Barriers to treatment among young adults living with a substance use disorder : findings from working with the community-oriented substance use program in Tshwane, South Africa

Abstract

Despite the high prevalence of substance use disorders (SUDs), utilisation of treatment services remains low. This study sought to explore and measure treatment barriers in order to gain knowledge and an understanding of such treatment barriers, and to promote contextually relevant interventions. The study was conducted within the Community-Oriented Substance Use Programme (COSUP), a substance-use harm-reduction initiative in Tshwane, South Africa that offers treatment relating to different substances. A mixed methods approach was used in this study which was conducted in three phases. In the first phase, 15 purposively sampled peer educators participated in two focus group discussions (FGDs), and in the second (quantitative) phase, 206 randomly sampled young adults receiving treatment through COSUP completed a self-report questionnaire. In the third phase, semi-structured interviews (SSIs) were conducted with 15 COSUP clients. Thematic analysis was used to analyse the qualitative data obtained, and descriptive analysis was performed on the quantitative data. The two strands of data were converged to enhance the understanding and interpretation of treatment barriers. Themes emerged from the study, relating to factors that either impede or facilitate service utilisation and these included fragmented services, stigma-related barriers, an information gap, lack of perceived treatment need and lack of perceived treatment efficacy, privacy concerns, lack of resources and support, denial and unreadiness to give up substance use, culture and religion/spirituality. Strategies identified to improve services and to build community resilience revolved around creating greater community awareness about substance use and treatment services, improving cultural competence, building social networks to support individuals and communities affected by SUDs, providing more accessible services, and advocating greater prioritisation of substance use treatment and mental health services in general.