Project Match treatment participation and outcome by self-reported ethnicity

BACKGROUND: There is a lively ongoing debate concerning the need for culturally congruent alcohol treatment, with the assumption that such treatment would meaningfully address treatment outcome disparities among ethnic minorities. Although valid on the face of it, no randomized clinical trials have yet prospectively investigated and documented whether, in fact, different ethnic groups actually fare better or worse from one another when offered mainstream, culturally "incongruent" treatment. The purpose of this study was to contrast Hispanic, black, and white client treatment engagement and outcome in an effort to identify potential health disparities related to client ethnicity. METHODS: The Project Match outpatient (N = 952) and aftercare (N = 774) samples were divided according to self-reported ethnicity: Hispanic (n = 141; 8%), black (n = 168; 10%), and white (n = 1380; 80%). Controlling for socioeconomic status using the Hollingshead Occupational scale, the three ethnic groups were contrasted on pretreatment characteristics, rates of treatment attendance, three scales of therapeutic alliance, satisfaction with treatment, and drinking outcomes for the 12 months after treatment. RESULTS: Ethnic differences in rates of therapy attendance were not robust and dissipated after controlling for socioeconomic status. No mean ethnic differences in ratings of therapeutic bonding and agreement with therapy goals were obtained, but blacks and Hispanics reported higher agreement on the value of therapeutic tasks relative to whites. Nevertheless, whites reported significantly higher global satisfaction with treatment relative to Hispanics and blacks. No ethnic main effect was found in drinking intensity during the 12-month follow-up. In contrast and only in the outpatient sample, blacks (n = 51) reported significantly higher rates of monthly abstinence relative to whites (n = 679). CONCLUSIONS: Pretreatment characteristics predictive of positive treatment outcome favored white clients relative to Hispanic and black clients, but Hispanic and black clients fared at least as well as white clients during the 12-month follow-up, at least on two measures of drinking behavior. The absence, then, of poorer drinking outcomes for the ethnic minorities suggests that they may mobilize (1). different behavior change strategies and/or (2). additional social resources to achieve comparable drinking outcomes with white clients. Specific recommendations for future research are made.