Certain racial and ethnic minority groups are over-represented in outpatient treatment for substance use disorder, yet they are less likely to complete treatment.
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Certain racial and ethnic minority groups are over-represented in outpatient treatment for substance use disorder, yet they are less likely to complete treatment.
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Of additional concern is the knowledge gap that exists at the intersection of race/ethnicity and choice of primary substance in studies of treatment completion. Ultimately, if we can identify who is most likely to not complete treatment, then we can conduct research as to the reasons why, and start to identify actionable targets to improve treatment retention.
The Treatment Episode Dataset-Discharge (TEDS-D; SAMHSA, 2013) is a system that includes records for approximately 1.5 million substance use disorder treatment admissions annually and is considered the gold standard for epidemiological research on US treatment programs. The TEDS dataset is comprised of a significant proportion of all admissions in the US and is of interest to stakeholders because many of the admissions are financed through public funds. Using the TEDS data set, this study analyzed 416,224 outpatient treatment completion episodes for adults in urban areas from the year 2011.
The Researchers Hypothesized:
White participants had the highest completion rate (50%) while Hispanic (47%) and African American participants were significantly lower (40%).
Specifically, participants who used alcohol had the highest completion rate (57%), followed by methamphetamine (52%), marijuana (46%), cocaine/crack (39%), and heroin (30%).
African American participants were significantly less likely than White participants to complete treatment across all types of substances (69% as likely after adjusting for demographics). The disparity in treatment completion between African American and White participants was significantly stronger when alcohol was the primary substance (i.e., African Americans 71% as likely to complete treatment) compared to when the primary substance was cocaine (82% as likely), marijuana (78% as likely), and heroin (87% as likely). African Americans were also 66% as likely than White participants to complete treatment when the primary substance was methamphetamines.
For Hispanic participants, the disparity is driven primarily by heroin use disorder, for which they are only 75% as likely as White participants to complete outpatient treatment. Interestingly, Hispanic participants whose primary substance was alcohol were significantly more likely to complete treatment than Whites; however, the effect size was negligible. For marijuana, being Hispanic as compared to being White is associated with lower treatment completion; however, the effect size was trivial whereas for cocaine and methamphetamine, being Hispanic (compared to White) had no significant effect on the likelihood of treatment completion. Although the effect size for Hispanic participants completing treatment for marijuana use disorder was trivial, its notable because a greater proportion of Hispanic patients enter outpatient treatment for marijuana use disorder compared to White patients (24% versus 15%) which means the effect impacts a greater share of the Hispanic population.
This is the first study that used national data to provide evidence that racial and ethnic disparities in urban outpatient substance use disorder treatment completion vary across primary substance.
African Americans were considerably less likely than Whites to be in treatment for methamphetamine use disorder (1% versus 8% respectively) or alcohol use disorder (32% versus 46% respectively) compared to other substances. If African Americans with an alcohol or methamphetamine use disorder are in a treatment environment where the majority of patients are from a different social, economic, or cultural backgrounds they may find it more difficult to feel connected and identify with other patients and thus feel more psychologically isolated. This could potentially decrease treatment retention.
The racial/ethnic disparity in treatment completion rates for heroin use disorder may reflect differences in other important determinants. The use of medication for the treatment of heroin use disorder has become more widely available. Racial/ethnic differences in the use of medication to treatment of heroin use disorder, however, may exist and be attributable to either patient preferences or discriminatory provider practices.
Provider differences in the likelihood of offering medication to various racial/ethnic groups with the same degree of heroin use disorder severity are unknown. Provider differences, however, have been well documented in opioid prescribing patterns to relieve pain for other conditions including those associated with drug-seeking behavior.
This study, along with many other studies of treatment completion, rely on client level characteristics that were assessed at admission to explain outcomes. More research needs to take into account program level factors (e.g., availability of open slots, non-profit versus for-profit ownership status, etc.) and the interaction with client level factors (e.g., recovery motivation to improve our understanding of why various racial/ethnic groups drop-out or complete treatment for substance use disorder.
In addition, the degree to which Hispanic individuals had equivalent access or use of medication to support treatment completion is unknown in this study. The degree to which patient preferences or attitudes towards the use of medication to treat heroin use disorder vary according to race or ethnicity is not well understood and warrants further research.
Mennis, J. & Stahler, G. J. (2016). Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. Journal of Substance Abuse Treatment, 63, 25-33.
l
Of additional concern is the knowledge gap that exists at the intersection of race/ethnicity and choice of primary substance in studies of treatment completion. Ultimately, if we can identify who is most likely to not complete treatment, then we can conduct research as to the reasons why, and start to identify actionable targets to improve treatment retention.
The Treatment Episode Dataset-Discharge (TEDS-D; SAMHSA, 2013) is a system that includes records for approximately 1.5 million substance use disorder treatment admissions annually and is considered the gold standard for epidemiological research on US treatment programs. The TEDS dataset is comprised of a significant proportion of all admissions in the US and is of interest to stakeholders because many of the admissions are financed through public funds. Using the TEDS data set, this study analyzed 416,224 outpatient treatment completion episodes for adults in urban areas from the year 2011.
The Researchers Hypothesized:
White participants had the highest completion rate (50%) while Hispanic (47%) and African American participants were significantly lower (40%).
Specifically, participants who used alcohol had the highest completion rate (57%), followed by methamphetamine (52%), marijuana (46%), cocaine/crack (39%), and heroin (30%).
African American participants were significantly less likely than White participants to complete treatment across all types of substances (69% as likely after adjusting for demographics). The disparity in treatment completion between African American and White participants was significantly stronger when alcohol was the primary substance (i.e., African Americans 71% as likely to complete treatment) compared to when the primary substance was cocaine (82% as likely), marijuana (78% as likely), and heroin (87% as likely). African Americans were also 66% as likely than White participants to complete treatment when the primary substance was methamphetamines.
For Hispanic participants, the disparity is driven primarily by heroin use disorder, for which they are only 75% as likely as White participants to complete outpatient treatment. Interestingly, Hispanic participants whose primary substance was alcohol were significantly more likely to complete treatment than Whites; however, the effect size was negligible. For marijuana, being Hispanic as compared to being White is associated with lower treatment completion; however, the effect size was trivial whereas for cocaine and methamphetamine, being Hispanic (compared to White) had no significant effect on the likelihood of treatment completion. Although the effect size for Hispanic participants completing treatment for marijuana use disorder was trivial, its notable because a greater proportion of Hispanic patients enter outpatient treatment for marijuana use disorder compared to White patients (24% versus 15%) which means the effect impacts a greater share of the Hispanic population.
This is the first study that used national data to provide evidence that racial and ethnic disparities in urban outpatient substance use disorder treatment completion vary across primary substance.
African Americans were considerably less likely than Whites to be in treatment for methamphetamine use disorder (1% versus 8% respectively) or alcohol use disorder (32% versus 46% respectively) compared to other substances. If African Americans with an alcohol or methamphetamine use disorder are in a treatment environment where the majority of patients are from a different social, economic, or cultural backgrounds they may find it more difficult to feel connected and identify with other patients and thus feel more psychologically isolated. This could potentially decrease treatment retention.
The racial/ethnic disparity in treatment completion rates for heroin use disorder may reflect differences in other important determinants. The use of medication for the treatment of heroin use disorder has become more widely available. Racial/ethnic differences in the use of medication to treatment of heroin use disorder, however, may exist and be attributable to either patient preferences or discriminatory provider practices.
Provider differences in the likelihood of offering medication to various racial/ethnic groups with the same degree of heroin use disorder severity are unknown. Provider differences, however, have been well documented in opioid prescribing patterns to relieve pain for other conditions including those associated with drug-seeking behavior.
This study, along with many other studies of treatment completion, rely on client level characteristics that were assessed at admission to explain outcomes. More research needs to take into account program level factors (e.g., availability of open slots, non-profit versus for-profit ownership status, etc.) and the interaction with client level factors (e.g., recovery motivation to improve our understanding of why various racial/ethnic groups drop-out or complete treatment for substance use disorder.
In addition, the degree to which Hispanic individuals had equivalent access or use of medication to support treatment completion is unknown in this study. The degree to which patient preferences or attitudes towards the use of medication to treat heroin use disorder vary according to race or ethnicity is not well understood and warrants further research.
Mennis, J. & Stahler, G. J. (2016). Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. Journal of Substance Abuse Treatment, 63, 25-33.
l
Of additional concern is the knowledge gap that exists at the intersection of race/ethnicity and choice of primary substance in studies of treatment completion. Ultimately, if we can identify who is most likely to not complete treatment, then we can conduct research as to the reasons why, and start to identify actionable targets to improve treatment retention.
The Treatment Episode Dataset-Discharge (TEDS-D; SAMHSA, 2013) is a system that includes records for approximately 1.5 million substance use disorder treatment admissions annually and is considered the gold standard for epidemiological research on US treatment programs. The TEDS dataset is comprised of a significant proportion of all admissions in the US and is of interest to stakeholders because many of the admissions are financed through public funds. Using the TEDS data set, this study analyzed 416,224 outpatient treatment completion episodes for adults in urban areas from the year 2011.
The Researchers Hypothesized:
White participants had the highest completion rate (50%) while Hispanic (47%) and African American participants were significantly lower (40%).
Specifically, participants who used alcohol had the highest completion rate (57%), followed by methamphetamine (52%), marijuana (46%), cocaine/crack (39%), and heroin (30%).
African American participants were significantly less likely than White participants to complete treatment across all types of substances (69% as likely after adjusting for demographics). The disparity in treatment completion between African American and White participants was significantly stronger when alcohol was the primary substance (i.e., African Americans 71% as likely to complete treatment) compared to when the primary substance was cocaine (82% as likely), marijuana (78% as likely), and heroin (87% as likely). African Americans were also 66% as likely than White participants to complete treatment when the primary substance was methamphetamines.
For Hispanic participants, the disparity is driven primarily by heroin use disorder, for which they are only 75% as likely as White participants to complete outpatient treatment. Interestingly, Hispanic participants whose primary substance was alcohol were significantly more likely to complete treatment than Whites; however, the effect size was negligible. For marijuana, being Hispanic as compared to being White is associated with lower treatment completion; however, the effect size was trivial whereas for cocaine and methamphetamine, being Hispanic (compared to White) had no significant effect on the likelihood of treatment completion. Although the effect size for Hispanic participants completing treatment for marijuana use disorder was trivial, its notable because a greater proportion of Hispanic patients enter outpatient treatment for marijuana use disorder compared to White patients (24% versus 15%) which means the effect impacts a greater share of the Hispanic population.
This is the first study that used national data to provide evidence that racial and ethnic disparities in urban outpatient substance use disorder treatment completion vary across primary substance.
African Americans were considerably less likely than Whites to be in treatment for methamphetamine use disorder (1% versus 8% respectively) or alcohol use disorder (32% versus 46% respectively) compared to other substances. If African Americans with an alcohol or methamphetamine use disorder are in a treatment environment where the majority of patients are from a different social, economic, or cultural backgrounds they may find it more difficult to feel connected and identify with other patients and thus feel more psychologically isolated. This could potentially decrease treatment retention.
The racial/ethnic disparity in treatment completion rates for heroin use disorder may reflect differences in other important determinants. The use of medication for the treatment of heroin use disorder has become more widely available. Racial/ethnic differences in the use of medication to treatment of heroin use disorder, however, may exist and be attributable to either patient preferences or discriminatory provider practices.
Provider differences in the likelihood of offering medication to various racial/ethnic groups with the same degree of heroin use disorder severity are unknown. Provider differences, however, have been well documented in opioid prescribing patterns to relieve pain for other conditions including those associated with drug-seeking behavior.
This study, along with many other studies of treatment completion, rely on client level characteristics that were assessed at admission to explain outcomes. More research needs to take into account program level factors (e.g., availability of open slots, non-profit versus for-profit ownership status, etc.) and the interaction with client level factors (e.g., recovery motivation to improve our understanding of why various racial/ethnic groups drop-out or complete treatment for substance use disorder.
In addition, the degree to which Hispanic individuals had equivalent access or use of medication to support treatment completion is unknown in this study. The degree to which patient preferences or attitudes towards the use of medication to treat heroin use disorder vary according to race or ethnicity is not well understood and warrants further research.
Mennis, J. & Stahler, G. J. (2016). Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances. Journal of Substance Abuse Treatment, 63, 25-33.
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