Drug treatment service utilization and outcomes for Hispanic and white methamphetamine abusers.

Ethnic disparities in the availability and quality of substance abuse treatment are of interest to both policy makers and treatment service providers. While there have been a number of studies indicating greater unmet needs for health services and poorer health outcomes for ethnic minorities across a range of disease areas (including cardiovascular disease, mental health, diabetes, and other chronic and infectious diseases) (IOM 2003), there has been little research on the service needs and treatment outcomes of Hispanics in substance abuse treatment. The lack of relevant data is particularly true for Hispanic methamphetamine (meth) abusers. Rates of meth abuse in California are among the highest in the country and continue to increase. Hispanics represent about 32 percent of the California population (California Department of Finance 2001). Yet we have limited information regarding service utilization and outcomes among Hispanic meth abusers receiving community-based drug treatment. In the present article, we use the term Hispanic to include Mexican Americans, Puerto Ricans, Cubans, and South and Central Americans living in California. Although there are little published data regarding ethnic disparities specifically among meth abusers, we review literature on drug treatment utilization and outcomes among Hispanics who abused other types of drugs that has relevance to the present study. Earlier studies reported opposing findings documenting both the underutilization of drug treatment services by ethnic minorities and an overrepresentation of Hispanics in drug abuse programs (Little 1981; De La Rosa, Khalsa, and Rouse 1990). However, more recent studies showed that among individuals with a perceived or clinical need for psychiatric or substance abuse services, Hispanics were less likely to be receiving services and less satisfied with the services they did receive as compared with whites (Wells et al. 2001). Among drug using arrestees, fewer Hispanics than whites reported receiving prior drug treatment, and Hispanics were more likely to believe that they had no need for treatment (Longshore et al. 1992). Hispanics have also been shown to have less access to speciality mental health care services than non-Hispanic whites (Padgett et al. 1994; Alegria et al. 2002). Few studies have examined the service needs of Hispanics in substance abuse treatment. Some studies have indicated more severe substance use and employment problems for Hispanics than blacks and whites in drug treatment (Kosten, Rounsaville, and Kleber 1985). Hispanics also entered treatment with a greater number of prior arrests and more time in jail than had whites (Anglin et al. 1988a, b). However, Morgenstern and Bux (2003) reported no ethnic differences in severity of legal problems between Hispanics and whites upon admission into treatment. An examination of mental health differences revealed that Hispanics who abused narcotics showed less psychopathology as compared to whites based on their multiphasic personality inventory (MMPI) scores (Penk et al. 1981). Clearly, additional research is needed to improve our understanding of Hispanic patients' clinical and psychosocial functioning upon entry into treatment so that improved care can be developed. The findings regarding substance abuse treatment retention among Hispanics are also inconsistent. In studies of outpatient cocaine abusers, some have reported that Hispanics are more likely to drop out of treatment than whites (Agosti, Nunes, and Ocepeck-Welikson 1996), while others have found no differences between Hispanics and whites (Kleinman et al. 1992). The latter study reported that Hispanics did not differ from whites in drug treatment retention but were more likely to be retained than blacks. Studies of narcotic-dependent individuals have consistently shown poor drug and legal outcomes for Hispanics. Following discharge from methadone maintenance, for example, Hispanics were less likely to be abstinent and were more likely to report daily drug use than whites (Anglin et al. 1988a, b). Approximately 12 years after entry into the California Civil Addict Program, more Hispanics (49 percent) than whites (31 percent) reported daily heroin use in the past 3 years (Brecht et al. 1987). An examination of legal outcomes showed that Hispanics in a methadone maintenance program were arrested more often and spent more time in jail than did whites during the year following treatment admission (Long and Demaree 1975). In a longitudinal study following narcotic-dependent men, Hispanics were more likely to be incarcerated or deceased than whites and had a more persistent and severe course of drug addiction (Prendergast, Hser, and Gil-Rivas 1998). Few studies have examined ethnic differences in outcomes of individuals who abuse drugs other than narcotics. Morgenstern and Bux (2003) reported no ethnic differences in alcohol, drug, legal, or psychiatric outcomes of 252 patients receiving community-based substance abuse treatment. However, a study of meth users found that being Hispanic (compared with white) was a significant predictor of time to relapse following treatment (Brecht, von Mayrhauser, and Anglin 2000). There is a notable lack of recent research examining Hispanic substance abuse outcomes generally and among meth abusers specifically. Based on a large treatment outcome study completed in California, we examined ethnic differences in service needs, treatment utilization, satisfaction, and outcomes between Hispanic and non-Hispanic white meth abusers. We hypothesized that Hispanics would receive fewer services, be less satisfied with the services they did receive, and have poor drug and psychiatric outcomes compared to whites. We also explored ethnic differences in alcohol, employment, family/social, medical, and legal outcomes because difficulties in these domains can be significant impediments to recovery. Our study objective was to contribute empirical data on how ethnicity is related to drug and psychosocial outcomes, and in turn, whether treatments need to be adapted to improve outcomes among different ethnicities.