In the United States, Black people with substance use disorders (SUDs) have less access to treatment and worse treatment outcomes compared to White people. Though systemic racism is the root of these inequities, adapting treatment settings to serve this population may be a pragmatic way to improve access and outcomes. Shared racial identity between a patient and a provider, or racial concordance, is one feature of culturally tailored care that may improve treatment access, experiences, and outcomes for Black people. There is some evidence that racial concordance improves medical treatment for Black patients in non-addiction settings, but it is unknown whether racial concordance affects experiences or outcomes in addiction treatment.
Methods:
We conducted a scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)—to understand the effect of racial concordance on Black patients in addiction treatment. Three reviewers read each title and abstract to identify eligible articles. The inclusion criteria were: (1) Black patients; (2) treatment access, experiences, or outcomes; and (3) patient-provider racial concordance in addiction treatment. One reviewer completed full-text reviews and data extraction.
Results:
We identified 259 nonduplicate articles and completed full-text reviews of 77 articles. Eleven articles, published between 1971 and 2016, met criteria. Racial concordance was not associated with treatment access or engagement, though it was associated with some positive outcomes including increased perceived provider empathy. Few studies met the review criteria and there were no randomized controlled trials.
Conclusions:
The studies identified in this review did not provide adequate evidence that racial concordance improved treatment access, experiences, or outcomes for Black patients. Future research should include a wider range of outcome measures, including relational measures (eg, medical trust, discrimination) and examine whether and under what circumstances racial concordance improves experiences and outcomes for Black patients in addiction treatment.
FarahmandPArshedABradleyMV.Systemic racism and substance use disorders. Psychiatr Ann. 2020;50(11):494-498. doi:10.3928/00485713-20201008-01
3.
FriedmanJRHansenH.Evaluation of increases in drug overdose mortality rates in the us by race and ethnicity before and during the COVID-19 pandemic. JAMA Psychiatry. 2022;79(4):379-381. doi:10.1001/jamapsychiatry.2022.0004
4.
HallOTJordanATeaterJ, et al. Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among Black patients seeking addiction treatment. J Subst Abuse Treat. 2022;133:108551. doi:10.1016/j.jsat.2021.108551
5.
BarnettMLMearaELewinsonT, et al. Racial inequality in receipt of medications for opioid use disorder. N Engl J Med. 2023;388(19):1779-1789. doi:10.1056/NEJMsa2212412
6.
NguyenTZiedanESimonK, et al. Racial and ethnic disparities in buprenorphine and extended-release naltrexone filled prescriptions during the COVID-19 pandemic. JAMA Netw Open. 2022;5(6):e2214765. doi:10.1001/jamanetworkopen.2022.14765
7.
StahlerGJMennisJBaronDA.Racial/ethnic disparities in the use of medications for opioid use disorder (MOUD) and their effects on residential drug treatment outcomes in the US. Drug Alcohol Depend. 2021;226:108849. doi:10.1016/j.drugalcdep.2021.108849
8.
OldfieldBJMcGinnisKAEdelmanEJ, et al. Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. J Subst Abuse Treat. 2020;109:14-22. doi:10.1016/j.jsat.2019.11.002
9.
WilliamsECGuptaSRubinskyAD, et al. Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups: a national study in the U.S. Veterans Health Administration. Drug Alcohol Depend. 2017;178:527-533. doi:10.1016/j.drugalcdep.2017.06.011
10.
BrahmbhattHBiggDStrathdeeSA.Characteristics and utilization patterns of needle-exchange attendees in Chicago: 1994–1998. J Urban Health. 2000;77(3):346-358. doi:10.1007/BF02386745
11.
KinnardENBluthenthalRNKralAHWengerLDLambdinBH.The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA. Drug Alcohol Depend. 2021;225:108759. doi:10.1016/j.drugalcdep.2021.108759
12.
MarshJCCaoDGuerreroEShinHC.Need-service matching in substance abuse treatment: racial/ethnic differences. Eval Program Plann. 2009;32(1):43-51. doi:10.1016/j.evalprogplan.2008.09.003
13.
AndrewsCMShinHCMarshJCCaoD.Client and program characteristics associated with wait time to substance abuse treatment entry. Am J Drug Alcohol Abuse. 2013;39(1):61-68. doi:10.3109/00952990.2012.694515
14.
MarshJCAmaroHKongYKhachikianTGuerreroE.Gender disparities in access and retention in outpatient methadone treatment for opioid use disorder in low-income urban communities. J Subst Abuse Treat. 2021;127:108399. doi:10.1016/j.jsat.2021.108399
15.
LappanSNBrownAWHendricksPS.Dropout rates of in-person psychosocial substance use disorder treatments: a systematic review and meta-analysis. Addiction. 2020;115(2):201-217. doi:10.1111/add.14793
16.
StahlerGJMennisJ.Treatment outcome disparities for opioid users: are there racial and ethnic differences in treatment completion across large US metropolitan areas?Drug Alcohol Depend. 2018;190:170-178. doi:10.1016/j.drugalcdep.2018.06.006
17.
MatsuzakaSKnappM.Anti-racism and substance use treatment: addiction does not discriminate, but do we?J Ethn Subst Abuse. 2020;19(4):567-593. doi:10.1080/15332640.2018.1548323
18.
DansereauDFJoeGWDeesSMSimpsonDD.Ethnicity and the effects of mapping-enhanced drug abuse counseling. Addict Behav. 1996;21(3):363-376. doi:10.1016/0306-4603(95)00067-4
19.
JooJYLiuMF.Culturally tailored interventions for ethnic minorities: a scoping review. Nurs Open. 2021;8(5):2078-2090. doi:10.1002/nop2.733
20.
LongshoreDGrillsC.Motivating illegal drug use recovery: evidence for a culturally congruent intervention. J Black Psychol. 2000;26(3):288-301. doi:10.1177/0095798400026003002
21.
StahlerGJKirbyKCKerwinME.A faith-based intervention for cocaine-dependent Black women. J Psychoactive Drugs. 2007;39(2):183-190. doi:10.1080/02791072.2007.10399877
22.
WeeksMRHimmelgreenDASingerMWoolleySRomero-DazaNGrierM.Community-based AIDS prevention: preliminary outcomes of a program for African American and Latino injection drug users. J Drug Issues. 1996;26(3):561-590. doi:10.1177/002204269602600304
23.
AktanGBKumpferKLTurnerCW.Effectiveness of a family skills training program for substance use prevention with inner city African-American families. Subst Use Misuse. 1996;31(2):157-175. doi:10.3109/10826089609045805
24.
GilAGWagnerEFTubmanJG.Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project. Addiction. 2004;99(suppl 2):140-150. doi:10.1111/j.1360-0443.2004.00861.x
25.
GuerreroEGKimA.Organizational structure, leadership and readiness for change and the implementation of organizational cultural competence in addiction health services. Eval Program Plann. 2013;40:74-81. doi:10.1016/j.evalprogplan.2013.05.002
26.
JordanABabuscioTNichCCarrollKM.A feasibility study providing substance use treatment in the Black church. J Subst Abuse Treat. 2021;124:108218. doi:10.1016/j.jsat.2020.108218
27.
OkpakuSMacMasterSADennieSTolliverDCooperRLRaschRFR. Preliminary outcomes of a model program for increasing treatment access for African American women who use crack cocaine and are at risk for contracting HIV. J Evid Based Soc Work. 2010;7(1-2):41-57. doi:10.1080/15433710903175874
28.
MaASanchezAMaM.The impact of patient-provider race/ethnicity concordance on provider visits: updated evidence from the medical expenditure panel survey. J Racial Ethn Health Disparities. 2019;6(5):1011-1020. doi:10.1007/s40615-019-00602-y
29.
MeghaniSHBrooksJMGipson-JonesTWaiteRWhitfield-HarrisLDeatrickJA.Patient-provider race-concordance: does it matter in improving minority patients’ health outcomes?Ethn Health. 2009;14(1):107-130. doi:10.1080/13557850802227031
30.
CooperLARoterDLJohnsonRLFordDESteinwachsDMPoweNR.Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907-915. doi:10.7326/0003-4819-139-11-200312020-00009
31.
JettyAJabbarpourYPollackJHuertoRWooSPettersonS.Patient-physician racial concordance associated with improved healthcare use and lower healthcare expenditures in minority populations. J Racial Ethn Health Disparities. 2022;9(1):68-81. doi:10.1007/s40615-020-00930-4
32.
LoebSRavenellJEGomezSL, et al. The effect of racial concordance on patient trust in online videos about prostate cancer: a randomized clinical trial. JAMA Netw Open. 2023;6(7):e2324395. doi:10.1001/jamanetworkopen.2023.24395
33.
ShenMJPetersonEBCostas-MuñizR, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5(1):117-140. doi:10.1007/s40615-017-0350-4
34.
SchnittkerJLiangK.The promise and limits of racial/ethnic concordance in physician-patient interaction. J Health Polit Policy Law. 2006;31(4):811-838. doi:10.1215/03616878-2006-004
35.
TriccoACLillieEZarinW, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850
36.
AllenIM.Posttraumatic stress disorder among Black Vietnam veterans. Psychiatr Serv. 1986;37(1):55-61. doi:10.1176/ps.37.1.55
37.
DieserRB.A Personal narrative of a cross-cultural experience in therapeutic recreation: unmasking the masked. Ther Recreation J. 2002;36(1):84–96.
38.
BorensteinD.The relative value of the medical staff versus addicts in the rehabilitation of the drug users in a drug abuse program. Johns Hopkins Med J. 1971;129(5):290-297.
39.
MadduxJFDesmondDP.Ethnic matching of caseworker and patient in methadone maintenance. J Subst Abuse Treat. 1996;13(3):233-239. doi:10.1016/S0740-5472(96)00053-0
40.
PollakKIYarnallKSHRimerBKLipkusILynaPR.Factors associated with patient-recalled smoking cessation advice in a low-income clinic. J Natl Med Assoc. 2002;94(5):354-363.
41.
RuglassLMHienDAHuMC, et al. Racial/ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-based treatment. Community Ment Health J. 2014;50(7):811-822. doi:10.1007/s10597-014-9732-9
42.
FiorentineRHillhouseMP.Drug treatment effectiveness and client-counselor empathy: exploring the effects of gender and ethnic congruency. J Drug Issues. 1999;29(1):59-74. doi:10.1177/002204269902900104
43.
GottheilESterlingRCWeinsteinSPKurtzJW.Therapist/patient matching and early treatment dropout. J Addict Dis. 1995;13(4):169-176. doi:10.1300/J069v13n04_05
44.
SterlingRCGottheilEWeinsteinSPSerotaR.The effect of therapist/patient race- and sex-matching in individual treatment. Addiction. 2001;96(7):1015-1022. doi:10.1046/j.1360-0443.2001.967101511.x
45.
SterlingRCGottheilEWeinsteinSPSerotaR.Therapist/patient race and sex matching: treatment retention and 9-month follow-up outcome. Addiction. 1998;93(7):1043-1050. doi:10.1046/j.1360-0443.1998.93710439.x
46.
UrecheDJSmithDCDavisJPTabbKM.Racial matching and adolescent self-disclosure of substance use and mental health symptoms. J Ethn Subst Abuse. 2016;15(2):176-188. doi:10.1080/15332640.2015.1017784
47.
RimerBKConawayMLynaP, et al. The impact of tailored interventions on a community health center population. Patient Educ Couns. 1999;37(2):125-140. doi:10.1016/S0738-3991(98)00122-0
48.
HargonsCNMiller-RoenigkBDMaloneNJMizelleDLAtkinsonJDStevens-WatkinsDJ.“Can we get a Black rehabilitation center”? Factors impacting the treatment experiences of Black people who use opioids. J Subst Abuse Treat. 2022;142:108805. doi:10.1016/j.jsat.2022.108805
49.
LaVeistTANuru-JeterA.Is doctor-patient race concordance associated with greater satisfaction with care?J Health Soc Behav. 2002;43(3):296-306. doi:10.2307/3090205
50.
LewisLM.Culturally appropriate substance abuse treatment for parenting African American women. Issues Ment Health Nurs. 2004;25(5):451-472. doi:10.1080/01612840490443437
51.
JonesLVHopsonLWarnerLHardimanERJamesT.A qualitative study of black women’s experiences in drug abuse and mental health services. Affilia. 2015;30(1):68-82. doi:10.1177/0886109914531957
52.
BravemanPAArkinEProctorDKauhTHolmN.Systemic and structural racism: definitions, examples, health damages, and approaches to dismantling. Health Aff (Millwood). 2022;41(2):171-178. doi:10.1377/hlthaff.2021.01394
53.
NuriddinAMooneyGWhiteAIR. Reckoning with histories of medical racism and violence in the USA. Lancet. 2020;396(10256):949-951. doi:10.1016/S0140-6736(20)32032-8
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
