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

OBJECTIVE Access to substance abuse treatment among historically disadvantaged communities (HDCs) in Cape Town, South Africa is limited, despite a growing demand for services. Although research has reported on structural barriers to treatment access, nonstructural factors remain largely unexplored. The aim of this paper is to describe two nonstructural influences on the use of substance abuse treatment services for people from HDCs: stigma and negative beliefs about treatment. METHOD Findings from the qualitative component of a multi-method study are reported. In-depth interviews were conducted with 20 key informants, all of whom worked or lived in HDCs in the greater Cape Town area. Content and thematic techniques were used to analyse data. RESULTS According to key informants (i) stigma towards individuals with substance use disorders was prevalent in HDCs and negatively impacted on attempts to access services; (ii) negative beliefs about the quality and effectiveness of treatment were commonplace and acted as barriers to the use of existing services; and (iii) several factors contributed to these non-structural barriers including media representations of both individuals with substance use disorders and treatment facilities for these disorders. CONCLUSION This paper moves beyond the description of structural barriers to treatment to describe how two nonstructural factors, stigma and negative beliefs about treatment, hinder treatment seeking for substance use disorders. Recommendations for addressing these barriers include efforts to (i) shift discourses about substance abuse treatment, (ii) improve service quality, and (iii) address myths and misconceptions about treatment.