Tonigan J Scott
Center on Alcoholism, Substance Abuse and Addiction, University of Mexico, Albuquerque, New Mexico, USA.
Alcohol Clin Exp Res. 2003 Aug;27(8):1340-4. doi: 10.1097/01.ALC.0000080673.83739.F3.
There is a lively ongoing debate concerning the need for culturally congruent alcohol treatment, with the assumption that such treatment would meaningfully address treatment outcome disparities among ethnic minorities. Although valid on the face of it, no randomized clinical trials have yet prospectively investigated and documented whether, in fact, different ethnic groups actually fare better or worse from one another when offered mainstream, culturally "incongruent" treatment. The purpose of this study was to contrast Hispanic, black, and white client treatment engagement and outcome in an effort to identify potential health disparities related to client ethnicity.
The Project Match outpatient (N = 952) and aftercare (N = 774) samples were divided according to self-reported ethnicity: Hispanic (n = 141; 8%), black (n = 168; 10%), and white (n = 1380; 80%). Controlling for socioeconomic status using the Hollingshead Occupational scale, the three ethnic groups were contrasted on pretreatment characteristics, rates of treatment attendance, three scales of therapeutic alliance, satisfaction with treatment, and drinking outcomes for the 12 months after treatment.
Ethnic differences in rates of therapy attendance were not robust and dissipated after controlling for socioeconomic status. No mean ethnic differences in ratings of therapeutic bonding and agreement with therapy goals were obtained, but blacks and Hispanics reported higher agreement on the value of therapeutic tasks relative to whites. Nevertheless, whites reported significantly higher global satisfaction with treatment relative to Hispanics and blacks. No ethnic main effect was found in drinking intensity during the 12-month follow-up. In contrast and only in the outpatient sample, blacks (n = 51) reported significantly higher rates of monthly abstinence relative to whites (n = 679).
Pretreatment characteristics predictive of positive treatment outcome favored white clients relative to Hispanic and black clients, but Hispanic and black clients fared at least as well as white clients during the 12-month follow-up, at least on two measures of drinking behavior. The absence, then, of poorer drinking outcomes for the ethnic minorities suggests that they may mobilize (1). different behavior change strategies and/or (2). additional social resources to achieve comparable drinking outcomes with white clients. Specific recommendations for future research are made.
关于是否需要提供文化适配的酒精治疗存在着热烈且持续的争论，人们认为这种治疗将切实解决少数族裔在治疗结果上的差异问题。尽管表面上看似合理，但尚无随机临床试验前瞻性地研究并记录，当提供主流的、文化上“不匹配”的治疗时，不同种族群体彼此之间的实际治疗效果究竟是更好还是更差。本研究的目的是对比西班牙裔、黑人和白人患者的治疗参与度及治疗结果，以确定与患者种族相关的潜在健康差异。
将“匹配计划”的门诊患者样本（N = 952）和后续护理样本（N = 774）根据自我报告的种族进行划分：西班牙裔（n = 141；8%）、黑人（n = 168；10%）和白人（n = 1380；80%）。使用霍林斯黑德职业量表控制社会经济地位，对比这三个种族群体在治疗前的特征、治疗出勤率、治疗联盟的三个量表、对治疗的满意度以及治疗后12个月的饮酒结果。
在控制社会经济地位后，各种族在治疗出勤率上的差异并不显著且逐渐消失。在治疗关系评分和对治疗目标的认同方面未发现种族平均差异，但黑人和西班牙裔相对于白人报告在治疗任务价值上有更高的认同度。然而，白人相对于西班牙裔和黑人报告对治疗的总体满意度显著更高。在12个月的随访期间，未发现饮酒强度上的种族主效应。相比之下，且仅在门诊样本中，黑人（n = 51）报告的每月戒酒率相对于白人（n = 679）显著更高。
预测积极治疗结果的治疗前特征对白人患者比对西班牙裔和黑人患者更有利，但在12个月的随访期间，西班牙裔和黑人患者至少在两项饮酒行为指标上与白人患者表现相当。因此，少数族裔饮酒结果并未更差这一情况表明，他们可能会调动（1）不同的行为改变策略和/或（2）额外的社会资源，以与白人患者取得相当的饮酒结果。文中还给出了对未来研究的具体建议。
