255274 Residential substance abuse treatment outcomes and costs for urban American Indians

Tuesday, October 30, 2012

Bentson McFarland, MD, PhD , Department of Psychiatry, Oregon Health and Science University, Portland, OR
Dale Walker, MD , Department of Psychiatry, Oregon Health and Science University, Portland, OR
Patricia Silk-Walker, RN PhD , Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
Background: Most American Indians and Alaska Natives live in metropolitan areas but there are few data about substance abuse treatment for this population.

Methods: The present study recruited and followed for 12 months 186 Native clients (46% female, 91% ages 21 through 49) from 69 tribes who entered two residential substance abuse treatment programs designed for American Indians and Alaska Natives. The programs offer culturally specific services such as sweat lodges. Program costs were measured with the Drug Abuse Treatment Cost Analysis Program.

Results: Most participants were enrolled tribal members with blood quantum (Native ancestry) of 50% or greater. Alcohol was primary substance for most and amphetamine next most common. Most completed residential substance abuse treatment. Composite outcome measures based on interviews and-or other data at 12 months were available for most. Optimal 12-month outcomes (known to be housed and not incarcerated) ranged from 95% for males and 47% for females at one agency to 32% for males and 17% for females at the other agency. In multivariate models including demographics, substance abuse, cultural measures, and co-occurring conditions, only program site (p less than 0.001) and male gender (p less than 0.001) consistently predicted either abstinence (for participants with 12-month interviews) or known optimal outcome (for all participants). Agencies differed some three-fold on economic cost per treatment episode. Better outcomes were associated with higher costs.

Conclusions: Urban Native people (especially American Indian women) face substantial challenges when dealing with substance abuse. Higher cost residential treatment may lead to improved outcomes.

Learning Areas:
Administration, management, leadership
Diversity and culture
Other professions or practice related to public health
Program planning
Social and behavioral sciences

Learning Objectives:
List expected 12-month outcomes following residential substance abuse treatment for urban American Indians. Describe anticipated facility expenditures for residential agencies providing substance abuse treatment to urban American Indians

Keywords: Substance Abuse Treatment, Native Americans

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator or co-investigator of several federally funded research grants focused on substance abuse treatment. My research has focused on outcomes of care for people with substance abuse problems.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.