An examination of racial and ethnic differences within a sample of Hispanic, white (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers. The MOTHERS Project

Race, Managed Care, And The Quality Of Substance Abuse Treatment

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and 1996. It evaluates whether a managed behavioral health care carve-out in FY1993 had a positive or negative effect on access, continuity of care, and 30-day re-admissions. Prior to managed care, access and continuity were worse for minorities than for whites. For all clients under managed care, access and continuity improved between 1992 and 1996. Access improved more for Hispanic clients relative to other racial groups. Continuity improved more for Black clients relative to other racial groups. Although seven-day and 30-day re-admissions also increased following managed care, the rate of increase was not significantly greater for minorities. Although managed care had a beneficial impact on the quality of treatment for minority clients, the percent of minority Medicaid-eligible clients who accessed treatment and the percent who achieved continuity of care remained lower than for whites in every year of the study. Managed care reduced, but did not overcome, racial disparities in behavioral health care.

Trauma history and relapse probability among patients seeking substance abuse treatment

We estimated the prevalence of trauma history and relapse in a sample of 959 patients at two outpatient chemical dependence clinics of a managed healthcare organization. A large majority (89%) reported a history of at least one traumatic event. The most common traumatic events were serious accidents, being robbed, seeing someone killed or seriously injured, and partner violence. One third of the patients had a history of substance abuse disorder relapse. There were gender and ethnic differences in the types of traumatic events reported. There were ethnic differences in relapse rates, which were highest among African American and multicultural patients. The types of traumatic events reported differed in patients of various sexual orientations. Bisexual patients had the highest rates of relapse, even when trauma exposure was controlled. Clinical implications of the findings are discussed.

Culturally appropriate substance abuse treatment for parenting African American women

Culturally appropriate strategies have been deemed necessary for the treatment of substance abuse among African American women. This qualitative study was conducted utilizing a grounded theory methodology within a womanist theoretical framework to explore the process by which parenting African American women participate in formal substance abuse treatment programs. Study findings yielded significant insights into this process and support the notion that culturally appropriate frameworks are necessary to help substance-abusing African American women enter into treatment programs and remain in recovery. In addition, specific interventions for treating substance-abusing African American women within a culturally relevant framework are discussed.

The impact of substance abuse treatment modality on birth weight and health care expenditures

During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities--residential, outpatient, residential/outpatient, methadone and detoxification-only--on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusetts between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-only group) for an additional cost of $17,211. Outpatient programs were the most cost-effective option, increasing birth weight by 139 grams over detoxification-only for an investment of only $1,788 in additional health care and treatment costs. A second regression using five intermediate treatment outcomes--prenatal care, weight gain, relapse, tobacco use and infection--suggested that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced in residential settings.

The costs of crime and the benefits of substance abuse treatment for pregnant women

Although many pregnant, drug-dependent women report extensive criminal justice involvement, few studies have examined reductions in crime as an outcome of substance abuse treatment programs for pregnant women. This is unfortunate, because maternal criminal involvement can have serious health and cost implications for the unborn child, the mother and society. Using the Addiction Severity Index, differences in pre- and posttreatment criminal involvement were measured for a sample of 439 pregnant women who entered publicly funded treatment programs in Massachusetts between 1992 and 1997. Accepted cost of illness methods were supplemented with information from the Bureau of Justice Statistics to estimate the costs and benefits of five treatment modalities: detoxification only (used as a minimal treatment comparison group), methadone only, residential only, outpatient only, and residential/outpatient combined. Projected to a year, the net benefits (avoided costs of crime net of treatment costs) ranged from US$32,772 for residential only to US$3,072 for detoxification. Although all five modalities paid for themselves by reducing criminal activities, multivariate regressions controlling for baseline differences between the groups showed that reductions in crime and related costs were significantly greater for women in the two residential programs. The study provides economic justification for the continuation and possible expansion of residential substance abuse treatment programs for criminally involved pregnant women.

The impact of women's family status on completion of substance abuse treatment

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal year 1996-97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American, pregnant, had custody of minor children, or were younger than age 21. However, African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

A review of recent findings on substance abuse treatment for pregnant women

Recent years have brought an increased interest in the treatment needs of pregnant substance abusers. This article reviews the literature on this subject, providing an overview of what is known about the prevalence of substance abuse during pregnancy; the factors in women's lives, especially pregnant women, that lead to substance abuse and that facilitate and impede treatment success; and the components of successful treatment programs. The prevalence of prenatal illicit drug use is known to be about 5% of all pregnant women nationwide, with higher rates for selected subgroups. Local studies have shown much higher rates. Substance abuse is associated with poverty, with the substance abuse of significant others, and with family violence. Perinatal substance abusers experience poorer birth outcomes. The negative consequences for babies do not stop at birth; home environments may be chaotic and often children are removed from their mother's care if substance abuse continues after birth. While the literature on prevalence, correlates, and outcomes of perinatal substance abuse is plentiful, there continues to be sparse information on successful treatment approaches. Sample sizes are small and there are few studies with adequate comparison groups. The small number of outcome studies we review suggest that, as with the broader treatment literature for other populations, success (as measured by abstinence) is associated with retention. Retention is facilitated by the provision of support services, such as child care, parenting classes, and vocational training. There is no clear empirical basis for concluding that one type of treatment (for example, residential treatment) is more effective than another.