Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA

Subst Abuse Treat Prev Policy

Villatoro

Kong

et al. 2014

BackgroundWe examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender.MethodsThis study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment.ResultsSignificant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City.ConclusionsDrug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.

Section: Discussionsupporting

confidence: 89%

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status

Subst Abuse Treat Prev Policy

Villatoro

Kong

et al. 2014

“…Consistent with other studies (Guerrero, Campos, Urada et al, 2012; Guerrero, Cepeda, Duan et al, 2012; SAMHSA, 2009a), results suggest clients’ primary drug of choice and co-occurring substance use and mental health disorders play a role in successfully completing the goals of treatment. This suggests that beyond ethnicity, programs should tailor practices to respond effectively to the service needs of heroin users and those with co-occurring conditions.…”

Section: Discussionsupporting

confidence: 87%

Does the implementation of evidence-based and culturally competent practices reduce disparities in addiction treatment outcomes?

Garner²,

Cook

et al. 2017

Addictive Behaviors

Self Cite

Rationale Research is limited on the extent to which implementation of evidence-based and culturally responsive practices reduces outcome disparities in substance use disorder treatment. We examined the role of contingency management treatment (CMT), medication-assisted treatment (MAT), and culturally competent practices on Mexican Americans’ rate of successful completion of treatment. Methods We analyzed a concatenated dataset from 153 publicly funded substance use disorder treatment programs in Los Angeles County, California, in 2011 and 2013. These data were merged with data from 15,412 adult clients in both periods, of whom we selected only Mexican Americans (46.3%) and non-Latino Whites (53.7%). The outcome was successful treatment completion. The main independent variables were client demographics, drug use severity, mental health issues, and program license and professional accreditation. Results Less than half of the programs highly implemented CMT, MAT, and culturally competent practices. CMT and cultural competence were not associated with successful treatment completion. However, Mexican Americans in programs with high degree of implementation of MAT had higher odds of successfully completing treatment compared to non-Latino Whites and programs with low MAT (OR = 1.389; 95% CI = 1.018, 1.897). Conclusions Findings highlight the role of MAT in reducing the disparity in treatment completion between Mexican Americans and non-Latino Whites. Implications for health policy and the dissemination of MAT are discussed.

“…This dichotomous measure was coded 1 if clients met the following criteria: (a) the client reported no days of alcohol or drug use during the 30 days prior to discharge, (b) the clinician reported client sobriety at discharge, and (c) the clinician coded treatment episode as successful based on the client meeting treatment goals for that episode. This measure of treatment completion is more comprehensive than recent regional [37] and national [38] studies used in several analyses [39, 40]. …”

Section: Methodsmentioning

confidence: 99%

Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance

Subst Abuse Treat Prev Policy

Garner

Cook

et al. 2017

Self Cite

BackgroundMedicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs’ acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites.MethodsWe analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments.ResultsMexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637).ConclusionsFindings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.