Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups

Abstract

This study examined gender differences within Black, Latino, and White subgroups in the utilization of comprehensive services and their relation to posttreatment substance use. Survey data were collected during the National Treatment Improvement Evaluation Study (NTIES), a prospective, longitudinal, multisite study of substance abuse treatment programs and their clients in the United States. The analytic sample consisted of 1,812 blacks (734 women and 1,078 men), 486 Latinos (147 women and 339 men), and 844 whites (147 women and 339 men) from 59 service delivery organizations. Results related to service utilization indicated that compared to men, women in all racial and ethnic groups needed and received more services targeted to their needs and reported more positive relations with service providers. Gender was a significant moderator of the relationship between service receipt and treatment outcomes for all racial and ethnic groups, but especially for the Latino subsample. Findings point to the need to consider race-specific gender differences in the development of culturally competent, comprehensive substance abuse treatment.

Keywords: Comprehensive services; Gender; Moderator; Race/Ethnicity; Service utilization; Treatment outcome.

Figure 1. Estimated Posttreatment Drug Use as a Function of Service among Women and Men by Race/Ethnicity

Posttreatment drug use (the number of days of use of five major drugs during the last 30 days) as a function of access services, substance abuse counseling, ratio of matched services, and duration for women and men in Black, Latino, and White subgroups. The estimated lines for women and men were based on the fitted coefficients of the main effect and interaction in Table 2, assuming all other controlling variables were equal. In each panel of the figure, the slope was determined by the main effect of service as well as the interaction term, whereas the intercept at X = 0 was determined by the main effect of gender, which was coded as 1 for men and 0 for women. For instance, for Latinos (top panel), the main effect of ratio of matched services was −0.474, the main effect of gender was 0.635, and the interaction term between ratio of matched services and gender was 0.614. Therefore, the estimated slope of the ratio of matched services for Latinos was −0.474 for women and 0.140 (−0.474 + 0.614) for men. The value at X = 0 was 0 for women and 0.635 for men. The value at X = −1 was 0.474 [−(−0.474) × (−1)] for women and 0.495 [0.635 + 0.14 × (−1)] for men. Note the units in the X and Y axes are real-world units, because access services, substance abuse counseling, ratio or matched services, and client–provider relationship were not standardized in the model fitting.