André Q C Miguel1, Ayana Jordan2, Brian D Kiluk3, Charla Nich4, Theresa A Babuscio5, Jair J Mari6, Kathleen M Carroll7. 1. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA; Department of Psychiatry, Federal University of Sao Paulo, Rua Major Maragliano 241, Vila Mariana, São Paulo, SP 04017-030, Brazil. Electronic address: andre.miguel@yale.edu. 2. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. Electronic address: ayana.jordan@yale.edu. 3. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. Electronic address: brian.kiluk@yale.edu. 4. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. Electronic address: charla.nich@yale.edu. 5. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. Electronic address: theresa.babuscio@yale.edu. 6. Department of Psychiatry, Federal University of Sao Paulo, Rua Major Maragliano 241, Vila Mariana, São Paulo, SP 04017-030, Brazil. Electronic address: jamari17@gmail.com. 7. Department of Psychiatry, Yale University School of Medicine, Temple Medical Building, Suite 6C, 40 Temple Street, New Haven, CT 06510, USA. Electronic address: kathleen.carroll@yale.edu.
Abstract
BACKGROUND: Most published treatment trials for cocaine use disorders (CUD) have been conducted with samples composed predominantly of White men and underrepresent women and racial/ethnic minorities. Because of the high prevalence of men and White individuals in CUD treatment trials, results from studies that have compared treatment outcomes by gender and race or ethnicity separately may not be representative of women or racial/ethnic minorities. METHODS: With a sample pooled from seven randomized clinical trials of treatment for CUD (n = 629), baseline characteristics and treatment outcome responses were compared with 4 subgroups of individuals created based on the intersection of gender and race (White men, Black men, White women and Black women). RESULTS: At baseline, sociodemographic status, pattern, frequency and severity of cocaine use, psychiatric comorbidities, employment and legal problems significantly differed across groups. Treatment outcome indicators collected during treatment and through follow-up, consistently indicated poorer outcomes among the sample of White women, but were similar for the other groups. CONCLUSIONS: Men and women with CUD from both racial groups enter treatment with different psychosocial issues (e.g., history of violence/trauma, financial problems, co-occurring psychiatric disorders) and substance use problems (e.g. types of substances) that may impact treatment outcomes and indicate a need for culturally-informed care to deliver more effective treatment for CUD. Poorer overall outcomes among White women may reflect the need for a more focused treatment approach for this group; and highlight the importance of evaluating gender and race in treatment trials to better address health disparities. Published by Elsevier Inc.
BACKGROUND: Most published treatment trials for cocaine use disorders (CUD) have been conducted with samples composed predominantly of White men and underrepresent women and racial/ethnic minorities. Because of the high prevalence of men and White individuals in CUD treatment trials, results from studies that have compared treatment outcomes by gender and race or ethnicity separately may not be representative of women or racial/ethnic minorities. METHODS: With a sample pooled from seven randomized clinical trials of treatment for CUD (n = 629), baseline characteristics and treatment outcome responses were compared with 4 subgroups of individuals created based on the intersection of gender and race (White men, Black men, White women and Black women). RESULTS: At baseline, sociodemographic status, pattern, frequency and severity of cocaine use, psychiatric comorbidities, employment and legal problems significantly differed across groups. Treatment outcome indicators collected during treatment and through follow-up, consistently indicated poorer outcomes among the sample of White women, but were similar for the other groups. CONCLUSIONS:Men and women with CUD from both racial groups enter treatment with different psychosocial issues (e.g., history of violence/trauma, financial problems, co-occurring psychiatric disorders) and substance use problems (e.g. types of substances) that may impact treatment outcomes and indicate a need for culturally-informed care to deliver more effective treatment for CUD. Poorer overall outcomes among White women may reflect the need for a more focused treatment approach for this group; and highlight the importance of evaluating gender and race in treatment trials to better address health disparities. Published by Elsevier Inc.
Authors: Kathleen M Carroll; Lisa R Fenton; Samuel A Ball; Charla Nich; Tami L Frankforter; Julia Shi; Bruce J Rounsaville Journal: Arch Gen Psychiatry Date: 2004-03
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