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Ware OD, Cano MT, Dalal Safa M, Garza N, Martinez S, Salloum I. Availability of substance use disorder treatment in Spanish: Associations with state-level proportions of Spanish speakers and treatment facility characteristics in the United States. Am J Addict 2024; 33:400-408. [PMID: 38264804 DOI: 10.1111/ajad.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Spanish is the second most spoken language in the United States. Not all substance use disorder (SUD) treatment facilities provide treatment in Spanish. This study examined factors associated with SUD treatment facilities having counselors that provide treatment in Spanish. METHODS State-level estimates of Spanish-speaking individuals were derived from the American Community Survey 2019. SUD treatment facility characteristics were captured from the National Survey of Substance Abuse Treatment Services 2020. We examined a sample of 15,246 facilities which included 12,798 outpatient, 3554 nonhospital residential, and 1106 with both outpatient and residential programs. Binary logistic regression models were used to observe state-level proportions of Spanish speakers and facility-level characteristics as factors associated with a facility having counselors that provide treatment in Spanish. RESULTS Approximately 23.3% of facilities had counselors able to provide treatment in Spanish. Among outpatient or nonhospital residential SUD facilities, those in a state with a larger proportion of Spanish-speaking individuals, facilities with pay assistance, facilities that accept Medicaid, and facilities that engage in community outreach had higher odds of having counselors that provide treatment in Spanish. CONCLUSIONS Considering that less than a quarter of facilities provide treatment in Spanish, increasing the availability of linguistically appropriate and culturally responsive services for SUD is imperative. SCIENTIFIC SIGNIFICANCE This national study is the first of its kind to examine associations between estimates of Spanish speakers and treatment facility characteristics associated with counselors that provide treatment in Spanish in outpatient and nonhospital residential SUD treatment.
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Affiliation(s)
- Orrin D Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monique T Cano
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - M Dalal Safa
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Noe Garza
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Suky Martinez
- Division on Substance Use Disorders, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York, USA
| | - Ihsan Salloum
- Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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Kong Y, Guerrero E, Frimpong J, Khachikian T, Wang S, D'Aunno T, Howard D. Identifying the Heterogeneity in the Association between Workforce Diversity and Retention in Opioid Treatment among Black clients. RESEARCH SQUARE 2024:rs.3.rs-3932153. [PMID: 38405811 PMCID: PMC10889050 DOI: 10.21203/rs.3.rs-3932153/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background This study investigates the impact of workforce diversity, specifically staff identified as Black/African American, on retention in opioid use disorder (OUD) treatment, aiming to enhance patient outcomes. Employing a novel machine learning technique known as 'causal forest,' we explore heterogeneous treatment effects on retention. Methods We relied on four waves of the National Drug Abuse Treatment System Survey (NDATSS), a nationally representative longitudinal dataset of treatment programs. We analyzed OUD program data from the years 2000, 2005, 2014 and 2017 (n = 627). Employing the 'causal forest' method, we analyzed the heterogeneity in the relationship between workforce diversity and retention in OUD treatment. Interviews with program directors and clinical supervisors provided the data for this study. Results The results reveal diversity-related variations in the association with retention across 61 out of 627 OUD treatment programs (less than 10%). These programs, associated with positive impacts of workforce diversity, were more likely private-for-profit, newer, had lower percentages of Black and Latino clients, lower staff-to-client ratios, higher proportions of staff with graduate degrees, and lower percentages of unemployed clients. Conclusions While workforce diversity is crucial, our findings underscore that it alone is insufficient for improving retention in addiction health services research. Programs with characteristics typically linked to positive outcomes are better positioned to maximize the benefits of a diverse workforce in client retention. This research has implications for policy and program design, guiding decisions on resource allocation and workforce diversity to enhance retention rates among Black clients with OUDs.
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Frimpong JA, Guerrero EG, Kong Y, Khachikian T, Wang S, D'Aunno T, Howard DL. Predicting and responding to change: Perceived environmental uncertainty among substance use disorder treatment programs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 145:208947. [PMID: 36880916 DOI: 10.1016/j.josat.2022.208947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) treatment programs offering addiction health services (AHS) must be prepared to adapt to change in their operating environment. These environmental uncertainties may have implications for service delivery, and ultimately patient outcomes. To adapt to a multitude of environmental uncertainties, treatment programs must be prepared to predict and respond to change. Yet, research on treatment programs preparedness for change is sparse. We examined reported difficulties in predicting and responding to changes in the AHS system, and factors associated with these outcomes. METHODS Cross-sectional surveys of SUD treatment programs in the United States in 2014 and 2017. We used linear and ordered logistic regression to examine associations between key independent variables (e.g., program, staff, and client characteristics) and four outcomes, (1) reported difficulties in predicting change, (2) predicting effect of change on organization, (3) responding to change, and (4) predicting changes to make to respond to environmental uncertainties. Data were collected through telephone surveys. RESULTS The proportion of SUD treatment programs reporting difficulty predicting and responding to changes in the AHS system decreased from 2014 to 2017. However, a considerable proportion still reported difficulty in 2017. We identified that different organizational characteristics are associated with their reported ability to predict or respond to environmental uncertainty. Findings show that predicting change is significantly associated with program characteristics only, while predicting effect of change on organizations is associated with program and staff characteristics. Deciding how to respond to change is associated with program, staff, and client characteristics, while predicting changes to make to respond is associated with staff characteristics only. CONCLUSIONS Although treatment programs reported decreased difficulty predicting and responding to changes, our findings identify program characteristics and attributes that could better position programs with the foresight to more effectively predict and respond to uncertainties. Given resource constraints at multiple levels in treatment programs, this knowledge might help identify and optimize aspects of programs to intervene upon to enhance their adaptability to change. These efforts may positively influences processes or care delivery, and ultimately translate into improvements in patient outcomes.
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Affiliation(s)
| | - Erick G Guerrero
- Research to End Healthcare Disparities Corp., United States of America
| | - Yinfei Kong
- California State University, Fullerton, United States of America.
| | | | - Suojin Wang
- Texas A&M University, United States of America.
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Borton D, Streisel S, Stenger M, Fraser K, Sutton M, Wang YC. Disparities in substance use treatment retention: An exploration of reasons for discharge from publicly funded treatment. J Ethn Subst Abuse 2022:1-19. [PMID: 36373804 DOI: 10.1080/15332640.2022.2143977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although Delaware is the seventh smallest state in the country (including Washington, D.C.) in terms of population size, it has the second highest drug overdose death rate. The Delaware Division of Substance Abuse and Mental Health has increased attention in identifying disparities in treatment outcomes. We explored reasons for discharge from publicly-funded treatment in Delaware with special attention to populations at risk for health inequities, with a focus on covariates of treatment non-completion. Using secondary data collected from publicly-funded treatment providers, we analyzed data from individuals that were admitted to substance use treatment between 2015 and 2019 and had been discharged in 2019. We did this by using logistic and multinomial regression, focusing on non-completion treatment outcomes such as failure to meet requirements, loss of contact, and treatment refusal. Clients who were Black or African American, compared to white clients, were more likely to be lost contact with, administratively discharged, or marked as failing to meet treatment requirements than having a completed treatment discharge. Women were 30% less likely than men to have "failed to meet treatment requirements" compared to completing treatment. Further investigation is needed into these patterns. While treatment quality cannot be assessed using this data, the results point to a need for closer study of disparities in treatment related to race, ethnicity, gender, employment, criminal justice involvement, and type of drug used. Treatment providers should be made aware of culturally informed care, as well as client-created goals, in order to reduce disparities in exit from treatment.
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Affiliation(s)
- David Borton
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
| | - Shannon Streisel
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
- Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware
| | - Madeline Stenger
- Center for Drug and Health Studies, University of Delaware, Newark, Delaware
- Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware
| | - Kris Fraser
- Department of Health and Social Services, Delaware Division of Substance Abuse and Mental Health, New Castle, Delaware
| | - Mark Sutton
- Department of Health and Social Services, Delaware Division of Substance Abuse and Mental Health, New Castle, Delaware
| | - Y Claire Wang
- Department of Health and Social Services, Delaware Division of Substance Abuse and Mental Health, New Castle, Delaware
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Alibrahim A, Marsh JC, Amaro H, Kong Y, Khachikian T, Guerrero E. Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study. BMC Health Serv Res 2022; 22:478. [PMID: 35410215 PMCID: PMC8996398 DOI: 10.1186/s12913-022-07886-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Commuting time to treatment has been shown to affect healthcare outcomes such as engagement and initiation. The purpose of this study is to extend this line of research to investigate the effects of driving time to opioid programs on treatment outcomes. METHODS We analyzed discharge survey data from 22,587 outpatient opioid use disorder treatment episodes (mainly methadone) in Los Angeles County and estimated the associated driving time to each episode using Google Maps. We used multivariable logistic regressions to examine the association between estimated driving time and odds of treatment completion after adjusting for possible confounders. RESULTS Findings show an average driving time of 11.32 min and an average distance of 11.18 km. We observed differences in estimated driving time across age, gender, and socioeconomic status. Young, male, less formally educated, and Medi-Cal-ineligible clients drove longer to treatment. A 10-min drive was associated with a 33% reduction in the completion of methadone treatment plans (p < .01). CONCLUSION This systemwide analysis provides novel time estimates of driving-based experiences and a strong relationship with completion rates in methadone treatment. Specifically, the result showing reduced treatment completion rates for drive times longer than 10 min may inform policies regarding the ideal geographic placement of methadone-based treatment programs and service expansion initiatives.
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Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering, College of Engineering & Petroleum, Kuwait University, Kuwait, Kuwait. .,Geo-Health Lab, Dasman Diabetes Institute, Kuwait, Kuwait.
| | - Jeanne C Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Hortensia Amaro
- Robert Stempel College Of Public Health and Social Work and Herbert Wertheim College of Medicine, Florida Internation University, Miami, USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, Fullerton, USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, USA
| | - Erick Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp, Los Angeles, USA
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Padwa H, Bass B, Urada D. Homelessness and publicly funded substance use disorder treatment in California, 2016-2019: Analysis of treatment needs, level of care placement, and outcomes. J Subst Abuse Treat 2021; 137:108711. [PMID: 35012791 DOI: 10.1016/j.jsat.2021.108711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Both homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. METHODS Observational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. RESULTS PEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. CONCLUSIONS Developing SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.
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Affiliation(s)
- Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America.
| | - Brittany Bass
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
| | - Darren Urada
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
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Guerrero E, Amaro H, Kong Y, Khachikian T, Marsh JC. Gender disparities in opioid treatment progress in methadone versus counseling. Subst Abuse Treat Prev Policy 2021; 16:52. [PMID: 34162420 PMCID: PMC8220800 DOI: 10.1186/s13011-021-00389-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. METHODS Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. RESULTS We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. CONCLUSIONS Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.
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Affiliation(s)
- Erick Guerrero
- I-Lead Institute, Research to End Health Disparities Corp, 12300 Wilshire Blvd, Suite 210, Los Angeles, CA 90025 USA
| | - Hortensia Amaro
- Herbert Wertheim College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th ST, AHC4, Miami, Florida 33199 USA
| | - Yinfei Kong
- College of Business and Economics, California State University Fullerton, 800 N. State College Blvd, Fullerton, CA 92831 USA
| | - Tenie Khachikian
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL 60637 USA
| | - Jeanne C. Marsh
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60th Street, Chicago, IL 60637 USA
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Tambling RR, D’Aniello C, Russell BS. Health Insurance Literacy among Caregivers of Substance Using Young Adults. ALCOHOLISM TREATMENT QUARTERLY 2021. [DOI: 10.1080/07347324.2021.1927926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rachel R. Tambling
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Carissa D’Aniello
- Department of Community, Family, and Addiction Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Beth S. Russell
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
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Tambling RR, Russell B, D'Aniello C. Where is the Family in Young Adult Substance Use Treatment? The Case for Systemic Family Therapy for Young Adults with Substance Use Disorders. Int J Ment Health Addict 2021; 20:1659-1670. [PMID: 33424512 PMCID: PMC7781401 DOI: 10.1007/s11469-020-00471-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 01/31/2023] Open
Abstract
Despite the prevalence of SUDs, many individuals remain untreated (Grant et al., JAMA Psychiatry, 73(1), 39-45, 2016). Substance use disorders (SUDs) in young adults present unique challenges and stressors to parents of these individuals (D’Aniello et al., American Journal of Family Therapy, 2020; Kaur et al., International Journal of Community Medicine and Public Health, 5(6), 2380-2383, 2018; Shumway et al., Alcoholism Treatment Quarterly, 37(1), 75-98, 2019). Parents and caregivers often facilitate their children’s care and provide pragmatic and emotional support to their children; this high level of care is challenging to maintain, as with any chronic, relapsing condition. In the case of SUDs, the challenges caregivers face may be exacerbated by the stigma and the blame associated with parents in the development and maintenance of children’s SUDs, and the strains that come with navigating barriers related to accessing treatment in the USA. Estimates suggest that healthcare spending for substance use treatment is relatively low and few utilize therapeutic family treatment. This disconnect between widespread SUD prevalence, and service underutilization, indicates that families who need treatment are not accessing it. The present paper synthesizes the extant literature on the role of family members in SUD treatment, as families are a primary context of care for their children’s treatment across many chronic, relapsing conditions. Finally, we identify the utility of family therapy in addressing family member’s unique needs related to their loved one with a SUD, in the family and in a treatment context.
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Affiliation(s)
- Rachel R Tambling
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Beth Russell
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Carissa D'Aniello
- Community, Family, and Addiction Services, Texas Tech University, 2500 Broadway, Lubbock, TX 79409 USA
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Garcia V, Pagano A, Recarte C, Lee JP. La Cultura Cura: Latino Culture, Shared Experiences, and Recovery in Northern Californian Anexos. ALCOHOLISM TREATMENT QUARTERLY 2020; 39:47-62. [PMID: 34305300 PMCID: PMC8294478 DOI: 10.1080/07347324.2020.1803167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article examines the anexo's use of Latino culture and shared experiences to promote recovery and its appeal to 1.5- and second-generation Latinos. Anexos are grassroots recovery groups with origins in Mexico that offer a residential Alcoholics Anonymous program in Latino communities. Data were gathered from a two-year (2014-2016) ethnographic study of anexos in Northern California and were analyzed thematically. Despite having access to publicly funded treatment, many 1.5- and second-generation Latinos accessed anexos based on cultural familiarity, shared experiences, and a desire to recuperate cultural practices lost during their substance use.
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Affiliation(s)
- Victor Garcia
- Department of Anthropology and Mid-Atlantic Research and Training Institute for Community and Behavioral Health (MARTI-CBH), Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Carlos Recarte
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
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Garcia V, Lambert E, Fox K, Heckert D, Pinchi NH. Grassroots interventions for alcohol use disorders in the Mexican immigrant community: A narrative literature review. J Ethn Subst Abuse 2020; 21:773-792. [PMID: 32757884 DOI: 10.1080/15332640.2020.1803781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This narrative literature review addresses grassroots interventions for alcohol use disorders as practiced in Mexican immigrant communities. These organic efforts are 24-hour AA groups, or anexos, fourth and fifth step AA groups, juramentos, and curanderismo. Literature was identified using PubMed and CINAHL and limited to works published from 2000 to 2018. In all, three publications on 24-hour groups were found, two on fourth and fifth step groups, four on juramentos, and one on curanderismo use. The review offers insight on their practices and concludes that the interventions' cultural resonance provides advantages over cultural competency AUDs programs developed in public health.
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Affiliation(s)
- Victor Garcia
- Indiana University of Pennsylvania, Indiana, Pennsylvania
| | - Emily Lambert
- Indiana University of Pennsylvania, Indiana, Pennsylvania
| | | | - Daniel Heckert
- Indiana University of Pennsylvania, Indiana, Pennsylvania
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Cultural competence and derivatives in substance use treatment for migrants and ethnic minorities: what’s the problem represented to be? SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00113-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mennis J, Stahler GJ, El Magd SA, Baron DA. How long does it take to complete outpatient substance use disorder treatment? Disparities among Blacks, Hispanics, and Whites in the US. Addict Behav 2019; 93:158-165. [PMID: 30711669 DOI: 10.1016/j.addbeh.2019.01.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 01/03/2023]
Abstract
This research investigates racial and ethnic disparities in outpatient substance use disorder treatment completion and duration in treatment, for different substances, across the US, using the national 2014 Treatment Episode Dataset-Discharge (TEDS-D) data set. Moderated fixed effects logistic regression models assessed effects of race/ethnicity on length of stay in treatment and treatment completion for different substances of use. Moderated models also assessed the differential effect of length of stay on treatment completion among Blacks, Hispanics, and Whites. While Blacks and Hispanics both have significantly lower treatment completion rates than Whites, treatment duration is substantially similar across the three groups. Blacks and Hispanics generally take longer to complete treatment than Whites, though this varies by substance for Hispanics. Disparities in treatment completion persist even after controlling for treatment duration. These results indicate that observed racial and ethnic disparities in treatment completion are not due to differences in length of stay in treatment. Economic, cultural, accessibility, or, potentially, discriminatory, factors may suppress the likelihood of treatment completion for minorities and result in longer treatment durations required for completion. Recognition by treatment providers of the unique challenges to treatment completion faced by minorities may enhance treatment outcomes for minorities in the US.
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Affiliation(s)
- Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, United States.
| | - Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, United States
| | | | - David A Baron
- Office of the Vice President for External and Clinical Affairs, Western University of the Health Sciences, Los Angeles, CA, United States
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Lucabeche VX, Haney JL. The effect of alcohol severity on outpatient treatment completion: The differential outcome by gender and race/ethnicity. J Subst Abuse Treat 2018; 90:1-8. [DOI: 10.1016/j.jsat.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
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Wendt DC, Gone JP. Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients. Int J Group Psychother 2018; 68:608-628. [PMID: 31527925 DOI: 10.1080/00207284.2018.1442225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.
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Cuadrado M. Roman Catholic Priests as Referral Sources and Treatment Aides for Hispanics with Substance Misuse/Abuse Problems. JOURNAL OF RELIGION AND HEALTH 2018; 57:609-621. [PMID: 28766248 DOI: 10.1007/s10943-017-0464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This self-administered mail survey study, conducted along the USA-Mexico border, examines Roman Catholic Priests' involvement in aiding Hispanic individuals with substance abuse problems. The Priests were found to be highly involved or willing to be involved in: (1) participating in juramentos (pledge usually to Virgin of Guadalupe, with Priest as witness, to temporarily abstain from substance use), (2) providing referrals, and (3) working with family and/or treatment resources in the community in order to help the person seeking their help. Fluency in Spanish, regardless of Hispanic ethnicity, was found to positively impact involvement in juramentos, providing referrals, and willingness to work with community resources.
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Affiliation(s)
- Mary Cuadrado
- School of Social and Behavioral Sciences, Mercy College, 555 Broadway, Dobbs Ferry, NY, 10522, USA.
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Guerrero EG, Song A, Henwood B, Kong Y, Kim T. Response to culturally competent drug treatment among homeless persons with different living arrangements. EVALUATION AND PROGRAM PLANNING 2018; 66:63-69. [PMID: 29049917 DOI: 10.1016/j.evalprogplan.2017.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 09/30/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
This study investigated the association between program cultural competence and homeless individuals' drug use after treatment in Los Angeles County, California. Los Angeles County has the largest and most diverse population of homeless individuals in the nation. We randomly selected for analysis 52 drug-treatment programs and 2158 participants who identified as homeless in the Los Angeles County Participant Reporting System in 2011. We included their living arrangements (indoors and stable, indoors and unstable, and outdoors) and individual and program characteristics (particularly whether their programs used six culturally competent practices) in multilevel regression analyses. The outcome was days of primary drug use at discharge.Results showed that higher levels of staff personal involvement in minority communities (IRR=0.437; 95% CI=0.222, 0.861) and outreach to minority communities (IRR = 0.406; 95% CI=0.213, 0.771) were associated with fewer days of drug use at discharge. Homeless individuals living outdoors used their primary drug more often than any other group. Yet, compared to individuals with other living arrangements, when outdoor homeless individuals were treated by programs with the highest community resources and linkages (IRR=0.364; 95% CI=0.157, 0.844), they reported the fewest days of drug use. We discuss implications for program evaluation and community engagement policies and practices.
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Affiliation(s)
- Erick G Guerrero
- Suzanne Dworak-Peck School of Social Work, and Marshall School of Business, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Ahyoung Song
- Department of Social Welfare, Gachon University, Seongnam, South Korea.
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, and Marshall School of Business, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA, 92834, USA.
| | - Tina Kim
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, Alhambra, CA, 91803, USA.
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Mazbouh-Moussa R, Ohtsuka K. Cultural competence in working with the Arab Australian community: a conceptual review and the experience of the Arab Council Australia (ACA) gambling help counselling service. ACTA ACUST UNITED AC 2017; 7:10. [PMID: 29250480 PMCID: PMC5725521 DOI: 10.1186/s40405-017-0029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/15/2017] [Indexed: 12/03/2022]
Abstract
Although Culturally And Linguistically Diverse (CALD) communities participate less in gambling than the general population, those who gamble are more likely to show signs of disordered gambling (Moore and Ohtsuka International Gambling Studies, 1, 87–101, 2001; Raylu and Oei Clinical Psychology Review, 23, 1087–1114, 2004; Yamine and Thomas The impact of gaming on specific cultural groups, Victorian Casino and Gaming Authority, Melbourne, 2000). Research data on gambling problems and interventions in the Arab Australian community are extremely scarce. Therefore, this article will present an overview of the Arab Australian community and cultural issues regarding gambling within the Arab Australian community. Identifying these issues is important to work effectively with Arab Australians clients and those from other CALD backgrounds. The article also presents a conceptual review of peer-reviewed research articles on cultural competence in working with the Arab clients, the overview of Arab migration history to Australia and a summary of recent events that suggest a tension between Arab and non-Arab Australian communities. Observations and experiences that were encountered during the gambling counselling service operating in the Australian Arab community in New South Wales are also discussed. The research data to validate the effectiveness and positive impact of cultural competence are still in its early stages. However, a small number of community education resources have been available for working with the Arab community. From the data in annual reviews on the Arab Council Australia gambling counselling service, it was identified that cultural beliefs and expectations influence risk-taking decisions, identification of gambling issues, and preference of help seeking within the client’s social network. Further, culturally-specific sensitive issues related to political and global security events, which in turn influenced openness and willingness for the help-seeking of the Arab Australians, were identified. In conclusion, we propose that recognising diversity within the Arab Australian community is a prerequisite for increasing cultural competence and cultural sensitivity for helping professionals working with Arab Australians.
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Guerrero EG, Garner BR, Cook B, Kong Y. Does the implementation of evidence-based and culturally competent practices reduce disparities in addiction treatment outcomes? Addict Behav 2017; 73:119-123. [PMID: 28501676 DOI: 10.1016/j.addbeh.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/13/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE Research is limited on the extent to which implementation of evidence-based and culturally responsive practices reduces outcome disparities in substance use disorder treatment. We examined the role of contingency management treatment (CMT), medication-assisted treatment (MAT), and culturally competent practices on Mexican Americans' rate of successful completion of treatment. METHODS We analyzed a concatenated dataset from 153 publicly funded substance use disorder treatment programs in Los Angeles County, California, in 2011 and 2013. These data were merged with data from 15,412 adult clients in both periods, of whom we selected only Mexican Americans (46.3%) and non-Latino Whites (53.7%). The outcome was successful treatment completion. The main independent variables were client demographics, drug use severity, mental health issues, and program license and professional accreditation. RESULTS Less than half of the programs highly implemented CMT, MAT, and culturally competent practices. CMT and cultural competence were not associated with successful treatment completion. However, Mexican Americans in programs with high degree of implementation of MAT had higher odds of successfully completing treatment compared to non-Latino Whites and programs with low MAT (OR=1.389; 95% CI=1.018, 1.897). CONCLUSIONS Findings highlight the role of MAT in reducing the disparity in treatment completion between Mexican Americans and non-Latino Whites. Implications for health policy and the dissemination of MAT are discussed.
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Guerrero EG, Garner BR, Cook B, Kong Y, Vega WA, Gelberg L. Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance. Subst Abuse Treat Prev Policy 2017; 12:27. [PMID: 28545551 PMCID: PMC5445402 DOI: 10.1186/s13011-017-0113-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/19/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs' acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. METHODS We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. RESULTS Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). CONCLUSIONS Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.
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Affiliation(s)
- Erick G. Guerrero
- Suzanne Dworak-Peck School of Social Work and Marshall School of Business, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | | | - Benjamin Cook
- Department of Psychiatry, Harvard Medical School, 2 West Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - Yinfei Kong
- Mihaylo College of Business and Economics, California State University, Fullerton, Fullerton, CA 90089 USA
| | - William A. Vega
- Department of Preventive Medicine, Keck School of Medicine, and Suzanne Dworak-Peck School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089 USA
| | - Lillian Gelberg
- Department of General Medicine, University of California, Los Angeles, Los Angeles, CA 90025 USA
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Program Capacity to Eliminate Outcome Disparities in Addiction Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:23-35. [PMID: 25450596 DOI: 10.1007/s10488-014-0617-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.
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Frimpong JA, Guerrero EG, Kong Y, Kim T. Abstinence at Successful Discharge in Publicly Funded Addiction Health Services. J Behav Health Serv Res 2016; 43:661-675. [PMID: 26882909 PMCID: PMC4987262 DOI: 10.1007/s11414-016-9497-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
| | - Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA
| | - Yinfei Kong
- Department of Information Systems and Decision Sciences, Mihaylo College of Business and Economics, California State University at Fullerton, 2250 Nutwood Avenue, Fullerton, 2831, USA
| | - Tina Kim
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, 1000 South Fremont Avenue, Building A-9 East, Alhambra, CA, 91803, USA
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Jason LA, Luna RD, Alvarez J, Stevens E. Collectivism and individualism in Latino recovery homes. J Ethn Subst Abuse 2016; 17:223-236. [PMID: 27115986 DOI: 10.1080/15332640.2016.1138267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research indicates that Latinos underutilize substance abuse interventions; cultural variables may contribute to difficulties accessing and completing treatment for this group. As a result, there is a need to understand the role of cultural constructs in treatment outcomes. The purpose of this study was to investigate how levels of collectivism (COL) and individualism (IND) relate to length of stay and relapse outcomes in self-run recovery homes. We compared Latinos in several culturally modified recovery Oxford Houses to Latinos in traditional recovery Oxford Houses. By examining COL and IND in the OH model, we explored whether aspects of COL and IND led to longer lengths of stay and better substance use outcomes. We hypothesized that higher levels of COL would predict longer stays in an Oxford House and less relapse. COL did not have a main effect on length of stay. However, COL had a significant interaction effect with house type such that COL was positively correlated with length of stay in traditional houses and negatively correlated with length of stay in the culturally modified condition; that is, those with higher collectivism tended to stay longer in traditional houses. When we investigated COL, length of stay, and substance use, COL was negatively correlated with relapse in the culturally modified houses and positively correlated with relapse in the traditional houses. In other words, those with higher COL spent less time and had less relapse in the culturally modified compared to the traditional Oxford Houses. The implications of these findings are discussed.
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Affiliation(s)
| | | | | | - Ed Stevens
- a DePaul University , Chicago , Illinois
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Mennis J, Stahler GJ. Racial and Ethnic Disparities in Outpatient Substance Use Disorder Treatment Episode Completion for Different Substances. J Subst Abuse Treat 2016; 63:25-33. [DOI: 10.1016/j.jsat.2015.12.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
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Otiniano Verissimo AD, Grella CE, Amaro H, Gee GC. Discrimination and substance use disorders among Latinos: the role of gender, nativity, and ethnicity. Am J Public Health 2014; 104:1421-8. [PMID: 24922159 DOI: 10.2105/ajph.2014.302011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. METHODS Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders. RESULTS Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups. CONCLUSIONS It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.
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Affiliation(s)
- Angie Denisse Otiniano Verissimo
- Angie Denisse Otiniano Verissimo and Christine E. Grella are with the Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles Integrated Substance Abuse Programs. Hortensia Amaro is with the Office of the Provost, School of Social Work, University of Southern California, Los Angeles. Gilbert C. Gee is with the Department of Community Health Sciences, University of California, Los Angeles
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Fernandez L, Rossouw T, Marcus T, Reinbrech-Schutte A, Smit N, Kinkel HF, Memon S, Hugo J. Factors associated with patients' understanding of their management plan in Tshwane clinics. Afr J Prim Health Care Fam Med 2014; 6:E1-9. [PMID: 26245390 PMCID: PMC4502834 DOI: 10.4102/phcfm.v6i1.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/20/2013] [Accepted: 10/26/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This research focused on patients' views regarding healthcare services and identified factors associated with understanding of their management plan. AIM To develop a baseline for patient-clinician collaboration and the extent to which patients felt included and understood their treatment plan. SETTING Tshwane district (South Africa) public health outpatient clinics. METHOD Medical students interviewed 447 patients in 22 clinics in Tshwane district. Agreement was measured by the percentage of cases in which patients and clinicians were in accord about a particular aspect of the consultation. RESULTS About one-third of patients incorrectly answered questions on whether changes in lifestyle or diet were prescribed as part of their treatment. The likelihood that patients understood their plan was associated with seeing the same clinician three or more times;having a consultation in their same or a similar language; patient participation in the diagnosis;and feeling that the clinician had explained their health problems to them. CONCLUSIONS There is need for greater emphasis on continuity of care, the clinicians' ability to speak the patient's language and involving patients in the consultation.
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Guerrero EG, Marsh JC, Cao D, Shin HC, Andrews C. Gender disparities in utilization and outcome of comprehensive substance abuse treatment among racial/ethnic groups. J Subst Abuse Treat 2013; 46:584-91. [PMID: 24560127 DOI: 10.1016/j.jsat.2013.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 11/22/2013] [Accepted: 12/10/2013] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, Los Angeles, CA 90089.
| | - Jeanne C Marsh
- School of Social Service Administration, University of Chicago, Chicago, IL 60637
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612
| | - Hee-Choon Shin
- National Center for Health Statistics, Hyattsville, MD 20782
| | - Christina Andrews
- College of Social Work, University of South Carolina, Columbia, SC 29208
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Guerrero EG, Marsh JC, Khachikian T, Amaro H, Vega WA. Disparities in Latino substance use, service use, and treatment: implications for culturally and evidence-based interventions under health care reform. Drug Alcohol Depend 2013; 133:805-13. [PMID: 23953657 DOI: 10.1016/j.drugalcdep.2013.07.027] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and treatment outcomes in an era of health care reform. METHODS The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies. RESULTS Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos' service use and immediate treatment outcomes have been both limited in number and inconsistent in findings. CONCLUSIONS This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, United States.
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Guerrero EG, Khachikian T, Kim T, Kong Y, Vega WA. Spanish language proficiency among providers and Latino clients' engagement in substance abuse treatment. Addict Behav 2013; 38:2893-7. [PMID: 24045032 DOI: 10.1016/j.addbeh.2013.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022]
Abstract
Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, California. An analytic sample of 1903 Latino clients nested within 40 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on days to initiate and spent in treatment. As hypothesized, Spanish language proficiency was negatively associated with client wait time and positively associated with retention in treatment, after controlling for individual and program characteristics. The path analysis models showed that Spanish language proficiency played a mediating role between professional accreditation and client wait time and retention. These preliminary findings provide an evidentiary base for the role of providers' Spanish language proficiency and Latino engagement in treatment for a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to enhance linguistically competent care, are discussed.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, United States.
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Guerrero EG, Kim A. Organizational structure, leadership and readiness for change and the implementation of organizational cultural competence in addiction health services. EVALUATION AND PROGRAM PLANNING 2013; 40:74-81. [PMID: 23816502 DOI: 10.1016/j.evalprogplan.2013.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/18/2013] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, Los Angeles, CA 90089, USA.
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Enhancing access and retention in substance abuse treatment: the role of Medicaid payment acceptance and cultural competence. Drug Alcohol Depend 2013; 132:555-61. [PMID: 23669458 DOI: 10.1016/j.drugalcdep.2013.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/29/2013] [Accepted: 04/01/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment. METHODS We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, CA. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment. RESULTS Programs that accepted public insurance (p<.001) and in which staff reported personal involvement (p<.01) and linkages and resources with minority communities (p<.001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p<.05) were positively associated with retention in treatment, after controlling for individual and program characteristics. CONCLUSIONS These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed.
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Guerrero EG, Marsh JC, Duan L, Oh C, Perron B, Lee B. Disparities in completion of substance abuse treatment between and within racial and ethnic groups. Health Serv Res 2013; 48:1450-67. [PMID: 23350871 DOI: 10.1111/1475-6773.12031] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California. DATA SOURCE The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006-2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time. STUDY DESIGN Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses. DATA COLLECTION Client data were collected during personal interviews at admission and discharge for most participants. PRINCIPAL FINDINGS African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only. CONCLUSIONS These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.
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Affiliation(s)
- Erick G Guerrero
- School of Social Work, University of Southern California, Los Angeles, CA 90089, USA.
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