African American Substance Users Research Articles

How can we help African American substance users stop smoking? client and agency perspectives

ABSTRACTResearch is needed to better understand barriers to smoking cessation and sustained abstinence among racial/ethnic minority polydrug users. We conducted community dialogue groups involving 49 clients in substance use treatment programs with predominantly ethnic minority clientele and individual dialogues/interviews with seven program providers (stakeholders). Most clients were African American, under 40 years old, women, current smokers, and high school graduates. Smoking cessation services in these programs were considered inadequate and community programs insufficiently culturally tailored and economically and geographically inaccessible. Participants discussed individual “willpower” and choice; agency tobacco-related programs and policies; the relationships between smoking, smoking cessation, and treatment goals; and steps needed to reshape agency services and policies to provide greater support for smoking cessation in this at-risk population.

Distress tolerance interacts with circumstances, motivation, and readiness to predict substance abuse treatment retention

BackgroundOur understanding of the conditions that influence substance abuse treatment retention in urban African American substance users is limited. This study examined the interacting effect of circumstances, motivation, and readiness (CMR) with distress tolerance to predict substance abuse treatment retention in a sample of urban African American treatment-seeking substance users. MethodsData were collected from 81 African American substance users entering residential substance abuse treatment facility in an urban setting. Participants completed self-reported measures on CMR and distress tolerance. In addition, participants were assessed on psychiatric comorbidities, substance use severity, number of previous treatments, and demographic characteristics. Data on substance abuse treatment retention were obtained using administrative records of the treatment center. ResultsLogistic regression analysis found that the interaction of CMR and distress tolerance was significant in predicting substance abuse treatment retention. Higher score on CMR was significantly associated with increased likelihood of treatment retention in substance users with higher distress tolerance, but not in substance users with lower distress tolerance. ConclusionsFindings of the study indicate that at higher level of distress tolerance, favorable external circumstances, higher internal motivation, and greater readiness to treatment are important indicators of substance abuse treatment retention. The study highlights the need for assessing CMR and distress tolerance levels among substance users entering treatment, and providing targeted interventions to increase substance abuse treatment retention and subsequent recovery from substance abuse among urban African American substance users.

Condom barriers among African American substance users: Age and gender differences

Condom barriers among African American substance users: Age and gender differences

The Criminal Justice Experience of African American Cocaine Users in Arkansas

ABSTRACTBackground: African Americans are incarcerated at rates much higher than other racial and ethnic groups in the United States. Objectives: We sought to qualitatively explore the relationships between ongoing involvement in the criminal justice system and continued drug use in a population of urban and rural African American cocaine users in a southern state. Methods: Semi-structured qualitative interviews were conducted among African American cocaine users in Arkansas between 2010 and 2012. Participants resided in both rural (two counties located in the eastern Arkansas Mississippi delta region) and urban (the county including the capital city of Little Rock) areas. Results: Numerous important themes emerged from participants’ narratives, including chronic involvement with the criminal justice system (being a “career criminal”), continued access to drugs while incarcerated, relapse, and reincarceration and lack of access to effective drug treatment. Conclusion/Importance: The themes which emerged from our data speak to the collective experience that many substance using populations in the United States face in dealing with the criminal justice system. Our findings highlight the need to better, more holistic ways of engaging African American substance users in community based substance use treatment and supportive services.

Substance Use Correlates of Depression among African American Male Inmates.

Substance use correlates of depressive symptoms among incarcerated adult male African American substance users were examined in the current study. Frequency of drug use was assessed with 12 items specific to an individual's substance use. The Patient Depression Questionnaire (PHQ-9) was used to assess symptoms of depression. Approximately 90% of the sample displayed symptoms of depression ranging from minimal to severe. Regression models revealed that three substance use variables demonstrated a significant predictor of depression, including alcohol (β = .16, p= .03), hallucinogens (β =-.17, p =.021), and ecstasy (β =-.14, p= .05). The study findings indicate a need to consider the role of specific substances with regard to symptoms of depression. The results are discussed in the context of transition planning for jail inmates.

Initial abstinence status and contingency management treatment outcomes: does race matter?

Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.

THE ASSOCIATION BETWEEN HIV STATUS AND HOMELESSNESS AMONG VETERANS IN CARE

Veterans seeking care in the Department of Veterans Affairs Health Care System (VA) are more vulnerable to HIV infection and homelessness. However, there is little scholarship on the association between serostatus and homelessness among VA veterans. We examined this association in the Veterans Aging Cohort Study, a sample of 6,819 HIV-positive and HIV-negative veterans attending 8 VAs across the country. We utilized logistic models regressing shelter use in the last month on correlates. HIV and homelessness prevalence was higher than in general veteran populations. Being HIV-positive was protective against homelessness. Substance use, hazardous alcohol use, depression, schizophrenia, and being African American and male increased risk of homelessness. HIV-positive status reduced the homelessness risk posed by substance use, especially among African American substance users. However, women veterans with HIV were at higher risk of homelessness than noninfected women veterans. Implications for policies on veteran homelessness and housing for people with HIV are discussed.

Motivational enhancement, readiness to change, and treatment success in African-American substance users

Aims: Although a body of literature supports the effectiveness ofMotivational Enhancement Therapy (MET) in reducing substance use for the general population, several studies report inconsistent findings, especially among African Americans (AA). In the National DrugAbuseTreatmentClinical TrialsNetwork, nooverall difference was found betweenMET and Counseling as Usual (CAU) in the CTN0004 protocol. Among AA overall, MET showed significantly more days of primary substance use than CAU; however, this patternwas reversedamong thosewithhighbaseline readiness to change (RTC). We therefore hypothesized a mediator relationship in AA patients, such that (1) MET would positively influence RTC over time and (2) increased RTC would be correlated with successful treatment outcomes. Methods: We conducted secondary analyses of 194 AA in CTN0004. RTC was assessed at baseline, 4, 8, and 16 weeks by the University of Rhode Island Change Assessment (URICA), based on precontemplation, contemplation, preparation, andaction.Ourprimary outcome assessed was the total number of days using the primary substance during the 16 week period. Results: Over the 16 week period, average total RTC score declined slightly, with no significant difference observed between MET and CAU treatment groups. Overall, the MET group reported 6.6 days of primary substance use vs. 3.1 days in the CAU group (p=0.08). We observed an inconsistent role for RTC as a mediator, with RTC change from baseline to 8 weeks significantly associated with substance use in the MET arm (p=0.03), but RTC change to other timepoints not significant. The MET treatment effect was similar in models with and without controlling for baseline RTC and RTC change over time. Conclusions: These results provide limited evidence for RTC as a mediator of MET effect in AA patients. It is possible that RTC plays a larger role inmaintenance of abstinence at the beginning of treatment. Financial Support: U10 DA013727 (Brady) and U10 DA013732 (Winhusen).

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory--goal-directed activation, positive reinforcement, and environmental punishment--as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.

Age Cohort Differences in Illicit Drug Use and Hepatitis C Among African American Substance Users

Identifying prognostic indicators for undiagnosed Hepatitis C is crucial to attenuate the negative impact of this disease. This study explored the influence of recent and more distal injection drug use on biologically confirmed Hepatitis C infection among a sample (N = 260) of older and younger African Americans. Data from the baseline assessment of the NEURO-HIV epidemiologic study was analyzed using confounder adjusted regression techniques. Older adults were more likely to test positive for Hepatitis C (OR = 2.80, 95% CI = 1.53–5.11) due to lifetime injection drug use (AOR = 5.37, 95% CI = 3.10–9.28). Clinical implications are discussed.

Taking a life course approach to studying substance use treatment among a community cohort of African American substance users

BackgroundLife course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors. MethodsTo investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment. ResultsOne-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity. ConclusionsThese findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.

Does treatment readiness enhance the response of African American substance users to Motivational Enhancement Therapy?

The development of effective treatments for African Americans and other ethnic minorities is essential for reducing health disparities in substance use. Despite research suggesting that Motivational Enhancement Therapy (MET) may reduce substance use among African Americans, the findings have been inconsistent. This research examined the extent to which readiness-to-change (RTC) affects response to MET among African American substance users. The study was a secondary analysis of the 194 African American substance users participating in a multisite randomized clinical trial evaluating MET originally conducted within the National Drug Abuse Treatment Clinical Trials Network. The participants were randomly assigned to receive either three sessions of MET or Counseling-As-Usual (CAU) followed by the ordinary treatment and other services offered at the five participating outpatient programs. Participants were categorized as either high or lower on RTC based on their scores on the University of Rhode Island Change Assessment. The participants reported their substance use at baseline and throughout the 16 weeks after randomization. Among the high RTC participants, those in MET tended to report fewer days of substance use per week over time than participants in CAU. However, among the lower RTC participants, the CAU group tended to report fewer days of substance use over time than MET participants. In contrast to previous thinking, the findings suggest that MET may be more effective for high than lower RTC African American participants.

Motivational enhancement therapy for African American substance users: A randomized clinical trial.

Limited empirical evidence concerning the efficacy of substance abuse treatments among African Americans reduces opportunities to evaluate and improve program efficacy. The current study, conducted as a secondary analysis of a randomized clinical trial conducted by the Clinical Trials Network of the National Institute of Drug Abuse, addressed this knowledge gap by examining the efficacy of motivational enhancement therapy (MET) compared with counseling as usual (CAU) among 194 African American adults seeking outpatient substance abuse treatment at 5 participating sites. The findings revealed higher retention rates among women in MET than in CAU during the initial 12 weeks of the 16-week study. Men in MET and CAU did not differ in retention. However, MET participants self-reported more drug-using days per week than participants in CAU. Implications for future substance abuse treatment research with African Americans are discussed.

The Social Determinants of Substance Abuse in African American Baby Boomers: Effects of Family, Media Images, and Environment

Grounded theory methodology was used to explore the social processes involved in the use of illicit drugs in older African Americans as an underpinning to the development of approaches to nursing care and treatment. Interviews were conducted with six older African American substance users who were currently in drug treatment programs. Responses to the questions were recorded, transcribed, and analyzed using constant comparative methods. Three core themes emerged: (a) family, (b) media images, and (c) environment. The core issues of substance abuse, such as the environment and larger societal forces, cannot be addressed by one discipline and mandate that clinicians move to an interdisciplinary approach to achieve a plan of care for this growing population.

The Feasibility of Modified Directly Observed Therapy for HIV-Seropositive African American Substance Users

Recently, modified directly observed therapy (MDOT) has emerged as a promising intervention to address nonadherence for hard-to-reach populations infected with HIV. To date, there are no existing data on MDOT focusing exclusively on African Americans. The present study sought to determine the feasibility of MDOT among 31 HIV-seropositive African American substance users in the South. An outreach worker observed the participants' medication intake 5 days per week (once per day) for a period of 3 months (intensive phase). This phase was followed by a transition phase of 3 months during which the frequency of MDOT was gradually tapered from 5 days to once weekly. Assessments to gather demographic information, HIV risk behaviors, substance use, depression, and medication adherence were conducted at baseline, 3 months, and 6 months. Results indicated that more participants adhered to their medication regimen and had viral loads of less than 400 copies per milliliter at 3 and 6 months compared to baseline. Participants reported significantly less depressive symptoms at the 6-month assessment compared to baseline and 3 months. With regard to acceptability, 95% of participants indicated they liked having the outreach visits, 100% reported MDOT helped them take their medications, and only 5% felt MDOT was a violation of privacy. These results suggest MDOT is feasible among African American substance users in the South and a larger controlled study of MDOT with this population is warranted.

Metropolitan Community AIDS Network: Faith-Based Culturally Relevant Services for African American Substance Users at Risk of HIV

Although representing 12 percent of the U.S. population, African Americans represent more than one-third of all cumulative AIDS cases and the majority of all new AIDS cases in the United States (Centers for Disease Control and Prevention, 2003). Despite this disproportionate representation by African Americans, traditional approaches to both substance abuse (Jones, 2004; Longshore, Hsieh, & Anglin, 1993; O'Connell & Langley, 1997) and HIV/AIDS (Cochran & Mays, 1993; Jones; Land, 2000) prevention and treatment continue to be problematic given unfavorable views of available treatments and distrust of mainstream social services (Wright, 1998). Furthermore, traditional middle-class European American intervention and treatment models do not consider the barriers to prevention and intervention facing African Americans and ignore the idea that individuals engage in behaviors that are functional for the environment in which they exist (McNair & Prather, 2004). Research has increasingly emphasized the need for promoting prosocial motives (that is, re-entry into a moral community, renewed spirituality, collective and individual self-esteem, as well as establishing/reestablishing role in family) to increase service use among African American clients (Longshore, Grills, Anglin, & Annon, 1997; O'Connell & Langley). The integration of a faith-based or spiritual component is important in the provision of culturally relevant services to African Americans. Spirituality has been a fundamental aspect of the African American experience (Constantine, Lewis, Conner, & Sanchez, 2000; Frames & Williams, 1996) and involves a relationship between the individual and some transcendent force or the representation of an integrative force in the individual's life providing meaning and core values (Van Hook, Hugen, & Aguilar, 2001). This concept is particularly important when working with African American clients in that as a group, African Americans' ethos is spiritual in nature. BACKGROUND Located in Nashville, Tennessee, Metropolitan Community AIDS Network (Metro CAN) was developed in response to the growing need to develop culturally relevant modes of service delivery specific to HIV/AIDS risk among substance users. The program is housed in the First Response Center of Metropolitan Interdenominational Church, a nonprofit faith-based organization founded as a ministry of inclusion in 1994. Believing that the church too often allows individuals to be excluded from active participation in a church on the basis of external characteristics, the congregation has used the central organizing theme of the single word whosoever, taken from John 3:16 in the Bible, as a mandate for inclusion and the basis of a mandate of service. This allows all individuals (regardless of past or current involvement in substance use or other similar circumstances) to participate in the social support system afforded through fellowship in a church. All programs are grounded using the principles of spirituality, love, and community to create a service-oriented environment where clients experience neither condemnation nor judgment. The program model is based on an enhancement of the strategies developed as part of the extensively evaluated National AIDS Demonstration Research (NADR) program and the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program, which is regarded as the best practice model for reaching out-of-treatment substance users (Needle & Coyle, 1997; Needle, Coyle, Normand, Lambert, & Cesari, 1998).The program combines elements of the NIDA/NADR Outreach model with extensive supportive case management. A faith-based noncoercive perspective is infused throughout all interventions. Specifically, this model is extended with the word whosoever. Recipients of services are not expected to accept, or even necessarily support, the religious faith of the service providers, but are viewed as co-equal participants in all interventions. …

Evaluation of a Faith-Based Culturally Relevant Program for African American Substance Users at Risk for HIV in the Southern United States

Objective: This article provides an evaluation of a federally funded faith-based program that serves African Americans who use heroin and cocaine and are at risk for HIV/AIDS in Nashville, Tennessee. Methods: Data were collected from 163 individuals at baseline and 6- and 12-month follow-up interviews. A subset of participants (n = 51) completed all three interviews. Results: Results suggested that this culturally relevant set of interventions was successful in reducing substance use and HIV/AIDS risk behaviors. The program was able to show data that supported the efficacy of a faith-based approach emphasizing spirituality rather than directive, aggressive, authoritarian, or coercive counseling techniques. Discussion: The model is important to the continued development of culturally relevant interventions that are vital to decreasing the disproportionate rates of HIV/AIDS within the African American community.