2P
Racial Matching and Self-Reported Mental Health Symptoms Among Adolescents Assessed for Substance Use Disorders
Background and Purpose: Obtaining accurate assessment data from adolescents presenting for substance use disorder treatments aids clinical decision making and facilitates more accurate outcomes evaluations. Unfortunately, although numerous researchers suggest that cultural mistrust may impact professional helping relationships, it is unclear if it would affect self-reported substance use disorder assessment data for adolescents. Racial and ethnic matching, or pairing clients with therapists from similar racial backgrounds, is positively associated with client retention and therapeutic alliance for adolescents in substance use disorder treatment. To our knowledge, this is the first study to examine whether racial and ethnic matching is positively associated with self-reported substance use and mental health symptoms at intake for racial minority adolescents in substance use disorder treatment. Methods: Baseline assessment data were obtained from a SAMHSA-funded study in which adolescents (n=94) received the Adolescent Community Reinforcement Approach (A-CRA). This study uses a subset of adolescents who self-reported that they were from a non-White racial minority background. On average, study participants were 16.0 years of age (SD = 1.3) and mostly male (74.7%). Participants self-reported racial backgrounds included: Black 45.8%, Biracial Black 22.9%, Hispanic 27.7%, Native American/Alaskan 1.2% and Other 2.4%. Regarding substance use severity, 41.0% and 36.6% of participants presented with past year DSM IV substance dependence and DSM IV substance abuse, respectively. If non-White youth completed their assessment with a staff member from a racial minority background (n=19) they were coded as a racial match, and if not, they were coded as a racial mismatch (n=64). Assessment data were collected using The Global Appraisal of Individual Needs (GAIN-Q), a reliable and valid assessment. We used t-tests or Mann-Whitney-U tests to compare racially matched and unmatched adolescents’ self-reported substance use frequency, substance use problems, ADHD symptoms, depression symptoms, general mental distress, and days of being bothered by emotional problems. There were no missing data for any of the dependent variables.
Results: There were no significant differences in substance use frequency or substance use problems between racially matched and unmatched adolescents. However, and contrary to our hypotheses, racial matched adolescents reported significantly fewer ADHD (t=2.29, p=.025) and depression-related symptoms (t=2.18, p=.034). Further, racially matched youth reported lower general mental distress (t=1.67, p=.10) and days of emotional problems (t=1.67, p=.099), which were both marginally significant.
Conclusions and Implications: We did not find support for the hypothesis that racial matching would increase substance use or mental health symptom reporting. To the contrary, being racially matched with an intake assessor was associated with lower mental health symptom reporting. This is possibly due to perceptions of the therapist and positive expectations for treatment. Future research should replicate findings and examine mechanisms driving these differences in self-report.