Personal and contextual factors in substance abuse treatment among racial and ethnic minorities: Studies from the NIDA clinical trials network

The National Drug Abuse Treatment Clinical Trials Network (CTN) is a collaboration of substance abuse researchers and treatment providers aimed at developing, evaluating, and disseminating effective treatment options to individuals with substance disorders. The CTN includes thirteen research nodes that provide a broad and powerful infrastructure for the evaluation of promising science-based therapies and the subsequent dissemination of these treatments across the nation. Since its inception, the CTN has completed or is currently conducting over 100 research activities, including 45 multi-site clinical trials.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has documented significant racial and ethnic differences in the prevalence of substance use and participation in substance abuse treatment. While racial and ethnic groups comprise 40% of admissions to publicly funded substance abuse treatment programs, these populations appear to be at increased risk for poor treatment outcomes, largely due to socioeconomic factors (Saloner & Le Cook, 2013). In spite of well-known difficulties in fulfilling the National Institutes of Health (NIH) requirement for the inclusion of racial and ethnic minorities in clinical trials, the CTN has consistently demonstrated success in the recruitment and retention of these populations (Burlew et al., 2011; Carroll et al., 2007). Accordingly, the CTN offers a unique opportunity to evaluate treatments that may ultimately improve outcomes for racial/ethnic substance users.

The treatment studies included in this special issue corroborate previous findings that different racial/ethnic groups respond differently to interventions, and that novel approaches to treatment offer hope. Blacks and Hispanics responded more favorably than Whites to the internet delivered treatment in the Campbell et al. study. This pattern suggests an alternative treatment option especially for Blacks and Hispanics. In the Montgomery and Carroll study, despite significant differences in race and psychosocial factors at baseline among cocaine dependent patients, pharmacological and behavioral treatments demonstrated similar outcomes among groups at follow up. Sanchez et al. found that vigorous, regular exercise for the treatment of stimulant use disorder shows promise as an effective intervention but Blacks and Whites are less likely to participate than Hispanics.

The racial/ethnic differences described above argue for more intragroup research to identify personal factors that may predict outcomes for substance abusers. Several studies in this issue illustrate the value of secondary analyses for studying intragroup factors that were not the focus of the primary study. In a secondary analyses of CTN 0004 (Ball et al., 2007), Montgomery et al. demonstrated that an increase in readiness to change (RTC) is associated with treatment retention among Black substance users. Moreover, since this relationship was stronger in males than females, Montgomery et al., encourage clinicians to focus on improving RTC in treatment programs for Black men. Since substance abusing women are at increased risk for engaging in risky sexual behaviors, Ahuama-Jonas et al. examined whether a history of abuse reduced sexual relationship power among Black women in substance abuse treatment. Their findings revealed that adult sexual abuse was associated with lower sexual relationship power but not childhood sexual nor adult physical abuse. Therefore, addressing a history of adult sexual abuse in substance abuse treatment programs for Black women may increase the likelihood that the participants will engage in safer sexual behaviors.

Racial/ethnic differences in outcomes also remind us that contextual factors may play a significant role in outcomes. Several of the articles in this issue demonstrate the relation of contextual factors to substance use. Discrimination in health care due to substance use is one such contextual factor. In the Mcknight study, Hispanic and Black substance users not only reported substantial interpersonal discrimination in health care settings because they were drug users but also reported that drug use discrimination from health care providers was a barrier to receiving needed medical care. In a qualitative study of Asians and Pacific Islanders, Chang and colleagues’ examination of a broad and heterogeneous sample of Asian Pacific Islanders in treatment suggests that structural factors such as housing, neighborhood and age were drivers of type of substances used. Moreover, family, religion, and language played important roles in clients’ experiences with substance use treatment programs.

The Minority Interest Group of the CTN aims to learn as much as possible from CTN studies about racial /ethnic substance abuse and treatment. We are pleased to share some of that knowledge in this special issue.