Racial Disparities in Substance Abuse Treatment and the Ecological Fallacy

Abstract

This study examined engagement in treatment in substance abuse treatment programs that treated primarily either African American or White clients. Findings showed higher levels of engagement in White programs; however, engagement of African Americans in White programs was similar to that of Whites and was greater than Whites in African American programs. No significant differences emerged when a mixed model analysis considered additional variables of staff consensus (regarding treatment elements), treatment climate, acceptance of Medicaid clients, the proportion mandated to treatment, and the quality of the physical space. Although African American programs may show poorer levels of engagement than White programs, attribution of engagement in treatment to client level race/ethnicity should be made with caution.

KEYWORDS:

• African American
• differential effectiveness
• Medicaid
• racial/ethnic data
• treatment disparities

Acknowledgments

At time of writing, Alexandra Duncan and Azure Thompson received funding from the Behavioral Sciences Training in Drug Abuse Research, a program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) that receives support from the National Institute on Drug Abuse (5T32 DA07233). Points of view, opinions, and conclusions in this article do not necessarily represent the official position of the U.S. Government, Public Health Solutions, or NDRI.

Points of view, opinions, and conclusions in this paper do not necessarily reflect those of the U.S. Department of Health & Human Services, National Institutes of Health, National Institute of Drug Abuse, Public Health Solutions, or NDRI.

This research was supported in part by a grant (R01DA015264) from the National Institutes of Health, National Institute on Drug Abuse, which was awarded to the Center for the Integration of Research & Practice (CIRP), National Development and Research Institutes, Inc. (NDRI). The authors would also like to acknowledge the contribution of Steven Banks, PhD, for his invaluable assistance in the initial conceptualization of the article.

Notes

^a Range of scores: 0–3.

^b Range of index score: 0–1.

^c Count (number of items included in parentheses).

Tx = treatment; ns = not significant.

*P < 0.05; **P < 0.01; ***P < 0.001.

ns = not significant.

Ascribing characteristics or outcomes to groups that their members, as individuals, do not possess.

Long-term residential treatment, the focus of this investigation, is characterized as treatment more than 30 days (median: 75 days) (SAMHSA, 2004).