Can Cultural Competency Speak to the Race Disparities in Methadone Dosage Levels?
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Although national methadone treatment trends have improved substantially from 1988 to 2001, current research has found that African Americans still receive lower dosages of methadone treatment than their white and Hispanic counterparts, which has significant public health concerns. We sought to empirically examine whether the degree of cultural competency within an outpatient substance abuse treatment (OSAT) organization has influence on the methadone dosage levels received by African Americans in 1995 and in 2005. The 1995 and 2005 National Drug Abuse Treatment System Survey (NDATSS) provided a nationally-representative, stratified sample of 618 and 566 OSAT organizations, respectively, of which 121 and 140 affiliated methadone maintenance treatment programs, respectively, were analyzed. The organizations’ director and clinical supervisor were surveyed. Fixed-effects linear regression models were fitted with measures of cultural competency, client, and organizational characteristics to assess methadone dosage levels. Culturally-competent units have smaller numbers of methadone clients, greater percentages of clients who receive methadone dosages of less than 40 mg/d, smaller percentages of clients who receive methadone dosages of 80 mg/d or more, and provide a larger number of therapeutic and ancillary services during treatment than non-culturally-competent units. OSAT units with more African Americans are significantly more likely to have clients who receive dosages of less than 40 mg/d and are significantly less likely to have clients who receive dosages of 80 mg/d or more. There is no racial difference among culturally-competent unit clients who receive dosages of less than 40 mg/d, between 40 and 59 mg/d, between 60 and 79 mg/d, and 80 mg/d or more. However, among non-culturally-competent units, a racial difference exists among African Americans and other clients who receive these various dosage levels. Research indicating that African Americans receive lower dosages of methadone than their White and Hispanic counterparts may now be explained by whether these clients receive treatment in culturally competent organizations, rather than solely by arguments related to organizational differences in resources, experience and training of staff, staff bias and/or racism. Culturally competent organizations may seek a method of treatment that dissuades “replacing one drug for another,” while simultaneously treating the root cause of the addiction through the provision of comprehensive therapeutic and ancillary support services. Further research is needed to determine if cultural competency results in better substance abuse treatment outcomes for African Americans.
- Adams TK. Outpatient substance abuse treatment surveys (OSATSS) sampling and weighting documentation for OSATSS-6, 2004. Ann Arbor: Survey Research Center, Institute for Social Research, University of Michigan; 2005.
- Balsa A, McGuirre T. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ. 2003;22(1):89–116. CrossRef
- Betancourt J, Green A, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118:293–302.
- Bourgois P. Disciplining addictions: the bio-politics of methadone and heroin in the United States. Cult Med Psychiatry. 2000;24:165–95. CrossRef
- Bourgois P, Martinez A, Kral A, Edlin B, Schonberg J, Ciccarone D. Reinterpreting ethnic patterns among White and African American men who inject heroin: a social science of medicine approach. PLoS Medicine. 2006;3(10):e452. CrossRef
- Brach C, Fraser I. Can cultural competency reduce racial and ethnic disparities? A review and conceptual model. Med Care Res Rev. 2000;57(Supplement 1):181–217.
- Brady T, Krebs C, Laird G. Psychiatric co morbidity and not completing jail-based substance abuse treatment. Am J Addict. 2004;13:83–101. CrossRef
- Brown B. Federal drug abuse policy and minority group issues: reflections of a participant observer. Int J Addict. 1985;20:203–15.
- Campbell C, Alexander J. Culturally competent treatment practices and ancillary services in outpatient substance treatment. J Subst Abuse Treat. 2002;22:109–19. CrossRef
- D’Aunno T, Pollack HA. Changes in methadone treatment practices: results from a national panel study, 1988–2000. JAMA. 2002;267:253–67. CrossRef
- Faggiano F, Vigna-Taglianti F, Verdino E, Lemma P. Methadone maintenance at different dosages for opiod dependence. The Cochrane Library Issue 1; 2007.
- Groves RM. Telephone survey methodology. New York: Wiley; 1988.
- Heeringa S. Outpatient drug abuse treatment studies: technical documentation. Ann Arbor: Institute for Social Research, University of Michigan; 1996.
- Holt M. Agency and dependency within treatment: drug treatment clients negotiating methadone and antidepressants. Soc Sci Med 2007;64(9);1937–47.
- Howard DL. Culturally competent treatment of African American clients among a national sample of outpatient substance abuse treatment units. J Subst Abuse Treat. 2003a;24:89–102. CrossRef
- Howard DL. Are treatment goals of culturally competent outpatient substance abuse treatment units congruent with their client profile? J Subst Abuse Treat. 2003b;24:103–13. CrossRef
- Jacobson J, Robinson P, Bluthenthal R. Racial disparities in completion rates from publicly funded alcohol treatment: economic resources explain more than demographics and addiction severity. Health Serv Res. 2007;42(2):773–92. CrossRef
- Joseph H, Stancliff S, Langrod J. Methadone maintenance treatment (MMT): a review of historical and clinical issues. Mt Sinai J Med. 2000;67(5):347–64.
- Kayman DJ, Godstein M, Deren S, Rosenblum A. Predicting treatment retention with a brief “opinions about methadone” scale. J Psychoact Drugs. 2006;38(1):93–100.
- Kirdorf M, Hollander JR, King VL, Brooner RK. Increasing the employment of opiod dependent outpatient: an intensive behavioral intervention. Drug Alcohol Depend. 1998;50(1):73–80. CrossRef
- Longshore D, Grills C, Annon K, Grady R. Promoting recovery from drug abuse: an Afrocentric intervention. J Black Stud. 1998;28(3):319–33.
- Marion I. Methadone Treatment at Forty. Clinical Perspectives. 2005; December 25–33.
- National Institute of Drug Abuse. High-dose improves treatment outcomes. NIDA Notes. 1999;14:5.
- Nurco D, Hanlon T, Shaffer J, Kinlock T, Duszynsk K, Stephenson P. Differences among treatment clinic types in attitudes toward narcotic addiction. J Nerv Ment Dis. 1980;176(12):714–8.
- Pollack H, D’Aunno T. Continued disparities inmethadone treatment : Results from a national survey, 1988–2005; 2007. (Under review)
- Rathore S, Rumholz H. Differences, disparities, and biases: clarifying racial variations in healthcare use. Ann Intern Med. 2004;141:635–8.
- Rosen D. Factors associated with illegal drug use among older methadone clients. The Gerontologists. 2004;44(4):543–7.
- Stancliff S, Myers J, Steiner S. Beliefs about methadone in an inner-city methadone clinic. J Urban Health. 2002;79(4):571–8.
- Strain E, Bigelow G, Liebson I, Stitzer M. Moderate- vs. high-dose methadone in the treatment of opiod dependence: a randomized trial. J Am Med Assoc. 1999;281(11):1000–5. CrossRef
- Trafton J, Minkel J, Humphrey K. Determining effective methadone doses for individual opiod-dependent patients. PloS Medicine. 2006;3(3):e80. CrossRef
- White W, Coon B. Methadone and the anti-medication bias in addiction treatment. Counselor. 2003;4(5):58–63.
- Woods J. Methadone advocacy: the voice of the patient. Mt. Sinai J Med. 2001;68(1):75–8.
- Can Cultural Competency Speak to the Race Disparities in Methadone Dosage Levels?
The Review of Black Political Economy
Volume 37, Issue 1 , pp 7-23
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- National drug abuse treatment system survey
- Author Affiliations
- 2. The Robert Wood Johnson Foundation (RWJF) Center for Health Policy at Meharry College (MMC), Nashville, TN, USA
- 1. Institute for Health, Social, and Community Research, Shaw University, 118 E. South Street, Raleigh, NC, 27601, USA
- 3. Department of Sociology, University of Central Florida, Orlando, FL, 32816, USA