Implementation of Cognitive-Behavioral Substance Abuse Treatment in Sub-Saharan Africa: Treatment Engagement and Abstinence at Treatment Exit

Abstract

AimsThis study documented the treatment cascade for engagement in care and abstinence at treatment exit as well as examined correlates of these outcomes for the first certified Matrix Model® substance abuse treatment site in Sub-Saharan Africa.DesignThis retrospective chart review conducted at a resource-limited community clinic in Cape Town, South Africa, assessed treatment readiness and substance use severity at treatment entry as correlates of the number of sessions attended and biologically confirmed abstinence at treatment exit among 986 clients who initiated treatment from 2009–2014. Sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately.ResultsOf the 2,233 clients who completed screening, approximately 44% (n = 986) initiated treatment. Among those who initiated treatment, 45% completed at least four group sessions, 30% completed early recovery skills training (i.e., at least eight group sessions), and 13% completed the full 16-week program. Approximately half (54%) of clients who provided a urine sample had negative urine toxicology results for any substance at treatment exit. Higher motivation at treatment entry was independently associated with greater odds of treatment completion and negative urine toxicology results at treatment exit.ConclusionsFindings provide initial support for the successful implementation the Matrix Model in a resource-limited setting. Motivational enhancement interventions could support treatment initiation, promote sustained engagement in treatment, and achieve better treatment outcomes.

A Mixed-Methods Evaluation of the Implementation of a Performance Measurement System for South Africa’s Substance Use Treatment Services

“…Improving target population coverage so that the feedback generated from this system is representative of patients’ experiences is also key to system implementation. As in other studies (Gouse et al, 2016), we noted high rates of attrition from outpatient treatment. Because this attrition occurred mainly during the first 2 weeks of treatment, it affected the completion of the patient survey component of the SQM system.…”

Beyond methamphetamine: Documenting the implementation of the Matrix model of substance use treatment for opioid users in a South African setting

“…However, due to the limited drug treatment services in the region, clients from outlying areas also utilize the site. At this facility, after methamphetamine, opioids are the second most common primary substance, followed by alcohol, methaqualone (mandrax) and cannabis (Gouse et al, 2016). The initial point of contact with the program is a drop-in, non-appointment screening visit.…”

“…Yet, given the lack of access to other affordable treatments for opioid use disorders, primary opioid users also utilize the Matrix model as an available treatment for substance use; indeed, opioids (i.e., heroin) are the second most common primary drug reported among individuals entering substance use treatment in this setting (after methamphetamine) (Gouse et al, 2016). Yet, there is limited data documenting the implementation of Matrix for primary opioid users, particularly in a resource-limited setting.…”

Contingency management treatment for methamphetamine use disorder in South Africa

“…In one recent study of Matrix Model, conducted within a community health centre outside of Cape Town, only 129 of the 986 clients (majority who presented with methamphetamine or heroin as the primary drug of choice) who initiated treatment (13%) completed the 16‐week program. Most of these program enrolees presented with methamphetamine or heroin as the primary drug of choice, underscoring the need for alternative or complementary therapies to those already in place . Contingency management (CM), a behavioural therapy that provides positive reinforcers (such as financial incentives) in exchange for objective evidence of abstinence from substance use, has demonstrated efficacy in promoting continued abstinence from methamphetamine use and other stimulants with treatment effect sizes (Cohen's d ) ranging from 0.32 to 0.42 .…”