Transcript PowerPoint Poster for CPDD - CTN Dissemination Library

Racial Differences of Stimulant Abusers’ Prior Experiences, Expectations, and Readiness to
Engage in 12-Step Programs
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K. Michelle Peavy, PhD, Sharon B. Garrett, MPH, Suzanne R. Doyle, PhD, & Dennis M. Donovan, PhD
University of Washington, Alcohol & Drug Abuse Institute
Introduction
There is a growing body of literature supporting the 12step approach for stimulant users (see Donovan & Wells1
for a review). Important differences may exist between
African American and Caucasian substance abusers
regarding involvement in 12-step programs. Research has
shown that, compared to Caucasians, African Americans:
• were more likely to attend 12-step groups at 6-month
follow-up in a sample of treated substance abusers. 2
• had higher rates of lifetime 12-step meeting attendance;
were more likely to report a “spiritual awakening” as a
result of AA; were more likely to have performed service
work at a meeting within the past year; and reported
feeling a part of AA. 3
• reported more affiliation with 12-step than Caucasians
in an inpatient treatment sample.4
In the current study, we used a large sample from a
multisite, randomized clinical trial conducted within the
National Drug Abuse Treatment Clinical Trials Network
(CTN) to examine race in the context of the STAGE-12
intervention (Stimulant Abuser Groups to Engage in 12Step Programs).5 STAGE-12 is a combined group and
individual 12-step facilitative treatment targeting stimulant
abusers.
Measures:
• Addiction Severity Index-Lite7 (ASI-Lite)
• 12-Step Experiences and Expectations (TSEE)
• Survey of Readiness for Alcoholics Anonymous
Participation8 (SYRAAP)
• Understanding of Alcoholism and Drug
Addiction9 (SUSS); three subscales: 1) disease
model; 2) psychosocial model; and 3) eclectic
orientation.
• Spiritual Involvement and Beliefs ScaleRevised10 (SIBS–R); includes a total score and
four subscales:
1. Core Spirituality (connection, meaning, faith,
involvement, and experience)
2. Spiritual Perspective/Existential
3. Personal Application/Humility
4. Acceptance/Insight (i.e., insight into futility of
focusing attention on things that cannot be
changed)
Methods
Participants:
471 stimulant abusers recruited from 10 substance abuse
outpatient community treatment programs (see Table 1).
Participants were randomized into one of two conditions:
• Treatment as usual (TAU): 2 sessions and 5-15 hours of
weekly outpatient therapy as typically provided
• STAGE-12: 5 group sessions based on the adaptation
of Twelve-step Facilitation for a group format by Brown
and colleagues,6 and 3 individual STAGE-12 sessions
replaced 5 group and 3 individual TAU sessions.
Participants were categorized into African American
(n=171) or Caucasian (n=224) groups based on their selfreported race; individuals endorsing more than one race
were not included in these analyses.
Table 1.
Total Sample
N (%)
M (SD)
African American
N (%)
M (SD)
Caucasian
N (%)
M (SD)
N
395
171 (43.3)
224 (56.7)
Age
39.1 (9.8)
42.7 (8.7)
36.3 (9.8)*
Gender (Female)
232 (58.7)
91 (53.2)
141 (63.0)
Mean years of education
12.1 (1.6)
12.07 (1.49)
12.16 (1.73)
Amphetamines
2 (0.51)
0
2 (0.89)
Methamphetamine
95 (24.1)
1 (0.58)
94 (42.0)*
Cocaine
223 (56.5)
142 (63.7)
81 (36.2)*
Alcohol
40 (10.1)
20 (11.7)
20 (8.9)
Marijuana
12 (3.0)
4 (2.3)
8 (3.6)
Opiates
22 (5.6)
4 (2.3)
18 (8.0)
Other
1 (0.25)
0
1 (0.45)
0.16 (0.09)
0.15 (0.09)
0.16 (0.09)
Primary Drug
ASI Drug Composite Score
(Baseline)
*p< .0001
Results
22.49
SUSS
21.15
African American
Hypotheses:
• African American participants will endorse more interest
in becoming involved in 12-step groups, as well as a
more favorable view of 12-step groups than their
Caucasian counterparts.
• The African American group will score more positively
on the instrument measuring spiritual involvement and
beliefs than the Caucasian group.
Conclusions
Methods (cont).
11.71
Caucasian
12.59
10.16 *
8.54
Disease
Psychosocial
Eclectic
* p = .0009
• SUSS: Caucasian participants reported
higher scores on the eclectic subscale
reflecting participants’ beliefs about the
treatment and etiology of addiction
(F1,338 = 11.21, p = .0009). Groups were
not significantly different in terms of
ratings on the other two subscales (i.e.,
disease and psychosocial) measuring
participants’ understand about the
treatment and etiology of addiction.
• SIBS-R: African American participants had
higher scores than Caucasian participants
on:
• the Core Spirituality subscale (F1,329 =
18.71, p < .0001),
• the Personal Application/Humility
subscale (F1,374 = 10.88, p = .0011)
• Total SIBS-R measure of spirituality
(F1,317 = 14.45, p = .0002).
• TSEE: Caucasian participants indicated a greater
likelihood to get involved in self-help groups
(Z=3.49, p=.0005) than African American
participants. There were no differences between
groups in terms of prior experiences with 12-step.
• SYRAAP: African Americans scored higher on a
scale measuring the perceived benefits of 12-step
groups (Z=2.35, p=.019). Groups did not differ on
the perceived severity or barriers subscales.
• African Americans tended to be older, and they were more likely to report
cocaine as their primary substance than Caucasians. These results are
consistent with the literature.11,12,13
• Caucasian participants reported a higher likelihood of attending 12-step
groups. However, African Americans reported more perceived benefit
from meeting attendance than Caucasians.
• The two groups were similar in terms of the model by which they
understand addiction. However, the Caucasian group exhibited a higher
score on the eclectic model scale, which is less consistent with the
STAGE-12 intervention than the disease model.
• The African American group reported more spirituality (as measured by
SIBS-R) than Caucasians, which is consistent with previous research.14
This is important because spirituality is an important part of the 12-step
model. Racial differences here could be related to specific features of
African-American culture, for example the important role of church in the
African American community.
Implications:
• Encouragement to attend 12-step groups may be appropriate for substance
abuse clients of both races.
• African Americans may be more open to the spiritual aspects of the 12-step
philosophy than Caucasians.
Future research:
• Studies to determine how racial differences might translate into actual 12-Step
participation and attendance.
• Inclusion of multivariate analysis statistically controlling for age, primary drug
use to determine whether racial differences are due to these variables.
• Measurement equivalence analysis to determine whether racial differences are
attributable to differences in measurement rather than differences in the study
variables.
Acknowledgements
This study was supported by the National Institute on Drug Abuse (NIDA; U10-DA013714 Clinical Trials
Network – Pacific Northwest Node; Dennis M. Donovan, PI). The authors would like to thank the many clinical
and research involved in the STAGE-12 study, as well as the treatment participants who volunteered to take
part in the study.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Donovan, D., & Wells, E. ‘Tweaking 12-step’: the potential role of 12-step self-help group involvement in methamphetamine
recovery. Addiction, 2007. 102: p. 121-129.
Humphreys, K., B. Mavis, and B. Stofflemayr, FACTORS PREDICTING ATTENDANCE AT SELF-HELP GROUPS AFTER
SUBSTANCE-ABUSE TREATMENT - PRELIMINARY FINDINGS. Journal of Consulting and Clinical Psychology, 1991.
59(4): p. 591-593.
Kaskutas, L., & Weisner, C. Alcoholics Anonymous affiliation at treatment intake among white and black Americans. Journal
of Studies on Alcohol, 1999. 60: p. 810.
Kingree, J. Measuring Affiliation with 12-step Groups. Substance Use & Misuse, 1997. 32(2): p. 181-194.
Donovan, D.M., et al., Stimulant Abuser Groups to Engage in 12-Step (STAGE-12): A Multisite Trial in the NIDA Clinical
Trials Network. Journal of Substance Abuse Treatment, in press.
Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. Process and outcome changes with relapse prevention versus 12Step aftercare programs for substance abusers. Addiction, 2002. 97(6): p. 677-689.
McLellan, A.T., et al., THE 5TH EDITION OF THE ADDICTION SEVERITY INDEX. Journal of Substance Abuse Treatment,
1992. 9(3): p. 199-213.
Kingree, J.B., et al., The development and initial evaluation of the Survey of Readiness for Alcoholics Anonymous
Participation. Psychology of Addictive Behaviors, 2006. 20(4): p. 453-462.
Humphreys, K., M. A. Greenbaum, et al., Reliability, validity, and normative data for a short version of the Understanding of
Alcoholism Scale. Psychology of Addictive Behaviors, 1996. 10(1): 38-44.
Hatch, R.L., et al., The spiritual involvement and beliefs scale - Development and testing of a new instrument. Journal of
Family Practice, 1998. 46(6): p. 476-486.
Kramer, T.L., et al., Childhood Conduct Problems and Other Early Risk Factors in Rural Adult Stimulant Users. Journal of
Rural Health, 2009. 25(1): p. 50-57.
Booth, B.M., et al., Correlates of rural methamphetamine and cocaine users: Results from a multistate community study.
Journal of Studies on Alcohol, 2006. 67(4): p. 493-501.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2008) The DASIS Report: Primary
Methamphetamine/Amphetamine Admissions to Substance Abuse Treatment: 2005. Rockville, MD. Retrieved from
http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdf
Krentzman, A.R., K.J. Farkas, and A.L. Townsend, Spirituality, Religiousness, and Alcoholism Treatment Outcomes: A
Comparison between Black and White Participants. Alcoholism Treatment Quarterly, 2010. 28(2): p. 128-150.