Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample

Ethan Sahker; George Pro; Masatsugu Sakata; Toshiaki A Furukawa

doi:10.1016/j.drugalcdep.2020.108087

Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample

Drug Alcohol Depend. 2020 Aug 1:213:108087. doi: 10.1016/j.drugalcdep.2020.108087. Epub 2020 May 24.

Authors

Ethan Sahker¹, George Pro², Masatsugu Sakata³, Toshiaki A Furukawa⁴

Affiliations

¹ Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Japan Society for the Promotion of Science (JSPS), Overseas Fellowship Division, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan. Electronic address: sahker.ethan.78r@st.kyoto-u.ac.jp.
² Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA. Electronic address: george.pro@nau.edu.
³ Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. Electronic address: masatzg.sakata@outlook.com.
⁴ Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. Electronic address: furukawa@kuhp.kyoto-u.ac.jp.

PMID: 32492601
DOI: 10.1016/j.drugalcdep.2020.108087

Abstract

Background: Racial/ethnic disparities exist at many levels of substance use disorder (SUD) treatment and recovery, reflecting biological and socioeconomic factors. However, racial/ethnic disparities in SUD treatment effectiveness have not been sufficiently investigated.

Methods: Data for US outpatient SUD treatment facilities receiving public funding from 2015 to 2017 were analyzed using the Treatment Episode Datasets-Discharge (TEDS-D). The study sample (N = 72,242) were White (n = 51,663), Black (n = 11,789), and Latino (n = 8782) clients reporting substance use frequency at admission and discharge. Multiple logistic regression was used to predict substance use improvement from race/ethnicity, socioeconomic variables, and their interactions. Moderating effects and their clinically meaningful effect sizes of risk differences (RD) were of primary interest.

Results: The simple improvement comparison was statistically significant (χ²_[2] = 380.59, p < 0.0001). Latino clients improved more (RD = 5.12, 95 % CI = 4.02, 6.22) and Black clients improved less than White clients (RD = -7.93, 95 % CI = -8.93, -6.93). However, race/ethnicity significantly and meaningfully moderated the relationship between substance use improvement and age, employment status, problem substance, and referral source (Wald χ²_[77] = 5005.94, p < 0.0001).

Conclusions: Latinos demonstrated greater use improvement than Black and White clients. Socioeconomic characteristics moderated this general tendency. Culturally sensitive treatments can be enhanced by addressing culturally specific needs according to client age, employment, specific problem substance, and referral source. For example, Black clients referred from school improved more than Whites and Latinos. Increasing resources for school referrals may further improve Black client outcomes.

Keywords: Culturally sensitive treatment; Health disparity; Substance use treatment; racial/ethnic minority.