What motivates someone to change is complex, particularly when it comes to addictive behaviors. Substance abuse programs in the U.S. reflect the disparity evident in the health care system as a whole—while Whites are twice as likely to report substance abuse problems as Blacks, Black clients are two times less likely to complete substance abuse treatment programs.

Race and referral sources

In an effort to investigate this paradox, a team of University of Iowa researchers, including Marizen Ramirez, associate professor of occupational and environmental health in the College of Public Health, considered how referral source might affect completion of treatment among racial groups. They found that Black clients were most likely to successfully complete treatment when referred by an employer, while for White clients, criminal justice referrals such as court orders were associated with the highest percentage of program completion.

The study, which was published online April 18, 2015, in the journal Addictive Behaviors, drew on the vast data sets collected by the national Substance Abuse and Mental Health Services Administration from the years 2006–2009. Clients were over 18 and had received no prior treatment; more than 2.5 million cases met these criteria. Overall, the study found a 44.2% successful treatment completion rate for all clients. The treatment completion rate was 47.1% for Whites and 34.9% for Blacks.

Referral sources included self-referral, drug abuse agency, health care professional, school, employer, community, and criminal justice agency. It was noted that several of these may include a certain amount of coercion, as failure to comply would result in consequences such as loss of freedom, employment, or education.

Although the researchers could not say definitively that this was where racial differences entered the equation, they suggest that Blacks may not have been as affected by the coercive nature of possible incarceration as Whites in that they may not have believed that their behavior would have an impact on whether or not they received jail time.

Criminal justice, employer, and student referral sources had the highest success rate for both White and Black clients. Interestingly, self-referrals and referrals from health care providers were associated with the lowest success rates for both Black and White clients.

Multicultural perspectives

The study makes a strong case for the argument that incentives for substance abuse treatment might benefit from a multicultural perspective.

“Health care providers need to learn better follow-up techniques to help their patients recover,” says corresponding author Stephan Arndt, director of the Iowa Consortium for Substance Abuse Research and Evaluation. “Making more of an effort to involve employers rather than the criminal justice system may reduce the disparities.” Arndt is also a professor in biostatistics and psychiatry.

The research team also included Ethan Sahker, graduate research assistant in the Iowa Consortium for Substance Abuse Research and Evaluation and the Department of Psychological and Quantitative Foundations; Maisha Toussaint, graduate research assistant in the Department of Epidemiology; and Saba Ali, associate professor in the Department of Psychological and Quantitative Foundations.