Introduction Results and Conclusions Analyses of demographic and social variables indicated that Hispanics were more likely to be male, married, and living.

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Presentation transcript:

Introduction Results and Conclusions Analyses of demographic and social variables indicated that Hispanics were more likely to be male, married, and living with family, and were less likely to be legally involved relative to Whites and Blacks. Black clients were more often never married and homeless. In the psychiatric domain, greater proportions of the Hispanic clients received diagnostic impressions of depression, obsessive-compulsive, and generalized anxiety disorders from the M.I.N.I. interview. Hispanics were less likely to receive bipolar disorder diagnoses and White clients had the highest incidence of panic disorder. Hispanic clients reported greater symptom severity on nearly all scales of the BSI compared to both Whites and Blacks, whereas Blacks reported the lowest levels of depression and anxiety. Hispanics also received higher severity ratings by clinicians on the somatization, phobic anxiety, paranoid ideation, psychoticism, and global severity index scales relative to Whites and Blacks. By contrast, Black clients received the lowest clinician ratings on the somatization, obsessive-compulsive, depression, anxiety, and global severity index scales. In the area of substance use patterns, Hispanics were more likely to use powder cocaine as their primary substance, whereas Blacks more often used crack cocaine and marijuana and had a higher incidence of polysubstance use. Black clients were less likely to use alcohol as their primary substance relative Whites and Hispanics. Hispanics reported more days of primary substance use during the month prior to treatment; however, a greater proportion of Whites reported daily use of their primary substance during the 6 months prior to admission. Hispanics had a higher incidence of both previous detox and non-detox treatment and were less likely to have attended AA/NA in the month prior to admission compared to Whites and Blacks. At discharge, Hispanics achieved higher rates of treatment completion and past month abstinence but no group differences were found in length of stay or AA/NA attendance in the month prior to discharge. Examination of recovery support service utilization revealed that Hispanic clients more often received peer mentoring and food assistance but had comparatively lower levels of vocational and educational services. Whites were more likely to receive prescription services relative to Hispanics and Blacks. Results indicate that in this sample of COD clients, Hispanics displayed evidence of greater psychiatric severity on both client report and clinician rating measures. By contrast, Blacks demonstrated the lowest levels of psychiatric symptomatology. Hispanics also displayed evidence of greater substance use severity and had a higher incidence of past addiction treatment compared to Whites and Blacks. Despite this greater symptomatology, Hispanic clients had higher rates of treatment completion and abstinence at discharge relative to non- Hispanic clients. Further, approximately 75% of Hispanic clients received peer mentoring services, compared to 45% of Blacks and 29% of Whites, representing the greatest proportional difference among the recovery support service categories. These results suggest that future studies are needed to further explore client differences related to ethnicity and to examine the potential role of peer mentoring in enhancing outcomes of COD clients. Acknowledgements Presented at the Research Society on Alcoholism Conference, Chicago, Illinois, July 10, 2007 Demographic and Social Characteristics Diagnostic Impressions from M.I.N.I Recovery Support Services Received Treatment History and Substance Use The co-occurrence of psychiatric and substance use disorders (COD) and the effects of comorbidity on the clinical presentation and outcomes of substance abuse treatment are growing areas of study. Early studies in this area focused on severely mentally ill (SMI) populations and led to the development of specialized integrated treatment programs for these clients. As research progresses, studies and intervention models are expanding to include non-severe psychiatric disorders that are often prevalent in addiction treatment settings. Further, lines of research are focusing on identifying client characteristics that may be associated with treatment response and recovery for individuals with COD. Hispanic ethnicity is one potential factor that may be associated with clinical features and outcomes; cultural differences associated with ethnicity may influence symptom presentation and response to treatment interventions. The 2000 U.S. Census indicated that 32% of the Texas population was of Hispanic origin and many areas of the state, such as the border regions, are predominantly Hispanic. This demographic pattern suggests that Hispanic individuals constitute a growing proportion of the population, pointing to the importance of exploring potential differences based on ethnicity among COD clients receiving addiction treatment. The Texas Co-Occurring State Incentive Grant (COSIG) project was designed to enhance services for COD clients in addiction treatment. The project consists of two components: 1) focused training at the counselor level on COD concepts and the use of psychiatric diagnostic and assessment instruments, and 2) a voucher program to provide recovery support services for COD clients. Clients who qualify for the COSIG program are provided a $1,800 voucher during treatment to procure recovery support services in ten categories: housing, transportation, food assistance, peer mentoring, education, clothing, medical, prescriptions, vocational, and childcare. Eleven addiction treatment programs are participating in the project and are located throughout Texas in urban, rural, and border regions. The current study examines client and service characteristics in a sample of COD clients who participated in the Texas COSIG project. The purpose of the study is to compare Hispanic and non- Hispanic client characteristics and service features to explore potential differences based on ethnicity. The author acknowledges the Texas Department of State Health Services (TDSHS), Mental Health and Substance Abuse Services Division for their assistance in providing data for this study. The author also acknowledges the treatment providers participating in the COSIG project for contributing client data and recognizes their continuing efforts to enhance services for clients with co-occurring disorders. The findings and conclusions of this in this presentation are the opinions of the author and do not necessarily reflect the official position of TDSHS. Sample and Method The sample consisted of 515 COSIG clients who entered and were discharged from substance abuse treatment during the period of February 2005 through October Clients qualified for the COSIG program based on the presence of a comorbid non-substance use disorder determined though the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was recruited from eleven state-funded addiction programs participating in the COSIG project. The total sample was 57% female, 46% White, 39% Hispanic, and 14% Black. Hispanics (n=202), Whites (n=239) and Blacks (n=74) were compared on demographic variables, M.I.N.I. psychiatric diagnoses, substance use characteristics, psychiatric severity, recovery support service utilization and treatment outcomes. Psychiatric severity measures included the Brief Symptom Inventory (BSI; client report) and the Brief Derogatis Psychiatric Rating Scale (BDPRS; clinician rating). Demographic, substance use, and treatment data were obtained from the Behavioral Health Integrated Provider System (BHIPS), which is the mandatory data collection and outcomes monitoring system for state-funded substance abuse treatment providers in the state of Texas. Data regarding COSIG voucher service utilization were also available from BHIPS. Continuous variables were analyzed using analysis of variance and Scheffe’s Test to contrast groups with significant differences. Chi-square analyses were used to examine categorical variables. Discharge Characteristics Client Characteristics Psychiatric Severity Alcohol and Drug Use, Psychopathology, and Treatment Characteristics of Hispanic Versus Non-Hispanic Clients with Co-Occurring Disorders Laurel Mangrum, Ph.D. University of Texas at Austin, Addiction Research Institute