Diversity In Relapse Prevention Needs: Gender And Race Comparisons Among Substance Abuse Treatment Patients - Statistical Data Included

American Journal of Drug and Alcohol Abuse, May, 2001 by Maureen A. Walton, Frederic C. Blow, Brenda M. Booth

INTRODUCTION

Substance abuse treatment is plagued by high relapse rates following treatment (1-3). Treatment programs have attempted to improve relapse rates through the implementation of relapse prevention programs (4-6). These programs generally consist of group practice of coping mechanisms to deal with high-risk situations with the aim of building self-efficacy (7). Evaluations of these efforts show mixed effects at attenuating relapse (8-13), perhaps because the use of a single relapse prevention approach does not acknowledge variations in need. Several studies suggest that women and minorities, in particular, may enter treatment with unique and different needs (14-18). In addition to training in coping skills, relapse prevention programs designed to meet the needs better of women and minorities might focus on social support, leisure activities, or resource acquisition.

Poorer treatment outcome is suggested for both men and women who lack social support for sobriety (19, 20). However, women in treatment may have less social support than men in treatment (16, 17, 21-23) and have fewer supportive friendship networks than women without substance abuse problems (24). In addition, women may have greater need for social support following treatment for several reasons. Women enter treatment in greater psychological distress, with lower self-esteem, and with more depression (25, 26). Women also have greater physical and sexual abuse histories (17, 27, 28) than men do.

Finally, studies show marriage is a protective factor for men leaving treatment, with married men having better outcomes than unmarried men (19). For women, the impact of marriage on treatment outcome is complex, with some studies showing marriage is protective and other studies showing marriage predicts relapse (19, 29-31). One reason that marriage may not be protective for women is because women's spouses are more likely to have alcohol or drug problems (17, 32). Women alcoholics also are more likely than men to drink in response to marital difficulties (33). Together, these findings suggest that relapse prevention services for women may need to focus more on social support.

Few studies have been conducted that examine social support among African-Americans in substance abuse treatment. In general, African-Americans often face more difficult social situations following treatment, including high-stress and low-support environments resulting from lower income urban neighborhoods with higher crime rates (15). African-American women have greater emotional distress (34) and more relationship problems due to drinking (35) than Caucasian women. Cocaine use by African-American women is more likely to be initiated and maintained in intimate partner and familial relationships (36). In contrast, cocaine use by African-American men is more likely to be initiated and maintained through friendships and income-related activities (36). Thus, African-Americans (particularly women) may be in greatest need of social support services.

Another alternative relapse prevention approach might focus on developing new sober leisure activities (5, 6, 37). Leisure activity approaches can be beneficial for both men and women, but for different reasons. For example, alcohol appears to serve a more social function for men, who report greater social pressure, greater availability of alcohol, and more positive enjoyment from drinking (38). Substance-abusing men may need to develop a new social network that does not focus on alcohol and drug use. In contrast, women are more likely to drink alone (23). Women may need to become involved in new social activities to prevent isolation. The need for leisure activity services among African-Americans has not been specifically documented. However, it is plausible that African-Americans coming from inner city high-crime neighborhoods (15) may find alcohol and drugs to be more available. For African-American men, cocaine use may be integrated into friendship and social relationships (36) and thus into leisure activities. Thus, African-Americans also may need to develop new sober leisure activities.

Finally, a variety of sources shows that women and African-Americans often enter treatment with fewer financial resources (14, 15, 21). These finding suggest that women and African-Americans might benefit from advocacy-based relapse prevention approaches that assist them in obtaining needed resources.

The relatively low numbers of women and minorities in treatment are reflected in the lack of research on these populations that documents the diversity in psychosocial issues and subsequent relapse prevention needs (39). The purpose of this study was to document the diversity of psychosocial concerns based on gender and race and to determine the basis of these differences. Analyses focus on (a) examining variation in psychosocial variables based on gender and race and (b) determining the basis of these differences by controlling for hypothesized confounding background characteristics. This study aimed to provide evidence for the need for developing alternative relapse prevention programming to address the unique needs of men and women, Caucasians and African-Americans.