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Background: The low retention rates among African Americans in substance abuse treatment (Milligan et al., 2004) combined with the limited number of treatments.

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Presentation on theme: "Background: The low retention rates among African Americans in substance abuse treatment (Milligan et al., 2004) combined with the limited number of treatments."— Presentation transcript:

1 Background: The low retention rates among African Americans in substance abuse treatment (Milligan et al., 2004) combined with the limited number of treatments with demonstrated efficacy for African American substance users (Nagayama-Hall, 2001) are both public health concerns. This study is designed to address these concerns by determining the efficacy of Motivational Enhancement Therapy (MET) for increasing retention and reducing drug use among African Americans who abuse substances (i.e., alcohol, cocaine, marijuana, opioids, benzodiazepines, methamphetamines and other drugs). MET is a client-centered approach grounded in Motivational Interviewing (MI) that enhances intrinsic motivation in the client to change their behaviors. A recent meta-analysis revealed that MI yielded a larger effect size for ethnic minority populations than White populations (Hettema et al., 2005). Few studies have focused exclusively on substance abusing African Americans. Results from these studies are promising. For example, Longshore and Grills (2000) examined the efficacy of a culturally tailored version of MET for African American substance users. They found that MET was successful in reducing drug use among African Americans. The current study is among the few to assess the efficacy of a generic (i.e., not culturally tailored) version of MET as compared to counseling as usual (CAU) with an African American sample. The study was a secondary analysis of a multi-site randomized clinical trial of MET conducted by the National Institute of Drug Abuse (NIDA) Clinical Trials Network (CTN) Hypotheses: Hypothesis 1: African Americans in MET will use fewer substances (i.e., self-report of drug use and urine screens) than African Americans in CAU. Hypothesis 2: African Americans in MET will have higher retention rates than African Americans in CAU. Acknowledgments: The authors would like to thank Dr. Kathleen Carroll and the rest of the NIDA CTN 0004 research team for sharing data for this project. Outcome Variables: Urine screens: Probability of receiving at least one positive urine screen during the four week active phase Self-report of drug use : Self-report of weekly drug use for each of the 16 study weeks Retention : Number of days between the day of enrollment and the last day that the participant received services Discussion: The efficacy of MET appeared to be more evident when urine screens rather than self report were used to assess substance use. Moreover, even the positive findings for urine screens were limited to primary alcohol users. This finding suggests that those primary alcohol users assigned to MET were less likely than those assigned to CAU to use other drugs during the 4 week active phase. The finding that MET was associated with better retention for African American females is promising. However, the fact that this finding was evident for females but not males suggests that the benefits of MET may vary for specific subgroups of African Americans. FUTURE STUDIES:  The pattern of findings was somewhat different for the African American sample than the overall sample. This suggests that outcomes should be analyzed separately for African Americans.  Future studies should focus more on identifying the specific subgroups of African Americans who may benefit from MET.  Future studies should examine whether a culturally adapted version of MET might yield better outcomes for African Americans. LaTrice Montgomery, M.A. 1, Kathleen Burlew, Ph.D. 1, Andrzej S. Kosinski, Ph.D. 2, & Alyssa Forcehimes, Ph.D. 3 1 University of Cincinnati, 2 Duke Clinical Research Institute, 3 University of New Mexico References: Hettema, J., Steele, J., & Miller, W.R. (2005). Motivational interviewing. Annual Review of Clinical Psychology,1, Longshore, D., & Grills, C. (2000). Motivating illegal drug use recovery: Evidence for a culturally congruent intervention. Journal of Black Psychology, 26(3), Milligan, C., Celeste, O., Nich, C., & Carroll, K. (2004). Ethnic differences in substance abuse treatment, retention, compliance and outcome from two clinical trials. Psychiatric Services, 55, Nagayama-Hall, G. (2001). Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and Clinical Psychology, 69, Hypothesis 1: Self-Report of Drug Use (Linear Mixed Modeling):  Overall, African Americans in MET reported using more drugs than those in CAU throughout the 16 study weeks (p < 0.001). Urine Screens (Logistic Regression):  Among alcohol users only, African Americans in MET were less likely to have a positive urine screen than those in CAU during the 4 week active phase (p = 0.05, OR = 0.28, 95% CI 0.08 – 1.01).  However, the probability of positive urines did not significantly differ among African Americans in MET and those in CAU overall during the 4 week active phase (p = 0.52). Hypothesis 2: Retention (Survival Analysis):  Among African American females, those in MET had better retention than those in CAU during the initial 12 weeks (log- rank p = 0.05 when considering the initial 12 weeks; log-rank p = 0.09 when considering the entire 16 week period).  However, the retention rates did not differ for African American males in MET and CAU (p =.10). The Efficacy of Motivational Enhancement Therapy for African American Substance Users Participants:  194 African Americans seeking substance abuse treatment at one of five community based treatment programs (CTPs)  Used drugs 28 days prior to randomization  48 females, 146 males  Average age of 38  Primary drug choices: cocaine (N = 50) and alcohol (N = 51) Measures:  Urine Monitoring Result Form  Substance Use Calendar  Client Disposition-End of Trial Status Form  Demographic Form Procedure: Individuals sought treatment and completed triage at CTP, were invited to participate and provide informed consent Completed brief assessment battery Randomized: CAU or MET 3 individual sessions of CAU (28 day window) 3 individual sessions of MET (28 day window) Referred to ongoing CAU treatment at CTPs Follow-up assessments at 8 and 16 weeks Results: Completed posttreatment assessment


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