Incarceration as a Reason for US Alcohol and Drug Treatment Non-completion: a Multilevel Analysis of Racial/Ethnic and S
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rrespondence to George Pro, PhD, Center for Health Equity Research, Northern Arizona University, PO Box 4065, Flagstaff, AZ 86011-4065, USA. Julie Baldwin, PhD, Center for Health Equity Research, Northern Arizona University, PO Box 4065, Flagstaff, AZ 860114065, USA. Ethan Sahker, PhD, Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. Ethan Sahker, PhD, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. Ethan Sahker, PhD, Department of Psychological and Quantitative Foundations, Counseling Psychology Program, University of Iowa College of Education, 361 Lindquist Center (South), Iowa City, IA 52242, USA. Julie Baldwin, PhD, Department of Health Sciences, Northern Arizona University, PO Box 15095, Flagstaff, AZ 86011, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–11. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09703-7
Incarceration as a Reason for Treatment Non-completion
PRO ET AL.
Introduction Initiation of treatment services is low among individuals with substance use problems and disorders; only 10–20% of those in need receive treatment.1, 2 Racial/ethnic disparities are well documented in treatment initiation, such that African Americans and Hispanics are less likely than Whites to seek treatment.3–5 Once admitted to treatment, successful treatment completion is an indicator of mid- and long-term positive health and substance use outcomes.6, 7 Additionally, treatment completion is associated with improved employment status8 and a reduction in criminal behavior.9, 10 Despite the positive health outcomes associated with treatment completion, completion rates are relatively low. In analyses of administrative treatment service records, Arndt and colleagues11 and the Substance Abuse and Mental Health Services Administration12 (SAMHSA) found that 44–49% of treatment episodes were successfully discharged. Both reports demonstrated that African Americans (36–45%) were the least likely to complete treatment, followed by Hispanics (42–50%) then Whites (48–54%). Both reports also demonstrated that women (41–50%) were less likely than men (46–52%) to complete treatment. Saloner and colleagues13 identified slightly higher rates of alcohol treatment completion specifically, and found significant differences between Whites (62%) and Hispanics (59%), Native Americans (57%), and African Americans (52%). Disparities in treatment completion among racial/ethnic minority treatment participants are widely supported in the literature.14–18 Thus, barriers to treatment completion may be greater depending on race/ethnicity. Several reports have outlined the barriers people face preventing them from ever initiating treatment. For instance, low educational attainment and low income are associated with a higher number of barriers to treatment initiation.19 Addressing specific reasons for not initiating substance abuse treatment between racial/ethnic groups, Verissimo and colleagues20 showed that structura
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