Gender and racial differences in treatment process and outcome among participants in the adolescent community reinforcement approach.

Abstract

Increasingly, evidence-based treatments are being implemented by community treatment providers, and it is important to understand whether they can be implemented with similar quality and equivalent effectiveness across gender and racial groups. This study examined whether initiation, engagement, dosage, treatment satisfaction, or outcomes for adolescents who received the Adolescent Community Reinforcement Approach (A-CRA) in a large implementation effort were equivalent by gender or racial group. Analyses of data from 2,141 adolescents representing 33 sites across the United States revealed no significant differences for initiation, engagement, or retention by gender or race. Ninety-six percent of the sample reported being satisfied with treatment; however, male adolescents had significantly higher rates of treatment satisfaction than female adolescents, and African American adolescents had significantly higher rates of treatment satisfaction than Caucasian adolescents. A subset of the initial sample (n = 1,819) was used to investigate outcomes. All racial groups had significant increases in days abstinent from alcohol and other drugs and in the percentage in recovery across the measurement period but did not differ from one another at the six-month follow-up. Female adolescents had a higher percentage of days abstinent from alcohol and other drugs and were more likely to be in recovery at the six-month follow-up than male adolescents. Overall, process indicators suggest the intervention was well implemented across gender and racial groups and equally effective across racial groups, with males having equivalent gains in abstinence and recovery compared with females despite males having greater intake severity and differential outcomes at six months.

Ethnic differences among substance-abusing adolescents in a treatment dissemination project

“…This lack of ethnic differences in treatment outcome is similar to the findings of Rounds-Bryant and Staab (2001) from the DATOS-A project and those of Strada et al (2006) in their review of ASA treatment studies. Results are also consistent with a recent multisite implementation study by Godley, Hedges, and Hunter (2011), which found that White, African American, and Latino youth had equivalent initiation, engagement, and treatment outcomes following an evidence-based outpatient intervention. Although we cannot disregard the possibility that differential completion of the posttreatment assessment contributes to these findings (discussed further below), our results are bolstered by the large sample size, as well as the consistency with prior investigations.…”

“…Third, among the variables not included in the EAT database was socioeconomic status (SES), which is often related to ethnicity and therefore may contribute to the observed effects of ethnic status on substance use. Moreover, this analysis intentionally focused on four putative covariates and did not consider other variables that might be associated with ethnicity, such as family composition, criminal justice involvement, level of acculturation, country of origin, and foreign-versus American-born status (Godley et al, 2011;Wallace et al, 2002Wallace et al, , 2003. Given the lack of ethnic effects on posttreatment outcome, confounding effects of SES and other covariates are somewhat less of a concern in this study.…”

Treatment of Adolescent Substance Use Disorders

“…A-CRA provides significantly more individual CBT sessions with the adolescent-alone compared to other family-based interventions and has been successfully used with homeless and minority youth [22, 23]. …”

A comparison of treatment outcomes for adolescent community reinforcement approach participants with and without co-occurring problems

“…Importantly, the effectiveness of A-CRA has been supported in randomized clinical trials (Dennis et al, 2004; Godley, Godley, Dennis, Funk, & Passetti, 2007; Slesnick et al, 2007). Moreover, A-CRA has been shown to have relatively high and equivalent rates of treatment engagement, retention, satisfaction, and substance use recovery outcomes across gender and racial groups (Godley, Hedges, & Hunter, 2011). …”