. This led to the elimination of several items. Next, we conducted an initial psychometric validation of the SAATSA with 364 patients from residential and outpatient services. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted to assess the latent structure of the SAATSA. Findings highlighted areas where the SAATSA required revision. Following revision, we conducted another psychometric validation with an additional sample of 285 patients. We used EFA and CFA to assess construct validity and we assessed reliability using Cronbach's measure of internal consistency.

RESULTS

The final version of the SAATSA comprised 31 items (rated on a four-point response scale) that correspond to six scales. Four of these scales are patient-reported outcome measures (substance use, quality of life, social connectedness and HIV risk outcomes) that together assess the perceived effectiveness of treatment. The remaining two scales assess patients' perceptions of access to and quality of care. The models for the final revised scales had good fit and the internal reliability of these scales was good to excellent, with Cronbach's α ranging from 0.72 to 0.89.

CONCLUSION

A lack of adequate measurement tools hampers efforts to improve the quality of substance abuse treatment. Our preliminary evidence suggests that the SAATSA, a novel patient survey that assesses patients' perceptions of the outcomes and quality of substance abuse treatment, is a psychometrically robust tool that can help fill this void.

A qualitative study of methamphetamine initiation in Cape Town, South Africa

BACKGROUND

Despite a significant rise in methamphetamine use in low- and middle-income countries, there has been little empirical examination of the factors that contribute to individuals' initiation of methamphetamine use in these settings. The goal of this study was to qualitatively examine factors associated with methamphetamine initiation in South Africa.

METHODS

In-depth interviews were conducted with 30 active methamphetamine users (13 women and 17 men) in Cape Town, South Africa. Interviews included narrative descriptions of the circumstances surrounding methamphetamine initiation. Interviews were audio recorded, transcribed, and translated. Transcripts were analyzed with document memos, data display matrices, and a constant comparison technique to identify themes.

RESULTS

On average, participants began regularly using methamphetamine around age 21 and had used for seven years. Four major themes emerged related to the initiation of methamphetamine use. The prevalence of methamphetamine users and distributors made the drug convenient and highly accessible to first time users. Methamphetamine has increased in popularity and is considered "trendy", which contributes to social pressure from friends, and less often, family members to initiate use. Initiation is further fueled by a lack of opportunities for recreation and employment, which leads to boredom and curiosity about the rumored positive effects of the drug. Young people also turn to methamphetamine use and distribution through gang membership as an attempt to generate income in impoverished communities with limited economic opportunities. Finally, participants described initiating methamphetamine as a means of coping with the cumulative stress and psychological burden provoked by the high rates of violence and crime in areas of Cape Town.

CONCLUSION

The findings highlight the complex nature of methamphetamine initiation in low- and middle-income countries like South Africa. There is a need for community-level interventions to address the availability and perceived normality of methamphetamine use, and to provide young people opportunities for recreation. On an individual level, addressing mental health and misconceptions about the dangers and benefits of methamphetamine could ameliorate willingness for initiation. Potential points of intervention include mass media campaigns and school-based interventions to raise awareness of the physical and social impacts of methamphetamine, and structural interventions to create safer neighborhoods, provide opportunities for employment and recreation, and expand mental health services to improve emotional health and coping skills.

Stigma among California's Medical Marijuana Patients

The enactment of California's Proposition 215 stipulates that patients may use marijuana for medical reasons, provided that it is recommended by a physician. Yet, medical marijuana patients risk being stigmatized for this practice. This article examines the way in which medical marijuana patients perceive and process stigma, and how it affects their interactions and experiences with others. Eighteen semi-structured interviews of medical marijuana patients were carried out using a semi-structured interview guide. Most patients circumvented their own physicians in obtaining a recommendation to use medicinal marijuana, and also used a host of strategies in order to justify their medical marijuana use to family, friends, and colleagues in order to stave off potential stigma. The stigmatization of medical marijuana thus has a profound effect on how patients seek treatment, and whether they seek medical marijuana treatment at all.

The Effect of Internalized Stigma on the Adherence to Treatment in Patients With Schizophrenia

This study was conducted to determine the effect of internalized stigma on the adherence to the treatment of patients with schizophrenia. The population of the study consisted of patients who were diagnosed with schizophrenia according to the DSM IV diagnostic criteria and compatible with the study criteria. The study was completed with 63 patients overall. The researcher used Demographics Questionnaire, Morisky Medication Adherence Scale, Drug Attitude Inventory and Internalized Stigma of Mental Illness Scale to gather data. Among the patients, 11.1% adhered to the treatment, and 54.0% did not. The mean score for the internalized stigma level of patients was 76.39±14.30. A positive significant relationship was found among the scales (p<0.05). The level of internalized stigma of patients with schizophrenia was determined to be high, and the internalized stigma had a negative impact on the adherence and attitude toward the treatment.

A qualitative study of referring agents' perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape

BACKGROUND

Despite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents.

METHODS

A qualitative study was conducted to explore referring agents' perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis.

RESULTS

The key barriers to emerge from the analysis pertained to referring agents' perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics.

CONCLUSIONS

Recommendations are made for interventions to address the identified barriers.

How Do Indian Substance Users Perceive Stigma Towards Substance Use Vis-A-Vis Their Family Members?

Perceived stigma towards substance use may determine family members' willingness to help in the treatment process of a substance user. This study aimed to compare the perceived stigma towards substance use among Indian substance users and their family members. Fifty dyads each of alcohol- and opioid-dependent men and their family members were recruited through purposive sampling. Perceived stigma was assessed using Perceived Stigma of Substance Abuse Scale (PSAS) in both the dependent men and the family members. PSAS scores of patients and the family members correlated with each other in both the alcohol- and opioid-dependent groups. Being currently employed predicted higher PSAS scores among patients, while being unmarried predicted higher PSAS scores among family members.

Respondent driven sampling is an effective method for engaging methamphetamine users in HIV prevention research in South Africa

BACKGROUND

South Africa, in the midst of the world's largest HIV epidemic, has a growing methamphetamine problem. Respondent driven sampling (RDS) is a useful tool for recruiting hard-to-reach populations in HIV prevention research, but its use with methamphetamine smokers in South Africa has not been described. This study examined the effectiveness of RDS as a method for engaging methamphetamine users in a Cape Town township into HIV behavioral research.

METHODS

Standard RDS procedures were used to recruit active methamphetamine smokers from a racially diverse peri-urban township in Cape Town. Effectiveness of RDS was determined by examining social network characteristics (network size, homophily, and equilibrium) of recruited participants.

RESULTS

Beginning with eight seeds, 345 methamphetamine users were enrolled over 6 months, with a coupon return rate of 67%. The sample included 197 men and 148 women who were racially diverse (73% Coloured, 27% Black African) and had a mean age of 28.8 years (SD=7.2). Social networks were adequate (mean network size >5) and mainly comprised of close social ties. Equilibrium on race was reached after 11 waves of recruitment, and after ≤3 waves for all other variables of interest. There was little to moderate preference for either in- or out-group recruiting in all subgroups.

CONCLUSIONS

Results suggest that RDS is an effective method for engaging methamphetamine users into HIV prevention research in South Africa. Additionally, RDS may be a useful strategy for seeking high-risk methamphetamine users for HIV testing and linkage to HIV care in this and other low resource settings.

Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa

BACKGROUND

Initiation of treatment for substance use disorders is low among young women from disadvantaged communities in Cape Town, South Africa. Yet little is known about the factors that influence perceived need for treatment (a determinant of treatment entry) within this population.

METHODS

Baseline data on 720 young, drug-using women, collected as part of a randomized field experiment were analyzed to identify predisposing, enabling and health need factors associated with perceived need for treatment.

RESULTS

Overall, 46.0% of our sample perceived a need for treatment. Of these participants, 92.4% wanted treatment for their substance use problems but only 50.1% knew where to access services. In multivariable logistic regression analyses, we found significant main effects for ethnicity (AOR = 1.54, 95% CI = 1.05-1.65), income (AOR = 0.96, 95% CI = 0.93-0.99), anxiety (AOR = 1.22, 95% CI = 1.05-1.45), and not having family members with drug problems (AOR = 1.45, 95% CI = 1.05-2.04) on perceived need for treatment. When the sample was stratified by methamphetamine use, income (AOR = 0.87, 95% CI = 0.79-0.96), awareness of treatment services (AOR =1.84, 95% CI = 1.03-3.27), anxiety (AOR =1.41, 95% CI = 1.06-1.87) and physical health status (AOR = 6.29, 95% CI = 1.56-25.64) were significantly associated with perceived need for treatment among those who were methamphetamine-negative. No variables were significantly associated with perceived need for treatment among participants who were methamphetamine-positive.

CONCLUSIONS

A sizeable proportion of young women who could benefit from substance use treatment do not believe they need treatment, highlighting the need for interventions that enhance perceived need for treatment in this population. Findings also show that interventions that link women who perceive a need for treatment to service providers are needed. Such interventions should address barriers that limit young women's use of services for substance use disorders.

Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa

BACKGROUND

A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers' to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development.

METHODS

Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions.

RESULTS

Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system.

CONCLUSION

Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.

The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa

INTRODUCTION

Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use.

METHODS

Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients' sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders.

RESULTS

The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use.

CONCLUSION

The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users.

The relevance of social contexts and social action in reducing substance use and victimization among women participating in an HIV prevention intervention in Cape Town, South Africa

Objectives

To examine qualitatively how women’s social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa.

Methods

Thirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women’s Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women’s CoOp intervention involved creating a new positive social environment for women within a group setting that also fostered women’s social action (eg, educating peers or family members) in the community. Interviews were analyzed using content analysis and coded to examine women’s descriptions of social contexts and social action, and the influence of these on women’s substance use abstinence and exposure to victimization.

Results

Social support (eg, via program staff and other participants) and social action (eg, engaging others in the community on issues relevant to substance use prevention or other health topics) promoted within the program, as well as outside social influences within women’s life contexts (eg, support from non-substance using family or male partners, leaving male partners or other peer relationships characterized by drug use, or finding employment) were key factors reported by women in terms of facilitating their substance use abstinence and in reducing women’s exposures to victimization.

Conclusion

Findings highlight the potential for group-delivered interventions that include mobilizing women to take social action in the larger community to be effective approaches for facilitating substance use abstinence, reductions in victimization, and ultimately, to address the intersection between substance use, violence, and HIV risk among women in this high HIV prevalence setting.

Negative attributions towards people with substance use disorders in South Africa: variation across substances and by gender

BACKGROUND

Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution.

METHOD

A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents' attitudes towards the specific cases were investigated.

RESULTS

Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less "dangerous" than the alcohol vignette. Respondents were more likely to offer "help" to women who use alcohol, but more likely to suggest "coercion into treatment" for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances.

CONCLUSION

The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.

Social service offices as a point of entry into substance abuse treatment for poor South Africans

Background

In South Africa, district social service offices are often the first point of entry into the substance abuse treatment system. Despite this, little is known about the profile of people presenting with substance-related problems at these service points. This has a negative impact on treatment service planning. This paper begins to redress this gap through describing patterns of substance use and service needs among people using general social services in the Western Cape and comparing findings against the profile of persons attending specialist substance abuse treatment facilities in the region.

Methods

As part of a standard client information system, an electronic questionnaire was completed for each person seeking social assistance. Data on socio-demographic characteristics, the range of presenting problems, patterns of substance use, perceived consequences of substance use, as well as types of services provided were analysed for the 691 social welfare clients who reported substance use between 2007 and 2009. These data were compared against clients attending substance abuse treatment centres during the same time period.

Results

Findings indicate that social services offices are used as a way of accessing specialist services but are also used as a service point, especially by groups under-represented in the specialist treatment sector. Women, people from rural communities and people with alcohol-related problems are more likely to seek assistance at social service offices providing low threshold intervention services than from the specialist treatment sector.

Conclusions

The study provides evidence that social services are a point of entry and intervention for people from underserved communities in the Western Cape. If these low-threshold services can be supported to provide good quality services, they may be an effective and efficient way of improving access to treatment in a context of limited service availability.

Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

Background

Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries. This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa.

Methods

Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in poor communities in Cape Town, South Africa who had accessed substance abuse treatment in 2006.

Results

Multiple regression analyses revealed that therapeutic alliance, treatment perceptions, abstinence-specific social support, and depression were significant partial predictors of treatment completion.

Conclusions

Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i) improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii) strengthening clients' abstinence-oriented social networks and, iii) strengthening the counselor-client therapeutic alliance.