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Abstract: Black participants experience a disproportionate burden of substance-related disabilities and premature death relative to other racial/ethnic groups, highlighting the need for additional research. The National Drug Abuse Treatment Clinical Trials Network (CTN), a research platform for multisite behavioral, pharmacological, and integrated trials designed to evaluate the effectiveness of a substance use treatments in community settings with diversified patient populations, provides a wealth of research knowledge on substance use. Although CTN trials have enrolled over 5,000 Black individuals since its inception in 2000, there has been no synthesis of the findings, discussion of the implications, or suggestions for future research for Black individuals. Members of the Minority Interest Group of the CTN conducted a scoping review of published research on Black participants in CTN trials. The primary source for identifying articles was the CTN Dissemination Library, with studies also identified through PubMed, PsycINFO, and Google Scholar. Studies were included if the sample was more than 75% Black and/or specific findings pertaining to Black participants were reported. The review yielded 50 articles, with studies that mostly focused on baseline characteristics, followed by substance use treatment outcomes, HIV/risky sex behaviors, retention, comorbid conditions and measurement issues. This review highlighted the importance of several issues that are critical to understanding and treating substance misuse among Black people, such as the characteristics of Black people entering treatment, measurement equivalence, and engaging/retaining adolescents and young adults in treatment. There is still a continued need to identify the most effective treatments for Black individuals who use substances. The CTN offers several untapped opportunities to further advance research on Black individuals who use substances (e.g., secondary analyses on publicly available data).

Abstract:

Underrepresentation in clinical trials limits the extent to which ethnic minorities benefit from advances in substance abuse treatment. The objective of this article is to share the knowledge gained within the Clinical Trials Network (CTN) of the National Institute on Drug Abuse (NIDA) and other research on recruiting and retaining ethnic minorities into substance abuse clinical trials.

The article includes a discussion of two broad areas for improving inclusion: community involvement and cultural adaptation. CTN case studies are included to illustrate three promising strategies for improving ethnic minority inclusion: respondent-driven sampling, community-based participatory research, and the cultural adaptation of the recruitment and retention procedures. The article concludes with two sections describing a number of methodological concerns in the current research base and a proposed research agenda for improving ethnic minority inclusion that builds on the CTN experience.

Abstract:

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 protocol CTN-0004 (“Motivational Enhancement Treatment to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance 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.

Conclusions: The results from this study reveal that MET may improve retention among African American women. This study highlights the significance of examining the efficacy of MI/MET as an adjunct to other evidence-based treatments, such as CBT, for African Americans. Implications for future substance abuse treatment research with this population group are discussed.

Related protocols: CTN-0004, CTN-0042-S

Abstract:

This is the Results Article for CTN-0033-Ot-2. Collaborations with Southwestern tribal entities and treatment programs in and around New Mexico were developed to investigate the extent of methamphetamine and other drug use among American Indians (AIs) in the Four Corners region. Nine focus groups were held, mostly with Southwestern AI participants (N=81) from three diverse New Mexico communities to understand community members’, treatment providers’, and clients/relatives’ views on methamphetamine. A telephone survey of staff was conducted (N=100) from agencies across New Mexico to assess perceptions of methamphetamine users among people working with AI populations. Self-reported drug use data from 300 AI clients/relatives who completed the Addiction Severity Index (AI) in the context of treatment at three diverse addiction treatment programs were collected and analyzed. Each focus group offered a unique perspective about the effect of drugs and alcohol on each respective community. Though data from the phone surveys and ASIs suggested concerning rates of methamphetamine use, with women more adversely affected by substance use in general, alcohol was identified as the biggest substance use problem for AI populations in the Southwest. There appears to be agreement that methamphetamine use is a significant problem in these communities, but that alcohol is much more prevalent and problematic. There was less agreement about what should be done to prevent and treatment methamphetamine use. Future research should attend to regional and tribal differences due to variability in drug use patterns, and should focus on identifying and improving dissemination of effective substance use interventions.

Related protocols: CTN-0033-Ot-2