Evidence-Based Interventions for Racial/Ethnic Minority Substance Abusing Juvenile Offenders: The Challenge of Treatment Dropout

BACKGROUND AND PURPOSE: Despite a proliferation of evidence-based approaches to treating adolescent delinquency and substance abuse, significant treatment disparities persist. More than 50% of adolescents drop out of substance abuse treatment (Office of Applied Studies, 2000a), and racial/ethnic minority clients dropout at significantly higher rates than Non-Hispanic Whites (NHWs) (Office of Applied Studies, 2000b). Treatment dropout is linked consistently to greater rates of criminal involvement (Jainchill, Hawke, DeLeon, & Yagelka, 2000) and substance use among adolescents (Winters, Stinchfield, Opland, Weller, & Latimer, 2000). While it is likely that risk factors for dropout vary across racial/ethnic groups, there has been little empirical research addressing this topic, and there is a dearth of research examining Hispanic subgroup differences in dropout predictors. The present research addresses this gap through an examination of the potential differential influence of psychosocial and contextual factors on dropout among racial/ethnic subgroups of substance using juvenile offenders.

METHODS: Data were derived from an NIAAA-funded clinical trial examining the efficacy of an adolescent-specific version of Guided Self Change (GSC) (Sobell & Sobell, 1998), an evidence-based, brief (5-session) behavioral and motivational intervention targeting juvenile offending youth with substance use and related behavioral problems. The treatment was delivered in one of two community-based offices depending on which location was most accessible to the youth/family. A unique feature of the study is a racial/ethnic minority sample (N=453), [U.S.-born Hispanics (n = 262), Foreign-born Hispanics (n = 117), and African-Americans (n = 74)]. Ten percent of the participants were female. Multivariate logit analyses were used to examine the influence of specific factors on dropout within racial/ethnic subgroups.

RESULTS: Several key findings emerge from the present research: 1) African-American youth were twice as likely to dropout; 2) contextual factors [e.g., waitlist (OR=5.0) and being court mandated to treatment (OR=1.8)] appear to be particularly influential in predicting dropout; 3) predictors of dropout vary considerably within each racial/ethnic subgroup; and, 4) the foreign-born Hispanics share no predictors with the other subgroups.

CONCLUSIONS AND IMPLICATIONS: Study findings underscore the importance of understanding the unique barriers to treatment still faced by marginalized youth within our society. Of particular significance is the finding that African American youth experience disproportionate risk for dropout even within a racial/ethnic minority sample. Removing barriers to effective treatment for minority youth is critical as minorities experience disproportionate consequences related to substance use and juvenile delinquency (Herd, 1989) including lifetime risk for prison which is 1 in 3 for African-American males compared to 1 in 6 for Hispanics and only 1 in 17 for NHWs (Children's Defense Fund, 2008). In an effort to address these disparities, results suggest the importance of individualizing interventions to adequately target the specific needs of marginalized subgroups of adolescents. Finally, as study findings indicate that the treatment needs of foreign-born youth may be distinct from other youth, it is imperative that future research further explore within racial/ethnic subgroup differences on important treatment related issues so that the treatment needs of specific subgroups do not go undetected.