Disparities in Completion of Substance Abuse Treatment between and within Racial and Ethnic Groups

Abstract

Objective. To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California. Data Source. The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006)(2007)(2008)(2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time. Study Design. Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses. Data Collection. Client data were collected during personal interviews at admission and discharge for most participants. Principal Findings. African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only. Conclusions. These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.

Preliminary findings on the association between clients’ perceived helpfulness of substance abuse treatment and outcomes: Does race matter?

“…Although several studies support the relationship between race/ethnicity and attitudes towards mental health treatment, a smaller number of studies examine the link between race/ethnicity and attitudes towards substance abuse treatment. Findings from the current study highlight the need for future research that examines substance abuse treatment experiences, especially among Black participants, to perhaps explain racial/ethnic health disparities observed in treatment outcomes (Cook and Alegria, 2011; Guerrero et al, 2013). …”

Does the implementation of evidence-based and culturally competent practices reduce disparities in addiction treatment outcomes?

“…Compare to non-Latino Whites, Latinos are more likely to drop out of substance use disorder (SUD) treatment (Guerrero & Andrews, 2011) and report lower rates of treatment completion (Guerrero, Campos, Urada, & Yang, 2012; Guerrero, Marsh, Duan, et al, 2013a; Substance Abuse and Mental Health Services Administration [SAMHSA], 2009a; Substance Abuse and Mental Health Services Administration [SAMHSA], 2009b). Evidence-based practices (EBPs) and culturally responsive treatment are considered promising approaches to improving treatment outcomes among Latinos (Bridge, Massie, & Mills, 2008; SAMHSA, 2014).…”

Organizational Capacity for Service Integration in Community-Based Addiction Health Services

“…We analyzed these regressions by using the CLUSTER command to account for the multilevel structure of the data (clients nested in facilities) and to obtain more accurate estimates of standard errors 58 as suggested in other research on multilevel program and client disparities. 3,59 The intraclass correlation between client and program measures was statistically significant ( r > 0.18; P < .01) and justified consideration of both in the analysis. However, programs served as the unit of analysis.…”