Between and within Racial and Ethnic Group Disparities in Completion of Substance Abuse Treatment

Background/Purpose: The comparative literature has been limited in exploring the extent to which disparities in treatment completion exist between and within racial and ethnic groups. Such knowledge is necessary to identify interventions that improve treatment adherence among subgroup first-time clients.

 

Methods: This study relied on hierarchical linear models to analyze a subset of multicross-sectional yearly data (2006-2009) from adult participants (n = 16,637) entering publicly funded treatment programs (n = 276) in Los Angeles County, CA. We examined individual, service, and system factors associated with treatment completion among participants during their initial treatment episode.

 

Results: African Americans reported the lowest treatment completion rate (9.4%) compared to Latinos (10.9%) and non-Latino Whites (14%). After accounting for several individual and service factors associated with treatment completion, African Americans (OR = 0.66, 95% CI = 0.57-0.77) and Latinos (OR = 0.82; 95% CI = 0.73-0.93) reported lower odds of completing treatment compared to Whites. Findings also revealed significant heterogeneity within groups, highlighting the role of primary drug problem, severity of drug use, mental illness and homelessness in treatment completion. Service factors such as referral by the criminal justice system played a significant role in enabling completion among all groups with greater impact on minority groups, according to within-group analysis.

 

Conclusion/Implications: These findings have implications for reducing health disparities among members of racial and ethnic minorities by highlighting promising individual and service factors associated with treatment adherence, particularly for first-time clients. Findings support the provision of integrated substance abuse, mental health and housing services to help the most vulnerable population reach their recovery goals in treatment.