Explaining Racial/Ethnic Differences in Adolescent Substance Abuse Treatment Completion in the United States: A Decomposition Analysis

Purpose: To identify contributors to racial/ethnic differences in completion of alcohol and marijuana treatment among adolescents at publicly funded providers. Methods: The 2007 Treatment Episode Data Set provided substance use history, treatment setting, and treatment outcomes for youth aged 12e17 years from five racial/ethnic groups (N = 67,060). Individual-level records were linked to variables measuring the social context and service system characteristics of the metropolitan area. We implemented nonlinear regression decomposition to identify variables that explained minority-white differences. Results: Black and Hispanic youth were significantly less likely than whites to complete treatment for both alcohol and marijuana. Completion rates were similar for whites, Native Americans, and Asian-Americans, however. Differences in predictor variables explained 12.7% of the black-white alcohol treatment gap and 7.6% of the marijuana treatment gap. In contrast, predictors explained 57.4% of the Hispanic-white alcohol treatment gap and 19.8% of the marijuana treatment gap. While differences in the distribution of individual-level variables explained little of the completion gaps, metropolitan-level variables substantially contributed to Hispanic-white gaps. For example, racial/ethnic composition of the metropolitan area explained 41.0% of the Hispanic-white alcohol completion gap and 23.2% of the marijuana completion gap. Regional differences in addiction treatment financing (particularly use of Medicaid funding) explained 13.7% of the Hispanic-white alcohol completion gap and 9.8% of the Hispanic-white marijuana treatment completion gap. Conclusions: Factors related to social context are likely to be important contributors to white-minority differences in addiction treatment completion, particularly for Hispanic youth. Increased Medicaid funding, coupled with culturally tailored services, could be particularly beneficial. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.