Racial and ethnic disparities in outpatient substance use disorder treatment episode completion for different substances

This study investigates how racial and ethnic disparities in treatment episode completion vary across different problem substances in an urban sample of 416,224 outpatient treatment discharges drawn from the 2011 U.S. Treatment Episode Dataset-Discharge (TEDS-D) data set. Fixed effects logistic regression is employed to test for the association of race and ethnicity with treatment episode completion for different substances of use while controlling for confounding demographic, socioeconomic, and geographic clustering factors. Results show that African Americans and Hispanics are less likely to complete a treatment episode than Whites, and that these disparities vary among users of different substances. For African Americans, this disparity is observed over all substances, but is particularly acute among users of alcohol and methamphetamine, substances for which African Americans generally have lower rates of use disorder as compared to Whites. For Hispanics, this disparity is driven primarily by users of heroin, for which Hispanics are only 75% as likely as Whites to complete a treatment episode. For users of cocaine and methamphetamine, there is no significant difference between Hispanics and Whites in the likelihood of treatment episode completion. These results contribute to emerging research on the mechanisms of substance use disorder treatment outcomes and highlight the need for culturally appropriate treatment programs to enhance treatment program retention and associated positive post-treatment outcomes. (author abstract)