Milligan Celeste O, Nich Charla, Carroll Kathleen M
Psychiatry Department at Yale University School of Medicine, Clinical Research Unit, New Haven, Connecticut 06511, USA.
Psychiatr Serv. 2004 Feb;55(2):167-73. doi: 10.1176/appi.ps.55.2.167.
This study examined the results of two previous studies that evaluated African Americans and whites who were undergoing treatment for cocaine dependence to determine whether the groups differed in pretreatment characteristics, treatment retention, compliance, and cocaine use outcome.
Data were taken from two trials (N=111 in each), in which patients were randomly assigned to groups that used different behavioral treatments (cognitive-behavioral treatment and 12-step facilitation) and pharmacotherapies (desipramine and disulfiram).
Few differences between African Americans and whites were found in terms of demographic characteristics, reasons for seeking treatment, or expectations of treatment. In both studies African Americans and whites did not differ significantly with respect to cocaine use outcomes, but African-American participants completed significantly fewer days of treatment than white participants. In study 2, which was not placebo controlled, African Americans who received disulfiram remained in treatment significantly longer than African Americans who did not receive disulfiram. However, in study 1, in which patients took either desipramine or a placebo, no interactions of ethnicity by medication were found. Among patients who expected improvement to take a month or longer in study 1, African Americans remained in treatment for fewer days than whites.
The behavioral therapies evaluated did not significantly differ in effectiveness for African Americans and whites, suggesting that they are broadly applicable across these ethnic groups. Findings also suggest possible strategies for improving retention of African Americans in treatment. Such strategies might include offering treatment with a medication component and better addressing participants' treatment expectations.
本研究考察了此前两项研究的结果，这两项研究评估了正在接受可卡因依赖治疗的非裔美国人和白人，以确定两组在治疗前特征、治疗保留率、依从性和可卡因使用结果方面是否存在差异。
数据取自两项试验（每项试验N = 111），其中患者被随机分配到采用不同行为疗法（认知行为疗法和12步促进疗法）和药物疗法（地昔帕明和双硫仑）的组中。
在人口统计学特征、寻求治疗的原因或治疗期望方面，未发现非裔美国人和白人之间存在显著差异。在两项研究中，非裔美国人和白人在可卡因使用结果方面均无显著差异，但非裔美国参与者完成治疗的天数明显少于白人参与者。在未设安慰剂对照的研究2中，接受双硫仑治疗的非裔美国人在治疗中的停留时间明显长于未接受双硫仑治疗的非裔美国人。然而，在研究1中，患者服用地昔帕明或安慰剂，未发现种族与药物之间的相互作用。在研究1中预计改善需要一个月或更长时间的患者中，非裔美国人接受治疗的天数少于白人。
所评估的行为疗法对非裔美国人和白人的有效性没有显著差异，这表明它们广泛适用于这些种族群体。研究结果还提出了提高非裔美国人治疗保留率的可能策略。这些策略可能包括提供含有药物成分的治疗，以及更好地满足参与者的治疗期望。
