Need-service matching in substance abuse treatment: racial/ethnic differences

Abstract

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.

Fig. 1

Post-treatment drug use (the number of days used the five major drugs in the last 30 days) as a function of treatment duration, access, substance abuse counseling and ratio of matched service for African Americans, Latinos and Whites. The estimated lines for each race/ethnicity group were based on the fitted coefficients of the main effect and interaction in Table 2, assuming all other controlling variables are equal. The main effect of race/ethnicity, 0.18 for Black and −0.233 for Latinos, determined the intercepts, while the main effect of service and the interaction term determined the slope of the lines. For instance, the main effect of ratio of matched service was −0.642, while the interaction term between the ratio of matched service and race/ethnicity was 0.198 (ratio × Black) or 0.718 (ratio × Latinos). The estimated slope of the ratio of matched service was −0.444 (−0.642 + 0.198), 0.076 (−0.642 + 0.718) and −0.642 for African Americans, Latinos and Whites respectively. Note the units in the X and Y axes are real world units, since the treatment duration, access, substance abuse counseling and ratio of matched service were not standardized in the model fitting. For illustration purpose, the post-treatment drug use with zero service was set to be 0 for whites in each panel. The interactions between race/ethnicity and service are all significant except the interaction between Latinos and access.