Ethnic differences in substance abuse treatment retention, compliance, and outcome from two clinical trials.
OBJECTIVE
This study examined the results of two previous studies that evaluated African Americans and whites who were undergoing treatment for cocaine dependence to determine whether the groups differed in pretreatment characteristics, treatment retention, compliance, and cocaine use outcome.


METHODS
Data were taken from two trials (N=111 in each), in which patients were randomly assigned to groups that used different behavioral treatments (cognitive-behavioral treatment and 12-step facilitation) and pharmacotherapies (desipramine and disulfiram).


RESULTS
Few differences between African Americans and whites were found in terms of demographic characteristics, reasons for seeking treatment, or expectations of treatment. In both studies African Americans and whites did not differ significantly with respect to cocaine use outcomes, but African-American participants completed significantly fewer days of treatment than white participants. In study 2, which was not placebo controlled, African Americans who received disulfiram remained in treatment significantly longer than African Americans who did not receive disulfiram. However, in study 1, in which patients took either desipramine or a placebo, no interactions of ethnicity by medication were found. Among patients who expected improvement to take a month or longer in study 1, African Americans remained in treatment for fewer days than whites.


CONCLUSIONS
The behavioral therapies evaluated did not significantly differ in effectiveness for African Americans and whites, suggesting that they are broadly applicable across these ethnic groups. Findings also suggest possible strategies for improving retention of African Americans in treatment. Such strategies might include offering treatment with a medication component and better addressing participants' treatment expectations.
Milligan
Celeste O
CO
Psychiatry Department at Yale University School of Medicine, Clinical Research Unit, New Haven, Connecticut 06511, USA. celeste.milligan@yale.edu
Nich
Charla
C
Carroll
Kathleen M
KM
D000328:Adult; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D044383:Black People / Q000523:psychology; D019970:Cocaine-Related Disorders / Q000208:ethnology* / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003237:Connecticut; D003891:Desipramine / Q000627:therapeutic use; D004221:Disulfiram / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000208:ethnology*; D010352:Patient Dropouts; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000523:psychology; D001741:Black or African American
D000929:Antidepressive Agents, Tricyclic; D004791:Enzyme Inhibitors; D003891:Desipramine; D004221:Disulfiram