title: The effect of social environment on treatment outcomes in outpatient substance misuse treatment organizations: does race really matter?
abstract: This study examines whether the racial mix of clients is related to treatment organization outcome rates after controlling for the social environment in which the organization operates. A nationally representative sample of 326 nonmethadone outpatient substance misuser treatment organizations was surveyed in 1990. Unit analysis is the treatment organization. Outcome measures are the percentages of clients who completed and dropped out of treatment. The percent of Black clients treated at the organization, the socioeconomic status of the organization's area, and other client characteristics, organizational factors, and treatment practices are evaluated through multivariate regression to determine their impact on organizational rates of treatment success and failure among clients. Ordinary least-squares regression analysis indicates that race is not a predictor of treatment success once socioenvironmental factors are included in the analysis. Treatment organizations must be wary of defining a person for treatment only in terms of his or her racial or ethnic group membership. Treatment approaches should place more emphasis on the socioenvironmental influences to which the client is exposed and less emphasis on a client's race.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106-4945, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Howard
authors.forename: T A
authors.initials: TA
authors.lastname: LaVeist
authors.forename: W C
authors.initials: WC
authors.lastname: McCaughrin
mesh_terms: D000328:Adult; D001741:Black or African American; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D008297:Male; D011897:Random Allocation; D012923:Social Class; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome; D044465:White People