A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network.

Abstract

Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data).

Article Commentary: Dismantling Racism Against Black, Indigenous, and People of Color across the Substance use Continuum: A Position Statement of the Association for Multidisciplinary Education and Research in Substance use and Addiction

“…34 Differential treatment retention is also evident among Black people receiving treatment for opioid, alcohol, stimulant, and cannabis use disorders. 35,36 Reasons for lower engagement and retention of Black individuals in SUD treatment are poorly studied, but likely due to less social, financial, and environmental supports, a lack of culturally-informed and responsive treatment, mistrust in the healthcare system, and unequal enforcement of treatment rules and requirements. 7,35,36 We would be remiss if we did not also address racial disparities in harm reduction and other services for persons who use drugs.…”

“…35,36 Reasons for lower engagement and retention of Black individuals in SUD treatment are poorly studied, but likely due to less social, financial, and environmental supports, a lack of culturally-informed and responsive treatment, mistrust in the healthcare system, and unequal enforcement of treatment rules and requirements. 7,35,36 We would be remiss if we did not also address racial disparities in harm reduction and other services for persons who use drugs. Harm reduction refers to pragmatic interventions aimed at minimizing the negative effects of unhealthy behaviors without a prerequisite that the behavior(s) cease.…”

Racial/ethnic equity in substance use treatment research: the way forward

“…Recent scoping reviews of CTN research involving both Blacks [3] and Hispanics [9] revealed that measurement equivalence cannot be assumed across substance using racial/ethnic groups. Measurement equivalence refers to the extent to which a measure assesses the equivalent underlying psychological construct in a group other than the group in which the measure was standardized.…”

“…These papers suggest that community engagement and the formation of academic/community research partnerships are both effective recruitment strategies [12,27,28]. Two recent scoping reviews of CTN research involving both Blacks [3] and Hispanics [9] revealed that measurement equivalence cannot be assumed across substance using racial/ethnic groups in CTN research. Moreover, several secondary analyses have revealed racial/ethnic differences in outcomes [3,[29][30][31][32][33].…”

“…Two recent scoping reviews of CTN research involving both Blacks [3] and Hispanics [9] revealed that measurement equivalence cannot be assumed across substance using racial/ethnic groups in CTN research. Moreover, several secondary analyses have revealed racial/ethnic differences in outcomes [3,[29][30][31][32][33]. Such findings are evidence of the need to investigate rather than to assume an intervention is equally effective across groups.…”