Despite socioeconomic disparities between racial and ethnic populations, the digital gap between Whites and minority groups has been narrowing over the last 15 years. Further, racial and ethnic minorities are more likely to access the Internet on smartphones and to take advantage of a wider array of their phones data functions, compared to White mobile phone users.
Given the integration of the Internet into the lives of racial and ethnic minorities, Internet-based interventions have the potential to reduce racial disparities in substance use disorder outcomes by increasing access to high-quality treatment and removing barriers to traditional treatment, such as stigma and time conflicts.
To date, there has not been a study exploring differences in outcomes or acceptability of Internet-delivered substance abuse interventions for racial and ethnic subgroups. This paper aims to fill that gap by exploring those differences for users of the Therapeutic Education System (TES), an Internet version of the Community Reinforcement Approach plus prize-based motivational incentives and one of only a few empirically supported technology-based interventions.
The study used data from a multisite effectiveness study of TES (CTN-0044) to explore whether race/ethnicity subgroups (White [n=267], Black/African American [n=112], and Hispanic/Latino [n=55]) moderate the effect of TES. Generalized linear mixed models were used to test whether abstinence, retention, social functioning, coping, craving, or acceptability differed by racial/ethnic subgroup.
Findings demonstrated that race/ethnicity did not moderate the effect of TES versus TAU on abstinence, retention, social functioning, or craving. A three-way interaction (treatment, race/ethnicity, and abstinence status at study entry) showed that TES was associated with greater coping scores among non-abstinent White participants (p=.008) and among abstinent Black participants (p<.001). Acceptability of the TES intervention, although high overall, was significantly different by race/ethnicity subgroup with White participants reporting lower acceptability of TES compared to Black (p=.006) and Hispanic/Latino (p=.008) participants.
Conclusions: Findings from this study lend additional support for the use of technology-based interventions in the treatment of substance use disorders. The acceptability of Internet-delivered interventions among racial/ethnic minority populations suggests promise for increasing access to services and reducing disparities in treatment outcomes. In this large multisite national study, racial/ethnic subgroups received similar benefit from Internet-based CRA/CM and reported high rates of acceptability, with Black participants reporting the highest rates of acceptability. TES should be considered as an additional tool to support usual care in outpatient treatment programs among diverse subgroups of patients.