Gender differences in barriers to alcohol and other drug treatment in Cape Town South Africa

The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided

Factors associated with retention and completion in substance abuse treatment among historically disadvantaged communities in Cape Town

Magister Psychologiae - MPsychCape Town is suffering from high rates of alcohol and other drug (AOD) problems. Despite the need for effective treatment, there are insufficient AOD treatment facilities available, with barriers to AOD treatment being particularly pronounced among historically disadvantaged communities (HDCs). In addition, the high drop-out rate of patients from AOD treatment, and the finding that retention in treatment is predictive of positive outcomes, increases the necessity of retaining people who enter AOD treatment.This study therefore aimed to identify those patient-level factors impacting on the successful completion of and retention in AOD treatment. In particular, the study aimed to describe the relationship between treatment process factors (therapeutic alliance,motivation, treatment satisfaction, social support), demographic and psychological variables, and treatment completion and retention. The Texas Christian University (TCU) Treatment Model, which conceptualises the AOD treatment process, provided the theoretical framework for the study. Using a quantitative design, secondary data analysis was conducted on a section of data that was originally collected by the Medical Research Council (MRC) via a cross-sectional survey. The sample consisted of 434 individuals from HDCs who had previously entered AOD treatment. Multiple regression analyses revealed that the therapeutic alliance, treatment satisfaction, abstinence-specific social support and depression were significant predictors of treatment completion, while race,therapeutic alliance, abstinence-specific social support and anxiety were predictive of the time spent in treatment. These predictors were positively associated with treatment completion and time in treatment. Black Africans spent significantly less days in treatment than Coloured individuals, although both groups were equally likely to complete treatment. The results suggest that by strengthening the therapeutic alliance,social support and treatment satisfaction, treatment completion and retention can be improved. This can be achieved by training, ongoing monitoring of these factors during treatment, and greater involvement of supportive social networks in a patient’s recovery. The findings also point towards the need for improved service delivery for Black Africans, who confront many barriers to accessing inpatient AOD treatment

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

Inequitable access to substance abuse treatment services in Cape Town, South Africa

BACKGROUND:Despite high levels of substance use disorders in Cape Town, substance abuse treatment utilization is low among people from disadvantaged communities in Cape Town, South Africa. To improve substance abuse treatment utilization, it is important to identify any potential barriers to treatment initiation so that interventions to reduce these barriers can be implemented. To date, substance abuse research has not examined the factors associated with substance abuse treatment utilization within developing countries. Using the Behavioural Model of Health Services Utilization as an analytic framework, this study aimed to redress this gap by examining whether access to substance abuse treatment is equitable and the profile of variables associated with treatment utilization for people from poor communities in Cape Town, South Africa. METHODS: This study used a case-control design to compare 434 individuals with substance use disorders from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of predisposing, treatment need and enabling/restricting variables thought to be associated with treatment utilization. A hierarchical logistic regression was conducted to assess the unique contribution that the need for treatment, predisposing and enabling/restricting variable blocks made on substance abuse treatment utilization. RESULTS: Findings revealed that non-need enabling/restricting variables accounted for almost equal proportions of the variance in service utilization as the need for treatment variables. These enabling/restricting variables also attenuated the influence of the treatment need and predisposing variables domains on chances of treatment utilization. Several enabling/restricting variables emerged as powerful partial predictors of utilization including competing financial priorities, geographic access barriers and awareness of treatment services. Perceived severity of drug use, a need for treatment variable) was also a partial predictor of utilization. CONCLUSIONS: Findings point to inequitable access to substance abuse treatment services among people from poor South African communities, with non-need factors being significant determinants of treatment utilization. In these communities, treatment utilization can be enhanced by (i) expanding the existing repertoire of services to include low threshold services that target individuals with less severe problems; (ii) providing food and transport vouchers as part of contingency management efforts, thereby reducing some of the financial and geographic access barriers; (iii) introducing community-based mobile outpatient treatment services that are geographically accessible; and (iv) employing community-based outreach workers that focus on improving awareness of where, when and how to access existing treatment services

Attempted suicide among South African adolescents living in a low resource environment : contested meanings, lived experience, and expressed support needs

Thesis (DPhil)--Stellenbosch University, 2020.ENGLISH ABSTRACT: Adolescent suicide is a serious public health concern, yet we do not understand the reasons South African adolescents give for their suicide attempts and the meanings they attach to their behaviour. Nor do we know how the adolescents’ caregivers and clinicians perceive their attempts, or how these experiences and understandings are framed by the socio-cultural context. The aim of this research was to provide a contextualised understanding of the phenomenon of suicide attempts by South African adolescents living in a low resource environment. I used a multiperspectival research design situated within a theoretical framework of hermeneutic phenomenology. All participants were recruited via the Child and Adolescent Mental Health unit of a large psychiatric hospital located in Cape Town. In-depth semi-structured interviews were conducted with 10 adolescents, their caregivers (n=10), and the clinicians who treated them (n=9). The adolescents also took photographs to illustrate their experience, and these were discussed during a second interview using the technique of photo-elicitation. I analysed data using Interpretative Phenomenological Analysis. All participants foregrounded the relational context of the adolescents’ suicide attempts, especially relationships with family members, which were described as both a mitigating and contributing factor to the suicide attempt. The adolescents explained how caregivers’ failure to acknowledge sexual and physical abuse, which they perceived as betrayal, led to emotional disconnection and subsequently, to precipitating a suicide attempt. In contrast, adolescents said that attachment to younger siblings and pets ameliorated their suicidality. The adolescents recounted how bonding with other suicidal peers reduced feelings of isolation, but that they also learned about suicidal behaviours from each other. Participants also spoke about how the adolescents’ suicide attempts were shaped by the socio-economic context, including exposure to poverty and high levels of violence. Both caregivers and clinicians described feelings of anxiety, powerlessness, and helplessness elicited by the adolescents’ suicidality, echoing the powerlessness reported by the adolescents. Participants did not endorse a purely psychiatric understanding of adolescent suicidal behaviour; instead they described the adolescents’ suicide attempts as an escape from pain, or an attempt to alleviate perceived economic burdensomeness. The adolescents experienced admission to a psychiatric hospital as providing safety, but also as exacerbating a loss of autonomy. Participants discussed how improved connectedness, belonging, communication, and validation of the adolescents’ experiences, to counter the adolescents’ sense of isolation and invisibility, were important for support after the attempt, and for the prevention of adolescent suicide. The participants’ accounts of the adolescents’ suicide attempts were incongruent with existing theories of suicidal behaviour, highlighting the need for adolescent specific, contextualised theories of suicidal behaviour. These findings also suggest that adolescent suicide prevention cannot solely be the responsibility of the mental health care sector, that the wellbeing of caregivers is essential for adolescent suicide prevention, and they emphasise the importance of adolescent-specific services that enhance feelings of autonomy. Potential areas for future research in the field of adolescent suicide prevention include the role of siblings, pets, and feelings of betrayal.AFRIKAANSE OPSOMMING: Selfmoord onder adolessente is ’n kommerwekkende openbare gesondheidsbelang, maar ons verstaan nie die redes wat Suid-Afrikaanse adolessente vir hul selfmoordpogings bied asook die betekenisse wat hulle aan hul gedrag heg nie. Ons weet verder ook nie hoe die adolessente se voogde en klinici hul pogings verstaan of hoe hierdie ervarings en insigte deur die sosio-kulturele konteks geraam word nie. Die doel van hierdie navorsing was om ʼn gekontekstualiseerde begrip van die verskynsel van selfmoordpogings deur Suid-Afrikaanse adolessente woonagtig in ’n lae hulpbron-omgewing te bied. Ek het gebruik gemaak van ʼn multi-perspektiewelike navorsingsontwerp binne die teoretiese raamwerk van hermeneutiese fenomenologie. Al die deelnemers is gewerf via die Geestesgesondheidseenheid vir kinders en adolessente van ʼn groot psigiatriese hospitaal in Kaapstad. In-diepte semi-gestruktureerde onderhoude is gevoer met 10 adolessente, hul voogde (n=10), en die klinici wie hulle behandel het (n=9). Die adolessente het ook foto’s geneem om hul ervaring te illustreer, wat tydens ʼn tweede onderhoud bespreek is met behulp van die foto-ontlokkingstegniek. Ek het data geanaliseer met behulp van Interpretatiewe Fenomenologiese Analise. Al die deelnemers het klem geplaas op die verhoudingskonteks van die adolessente se selfmoordpogings, veral verhoudings met familielede, wat as beide ʼn versagtende en bydraende faktor tot die selfmoordpoging beskryf is. Die adolessente het verduidelik dat die voogde se versuiming om seksuele en fisieke mishandeling te erken – wat hulle as verraad beskou het – gelei het tot emosionele afkoppeling en gevolglik tot ʼn selfmoordpoging. In teenstelling hiermee het adolessente beweer dat gehegtheid aan jonger broers en susters asook troeteldiere hul selfmoordneigings verlig het. Die adolessente het vertel hoe die saambinding met ander in ’n portuurgroep met selfmoordneigings hul gevoelens van isolasie verminder het, maar dat hulle ook van selfmoordgedrag by mekaar geleer het. Deelnemers het ook gepraat oor die maniere waarop die adolessente se selfmoordpogings beïnvloed was deur die sosio-ekonomiese konteks, insluitend hul blootstelling aan armoede en hoë vlakke van geweld. Beide voogde en klinici het beskryf hoe gevoelens van angs, magteloosheid en hulpeloosheid ontlok was deur die adolessente se selfmoordneigings. Dit word verder weerspieël in die magteloosheid wat deur die adolessente gerapporteer is. Deelnemers het nie ʼn suiwer psigiatriese begrip van selfmoordgedrag by adolessente beaam nie; hulle het eerder die adolessente se selfmoordpogings beskryf as ʼn ontsnapping van pyn, of ʼn poging om hul waargenome bydrae tot huishoudelike ekonomiese las te verlig. Die adolessente het die opname in ʼn psigiatriese hospitaal as ʼn bron van veiligheid ervaar, maar ook as ʼn verlies van outonomiteit. Deelnemers het bespreek hoe verbeterde verbondenheid, aanvaarding, kommunikasie en geldigmaking van die ervarings van die adolessente dien as teenwerking tot die adolessente se gevoel van isolasie en onsigbaarheid. Hulle beaam verder dat hierdie faktore belangrik was vir ondersteuning ná die poging, asook vir die voorkoming van selfmoord onder adolessente. Die deelnemers se verhale van die adolessente se selfmoordpogings was strydig met bestaande teorieë van selfmoordgedrag, wat sodoende die behoefte aan adolessente-spesifieke, gekontekstualiseerde teorieë van selfmoordgedrag beklemtoon. Hierdie bevindinge dui ook eerstens daarop dat adolessente-selfmoordvoorkoming nie alleenlik die verantwoordelikheid van die geestesgesondheidsektor kan wees nie, dat die welstand van voogde tweedens noodsaaklik is vir adolessente-selfmoordvoorkoming, en dit beklemtoon laastens die belangrikheid van adolessente-spesifieke dienste wat die gevoel van outonomie versterk. Die rol van broers en susters, troeteldiere, en gevoelens van verraad word geïdentifiseer as potensiële terreine vir toekomstige navorsing in die veld van selfmoordvoorkoming onder adolessente.Doctora

Attentional biases in patients with alcohol dependence: influence of coexisting psychopathology

Objective: the effects of coexisting psychopathology on disorder-specific attentional biases in patients with alcohol dependence are uncertain. We undertook a cross-sectional study assessing attentional biases to alcohol-, depression-, and anxiety- related stimuli using the visual probe task in patients with alcohol dependence, attending a community alcohol service.Methods: using the visual probe task, we presented disorder-specific words (relating to alcohol, anxiety, and depression) for 500 ms and measured reaction times.Results: participants demonstrated a significant attentional bias towards alcohol-related cues (mean 8.5, p = 0.03) but significant avoidance of depression-related cues (mean ?8.4, p = 0.01). The subgroup of participants who were recently abstinent (n = 70) showed greatest avoidance of depression-related cues (t(69) = 2.68, p < 0.01) but no significant vigilance towards alcohol or anxiety cues, whereas those still drinking (n = 43) showed attentional biases towards alcohol-related (t(42) = 2.70, p = 0.01) and social anxiety-related cues (t(42) = 2.84, p < 0.01). In the whole sample, the magnitude of attentional bias to alcohol was not correlated with length of drinking history, number of comorbid conditions, or severity of anxiety/depression.Conclusions: in a clinical sample of alcohol-dependent patients, further investigation is required to explore whether these attentional biases reflect current drinking status or factors indicating prognosi

Mid-morning Break and Poster Sessions: Clinical Profile and Psychiatric Co-Morbidity of Treatment-Seeking Individuals With Pathological Gambling

Background: Pathological gambling is a prevalent and disabling mental illness, which is frequently associated with mood, anxiety, and substance use disorders. However, there is relatively little data on comorbidity in pathological gambling from low and middle income countries such as South Africa