Approaches to treating substance abuse among African-Americans

The study led by LaTrice Montgomery, a doctoral student in the University of Cincinnati Department of Psychology, is published this month in Cultural Diversity and Ethnic Minority Psychology, a journal of the American Psychological Association.

The study investigated the effectiveness of Motivational Enhancement Therapy (MET) compared with the standard treatment, Counseling as Usual (CAU) -- two clinical approaches to treating substance abuse -- among African-Americans. The study, a secondary analysis of a clinical trial by the Clinical Trials Network of the National Institute of Drug Abuse, was a rare examination of both treatment retention rates and the effectiveness of MET in reducing drug abuse, specifically among African-Americans.

Motivation Enhancement Therapy is designed to address the ambivalence surrounding substance abuse treatment, whether abusers are at the stage where they're ready to live a substance-free life or whether they're against any treatment.

"The idea of MET is for counselors to help patients build motivation and strengthen commitment to behavior change," Montgomery says. "One technique that is commonly used in MET to facilitate this process is the use of decisional balance exercises which help patients examine the pros and cons of substance use."

"An example would be a patient discussing what he or she considers the 'pros' of substance use, such as drinking alcohol to reduce anxiety," explains Montgomery. "However, despite its ability to help reduce the patient's anxiety, the patient might also acknowledge that heavy drinking negatively influences their interpersonal relationships."

Montgomery added, "The task of the therapist in this situation would be to help the patient develop more reasons to change and identify more effective ways to reduce anxiety."

Previous research has suggested that the toll of substance abuse on African-Americans is greater than on other groups, not only in terms of health but also in the legal system.

The study compared the effectiveness of motivational enhancement therapy compared with counseling as usual over a 16-week period. The participants in the study were 194 African-Americans who were seeking outpatient substance abuse treatment at five different community-based treatment programs across the nation. The study included 146 African-American males (75.3 percent) and 48 females (24.7 percent), with the age of the participants averaging 37.5 years old. They were seeking treatment for issues such as cocaine abuse (25.8 percent), alcohol abuse (26.3 percent) and marijuana abuse (18 percent).

The study revealed higher retention rates among women in MET than in CAU. Men in MET and CAU did not differ in retention.

Among both genders, men and women in MET reported more days per week of substance abuse than participants in CAU.

"Previous studies have suggested that ethnic minorities in MET report more success in reducing substance abuse than non-ethnic minorities, but the studies combined several ethnic groups," explains Montgomery. "This research was examining the effectiveness of the treatment specifically for African-Americans."

"I think MET has a lot of value, in terms of being non-confrontational and non-judgmental as well as supporting self-efficacy," Montgomery says. "We found that the women stayed in MET treatment longer, but they didn't reduce their substance use. That's where my research is taking me now."

Secondary authors on the study are UC Psychology Professor Kathy Burlew, Duke University Biostatics and Bioinformatics Associate Professor Andrzej S. Kosinski and University of New Mexico Psychiatry Assistant Professor Alyssa Forcehimes.