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ORIGINAL ARTICLE

Look to the Relationship: A Review of African American Women Substance Users’ Poor Treatment Retention and Working Alliance Development

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Pages 662-672 | Published online: 13 Feb 2012
 

Abstract

Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment. This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.

RÉSUMÉ

Regardez à la Relation: Un Examen des Afro-Américains Femmes Toxicomanes Maintien du Mauvais Traitement et le Travail de Développement de L'Alliance

Conclusions émergentes spécifiques aux femmes Afro-Américaine de confirmer que leur taux de rétention de l'abus de substances est significativement plus faible que les autres groupes, qui est problématique d'un traitement de la toxicomanie est efficace en grande partie à la mesure où les clients sont conservés dans le traitement. Cet article examine la littérature existante concernant les disparités dans le maintien du traitement, met en évidence un obstacle important à la rétention de traitement pour cette population, et présente un soutien pour un accent empirique sur le développement d'alliance de travail culturellement adaptés comme une étape prometteuse vers l'amélioration des taux de rétention pour toxicomanes femmes Afro-Américaine.

Mots clés: Afro-Américaine Femmes, Toxicomanes, Traitement Rétention, Alliance de Travail

RESUMEN

Mira a la Relación: Una Revisión de Afroamericanos Mujeres Toxicómanos Pobre Retención de Tratamiento y Desarrollo de la Alianza de Trabajo

Conclusiones émergentes específicos a la mujer Afroamericana confirmar que sus tasas de retención de abuso de sustancias son significativamente más bajos que otros grupos, que es problemático dado tratamiento de abuso de sustancias es eficaz en gran medida en la medida que los clientes se mantienen en tratamiento. Este artículo revisa la literatura existente sobre las disparidades en la retención del tratamiento, destaca una barrera significativa para retención de tratamiento para esta población, y presenta soporte para un enfoque empírico sobre desarrollo de Alianza de trabajo culturalmente sensibles como un paso prometedor para mejorar las tasas de retención para mujer Afroamericana toxicómanos.

Palabras clave: Retención de Tratamiento Mujeres, Toxicómanos, Afroamericanos, Alianza de Trabajo

THE AUTHORS

Dr. Telsie A. Davis is a postdoctoral fellow in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine specializing in trauma-focused therapy and translational research with African Americans with co-morbid mental health and substance use disorders. She has presented and published in the areas of culturally informed psychological practice and substance abuse treatment with African American women. Dr. Davis describes herself as a scientist–practitioner–advocate dedicated to functioning in each of these roles in order to aid in the eradication of mental health disparities among women in the African American community.

Dr. Julie Ancis is an APA Fellow and professor in the Department of Counseling and Psychological Services at Georgia State University. She has published and presented in the areas of multicultural competence, race and gender, university climate, and women's family court experiences. She is the author of several books including The Complete Women's Psychotherapy Treatment Planner, published by Wiley, and Culturally Responsive Interventions: Innovative Approaches to Working with Diverse Populations, published by Taylor and Francis. Dr. Ancis’ professional activities include serving as Chair-Elect of APA Division 17's Section for the Advancement of Women, past Legal and Legislative Representative of the Georgia Psychological Association's Council on the Psychology of Women and Girls, and serving on the committee for the development of the APA Guidelines for Psychological Practice with Girls and Women.

Notes

2 Treatment can be briefly and usefully defined as a unique, planned, goal-directed, temporally structured, multidimensional change process of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (Alcoholics Anonymous, Narcotics Anonymous, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with nonsubstance users. Whether or not a treatment technique is indicated or contraindicated, and its selection underpinnings (theory-based, empirically-based, “principle of faith-based, tradition-based, etc.), continues to be a generic and key treatment issue. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) and well-being treatment-driven models, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Each ideological model has its own criteria for success as well as failure. Treatment is implemented in a range of environments, ambulatory as well as within institutions which can include controlled environments. Treatment includes a spectrum of clinician–caregiver–patient relationships representing various forms of decision-making traditions/models; (1) the hierarchical model in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive, (2) shared decision-making which facilitates the collaboration between clinician and patient(s) in which both are active, and (3) the “informed model” in which the patient makes the decision(s). Editor's note

3 The reader is reminded that substance users, whatever the “drug's of choice,” manner of use, patterns of use and meanings and functions associated with use, represent heterogeneous and not homogeneous populations. Editor's note.

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