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Haeny AM, McCuistian C, Burlew AK, Ruglass LM, Espinosa A, Jordan A, Roundtree C, Lopez J, Morgan-López AA. Integrative data analysis of clinical trials network studies to examine the impact of psychosocial treatments for black people who use cocaine: Study protocol. Contemp Clin Trials 2023; 133:107329. [PMID: 37652354 PMCID: PMC10635737 DOI: 10.1016/j.cct.2023.107329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Cocaine overdose death rates among Black people are higher than that of any other racial/ethnic group, attributable to synthetic opioids in the cocaine supply. Understanding the most effective psychostimulant use treatment interventions for Black people is a high priority. While some interventions have proven effective for the general population, their comparative effectiveness among Black people remains unknown. To address this gap, our NIDA-funded Clinical Trials Network (CTN) study (0125), will use Integrative Data Analysis (IDA) to examine treatment effectiveness across 9 CTN studies. This manuscript describes the study protocol for CTN-0125. METHODS Of the 59 completed randomized clinical trials in the CTN with available datasets, nine met our inclusion criteria: 1) behavioral intervention, 2) targeted cocaine use or use disorder, 3) included sub-samples of participants who self-identified as Black and 4) included outcome measures of cocaine and psychostimulant use and consequences. We aim to 1) estimate scale scores of cocaine use severity while considering study-level measurement non-invariance, 2) compare the effectiveness of psychosocial treatments for psychostimulant use, and 3) explore individual (e.g., concomitant opioid use, age, sex, employment, pre-treatment psychiatric status) and study-level moderators (e.g., attendance/retention) to evaluate subgroup differences in treatment effectiveness. CONCLUSION The NIDA CTN provides a unique collection of studies that can offer insight into what interventions are most efficacious for Black people. Findings from our CTN-0125 study have the potential to substantially inform treatment approaches specifically designed for Black people who use psychostimulants.
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Affiliation(s)
- Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, United States of America
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, United States of America.
| | - A Kathleen Burlew
- Department of Psychology, University of Cincinnati, United States of America
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Adriana Espinosa
- Department of Psychology, The City College of New York and The Graduate Center, CUNY, United States of America
| | - Ayana Jordan
- Department of Psychiatry, Department of Population Health, NYU Grossman School of Medicine, United States of America
| | | | - Joel Lopez
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, United States of America
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Stenersen MR, Thomas K, Struble C, Moore KE, Burke C, McKee S. The impact of self-help groups on successful substance use treatment completion for opioid use: An intersectional analysis of race/ethnicity and sex. J Subst Abuse Treat 2022; 136:108662. [PMID: 34840040 PMCID: PMC8940633 DOI: 10.1016/j.jsat.2021.108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/04/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited. METHODS Thus, the current study utilized responses from the Treatment Episodes Data Set-Discharges, 2015-2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity. RESULTS Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one's race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men. CONCLUSIONS The results of the current study extend the knowledge-base about self-help participation's role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.
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Affiliation(s)
| | - Kathryn Thomas
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Cara Struble
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Kelly E Moore
- Department of Psychology, East Tennessee States University, Johnson City, TN 37614, USA.
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Sherry McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.
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Haeny AM, Oluwoye O, Cruz R, Iheanacho T, Jackson AB, Fisher S, Crouch M, O'Malley S. Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III. J Subst Abuse Treat 2021; 131:108569. [PMID: 34393011 PMCID: PMC9084614 DOI: 10.1016/j.jsat.2021.108569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | | | - Rick Cruz
- Utah State University, United States
| | - Theddeus Iheanacho
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Asti B Jackson
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | | | - Maria Crouch
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States; University of Alaska Anchorage, United States
| | - Stephanie O'Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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Sahker E, Pro G, Sakata M, Furukawa TA. Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample. Drug Alcohol Depend 2020; 213:108087. [PMID: 32492601 DOI: 10.1016/j.drugalcdep.2020.108087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial/ethnic disparities exist at many levels of substance use disorder (SUD) treatment and recovery, reflecting biological and socioeconomic factors. However, racial/ethnic disparities in SUD treatment effectiveness have not been sufficiently investigated. METHODS Data for US outpatient SUD treatment facilities receiving public funding from 2015 to 2017 were analyzed using the Treatment Episode Datasets-Discharge (TEDS-D). The study sample (N = 72,242) were White (n = 51,663), Black (n = 11,789), and Latino (n = 8782) clients reporting substance use frequency at admission and discharge. Multiple logistic regression was used to predict substance use improvement from race/ethnicity, socioeconomic variables, and their interactions. Moderating effects and their clinically meaningful effect sizes of risk differences (RD) were of primary interest. RESULTS The simple improvement comparison was statistically significant (χ2[2] = 380.59, p < 0.0001). Latino clients improved more (RD = 5.12, 95 % CI = 4.02, 6.22) and Black clients improved less than White clients (RD = -7.93, 95 % CI = -8.93, -6.93). However, race/ethnicity significantly and meaningfully moderated the relationship between substance use improvement and age, employment status, problem substance, and referral source (Wald χ2[77] = 5005.94, p < 0.0001). CONCLUSIONS Latinos demonstrated greater use improvement than Black and White clients. Socioeconomic characteristics moderated this general tendency. Culturally sensitive treatments can be enhanced by addressing culturally specific needs according to client age, employment, specific problem substance, and referral source. For example, Black clients referred from school improved more than Whites and Latinos. Increasing resources for school referrals may further improve Black client outcomes.
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Affiliation(s)
- Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Japan Society for the Promotion of Science (JSPS), Overseas Fellowship Division, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
| | - George Pro
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA.
| | - Masatsugu Sakata
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Montgomery L, Burlew AK, Haeny AM, Jones CA. A systematic scoping review of research on Black participants in the National Drug Abuse Treatment Clinical Trials Network. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:117-127. [PMID: 31246072 DOI: 10.1037/adb0000483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Black individuals experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses of publicly available data). (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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