Initial abstinence status and contingency management treatment outcomes: Does race matter?

Abstract

Objective Limited research has evaluated African American substance users’ response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. Method A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.

Comparable efficacy of behavioral and pharmacological treatments among African American and White cocaine users

“…In contrast to multiple studies pointing to poorer substance use outcomes among African Americans (Field et al, 2012; Montgomery et al, 2011; Montgomery, Carroll, & Petry, 2015), findings from the current analysis suggest comparable retention and efficacy of the behavioral and pharmacological treatments evaluated in these trials for African American and White cocaine users. This is a significant finding given the use of data from five carefully controlled RCTs examining the effectiveness of contingency management, cognitive behavioral therapy, twelve-step facilitation, interpersonal therapy, and disulfiram.…”

“…Interventions that are tailored to older adults and severe cocaine users for African American and White adults, respectively, might result in improved treatment outcomes. Second, given that other studies have found racial differences in outcomes (Field et al, 2012; Montgomery et al, 2011, 2015), more research is needed to identify factors (e.g., socioeconomic status; Saloner & Cook, 2013) that might contribute to the inconsistent findings. Third, the inconsistent findings on racial health disparities in cocaine use outcomes suggest that additional studies are needed to disentangle the effects of race in treatment outcomes.…”

A randomized placebo-controlled trial of N-acetylcysteine for cannabis use disorder in adults

“…White participants had higher placebo response rates than racial minority participants, possibly reflecting previously observed racial differences in response to CM (Montgomery et al, 2012, 2015). Racial minority participants’ poorer response to CM may have allowed NAC effects to emerge, as suggested by a two-fold NAC versus placebo difference in abstinence outcomes.…”

A comparison of African American and Caucasian stimulant users in 12-step facilitation treatment

“…Not all evidence-based practices perform equally as well across subgroups. For example, treatment outcomes were not as favorable for African American cocaine users as they were for Caucasian cocaine users in a contingency management trial (Montgomery, Carroll, & Petry, 2015). We should note that any treatment outcome analyses using “race categories” as an independent variable are relatively rare.…”