Abstract: Applying Recognition Theory to Interpret Findings from a Scoping Review of Race Concordance between Black Patients and Clinicians in Substance Use Disorder Treatment (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)
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163P Applying Recognition Theory to Interpret Findings from a Scoping Review of Race Concordance between Black Patients and Clinicians in Substance Use Disorder Treatment

Schedule:
Friday, January 12, 2024
Marquis BR Salon 6, ML 2 (Marriott Marquis Washington DC)
* noted as presenting author
Corinne A. Beaugard, MSW, PhD Candidate, Boston University
Kaku So-Armah, PhD, Research Assistant Professor of Medicine, Boston University, MA
Sheila Chapman, MD, Clinical Associate Professor, Boston University
Avik Chatterjee, MD, Assistant Professor, Boston University, MA
Daneiris Heredia-Perez, MSPM, Senior Research Project Manager, Boston Medical Center, MA
Natrina L. Johnson, MSc, Doctoral Candidate, Boston University, Boston, MA
Christina Lee, PhD, Associate Professor, Boston University, MA
Philip Reason, MSW, Multi-Visit Patient Program Manager, Boston Medical Center, Boston, MA
Amy Yule, MD, Assistant Professor, Boston University, Boston, MA
Miriam Komaromy, MD, Professor, Boston University, Boston, MA
Background: Substance use disorder (SUD) treatment for Black people is impeded by interpersonal, institutional, and systemic racism. Though there is evidence that Black race concordance impacts patient-clinician communication in medical settings, the impact of Black race concordance on SUD treatment outcomes is not clear, nor are the mechanisms underlying this impact. We hypothesize that racism impacts treatment outcomes for Black people in part due to insufficient recognition. Axel Honneth’s Recognition Theory posits that individuals’ integrity, security, and self-regard are produced through authentic, positive interactions with other people, institutions, and legal structures. This study aimed to 1) summarize a scoping literature review on the relationship between race concordance and experiences and outcomes for Black patients in SUD treatment, and 2) examine the relationship of race concordance and SUD treatment outcomes in the current literature for Black patients through the lens of recognition theory.

Methods: We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) -guided search in PubMed and PsycInfo for research on the effect of race concordance on addiction treatment outcomes for Black patients. Three reviewers read each title and abstract; one reviewer completed full-text reviews and data extraction. Discrepancies were discussed until consensus was reached. Articles meeting inclusion criteria addressed: 1) Black individuals; 2) treatment outcomes; and 3) patient-clinician race concordance in SUD treatment. We included peer-reviewed articles and scholarly commentaries.

In a subsequent analysis, we identified the elements of treatment pertaining to the three spheres of recognition (i.e., affection and care, acknowledgment of achievement, and legal rights) in the articles reviewed and explored the potential for race concordance to improve patient experience in each domain.

Results: The scoping review identified 329 non-duplicate articles. We completed full text reviews of 141 articles; 14 articles met criteria. Articles were published between 1971-2021 (13 before 2002). We identified one randomized clinical trial examining the effects of race concordance for Black patients (n= 6). At the one-year follow-up, the three retained Black patients in race-concordant dyads reported less intravenous drug use and decreased usage of shared needles. Of the remaining 13 non-randomized studies, three reported significant associations with race concordance, with polysubstance abstinence, perceived provider empathy, and less time in jail nine-months post-treatment. The remaining studies did not report associations between race concordance and treatment outcomes.

Some findings in this review suggest the potential for race concordance to engender recognition via affective care by increased empathy in patient-clinician relationships and achievement through shared understanding of treatment goals. Legal recognition was not represented in the review findings, though ability to make informed decisions about medical care given institutional policies could be a proxy for legal recognition in medical settings.

Conclusions: The inconclusiveness regarding the effect of race concordance on SUD treatment outcomes may be due to the lack of measures related to recognition in the studies reviewed. Given the value that patients and clinicians place on race concordance, future research should explore how recognition by Black clinicians, through emotional investment, mutual reassurance, and equity in decision making, affects SUD treatment outcomes.

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