CAPA Blog

SUD treatment industry has a race problem

Can a well educated and trained substance use disorder therapist treat any and every patient equally without regard to the patient’s age, race and gender? That is…can a white male baby boomer therapist be successful with any patient on his caseload, such as a mixed-race millennial female, middle-age Hispanic male and white female baby boomer? Does every patient has an equal chance at SUD treatment success for this specific therapist regardless of patient characteristics?!

What is success?
The two most important measures of success in SUD treatment are: 1. Number of days patients remain in treatment; and 2. Number of patients completing treatment with “staff approval.” Patients who remain in treatment until successful completion have significantly improve health outcomes when compared with patients not successfully completing. Below is a table with overall number of days in several IOP programs across St Louis.

SUD treatment

What this shows is that White patients stay almost twice as long as non-white patients. This is very troubling for the industry of SUD treatment. So, what could be done to improve this outcome?

Great question!

CAPA has been investigating therapist-patient matching. That is, what happens when a patient is matched on 1 important factor — a therapist’s race. Disregarding the other important factors – age and gender, just looking at the race match, would this impact treatment success — which is treatment completion?

SUD treatment

What the table above shows is for all patients in the group of IOPs, the average completion rate was 22.5%. When therapists and patients were race-matched, completion rates increased to 33.6% — an 11% bump up! Please let that sink in.

Now…when therapists and patients were not matched on race, completion rates decreased to 9.1%. Please let that sink in.

The final point. The SUD treatment industry has mostly operated on and made decisions based on what’s best for its own system. As an example. below is a table…

SUD treatment

Let’s say you have an IOP with 4 therapists, A, B, C, & D. Therapist D has 14 current patients on her/his caseload while the other 3 therapists have 15. In this scenario, who would you guess would get the next patient admitted to that IOP program? Well…more than likely therapists D. The system is designed to be fair to the workers.

If we are to fix our race problem and retention and completion problems in SUD treatment — we have to try something very different and in the best interest of patients…not the system.

Stay tuned…Peace DAP

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