Introduction

1. + Racial Differences of Stimulant Abusers’ Prior Experiences, Expectations, and Readiness to Engage in 12-Step Programs K. Michelle Peavy, PhD, Sharon B. Garrett, MPH, Suzanne R. Doyle, PhD, & Dennis M. Donovan, PhD University of Washington, Alcohol & Drug Abuse Institute * Conclusions Methods (cont). Introduction • 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. Table 1. • There is a growing body of literature supporting the 12-step 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 12-Step Programs).5 STAGE-12 is a combined group and individual 12-step facilitative treatment targeting stimulant abusers. • 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. • 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 Scale-Revised10 (SIBS–R); includes a total score and four subscales: • Core Spirituality (connection, meaning, faith, involvement, and experience) • Spiritual Perspective/Existential • Personal Application/Humility • Acceptance/Insight (i.e., insight into futility of focusing attention on things that cannot be changed) *p< .0001 Results • 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. 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. • 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). References Methods • 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 12-Step 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. • 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 self-reported race; individuals endorsing more than one race were not included in these analyses.