Gender and Racial Differences in Treatment Process and Outcome Among Participants in the Adolescent Community Reinforcement Approach

Increasingly, evidence-based treatments are being implemented by community treatment providers, and it is important to understand whether they can be implemented with similar quality and equivalent effectiveness across gender and racial groups. This study examined whether initiation, engagement, dosage, treatment satisfaction, or outcomes for adolescents who received the Adolescent Community Reinforcement Approach (A-CRA) in a large implementation effort were equivalent by gender or racial group. Analyses of data from 2,141 adolescents representing 33 sites across the United States revealed no significant differences for initiation, engagement, or retention by gender or race. Ninety-six percent of the sample reported being satisfied with treatment; however, male adolescents had significantly higher rates of treatment satisfaction than female adolescents, and African American adolescents had significantly higher rates of treatment satisfaction than Caucasian adolescents. A subset of the initial sample (n = 1,819) was used to investigate outcomes. All racial groups had significant increases in days abstinent from alcohol and other drugs and in the percentage in recovery across the measurement period but did not differ from one another at the six-month follow-up. Female adolescents had a higher percentage of days abstinent front alcohol and other drugs and were more likely to be in recovery at the six-month follow-up than male adolescents. Overall, process indicators suggest the intervention was well implemented across gender and racial groups and equally effective across racial groups, with males having equivalent gains in abstinence and recovery compared with females despite males having greater intake severity and differential outcomes at six months.