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Treatment trajectories of ethnic minorities in substance abuse treatment

Research project DR/28 (Research action DR)

Persons :

Description :

1. Problem situation and hypotheses

International research has shown that ethnic minorities who abuse illicit drugs experience various difficulties when contacting treatment services. Similar problems concerning the accessibility of services have been reported for alcohol abusers from ethnic minorities. Still, epidemiological research has demonstrated that ethnic minority groups are more vulnerable to (ab)use substances. Various barriers may influence accessibility of alcohol and drug treatment services, such as language and communication problems and lack of “cultural responsiveness” of existing services. Except treatment access, also other aspects of the treatment trajectory of substance abusers from ethnic minority groups seem to be problematic. Research has shown that clients from ethnic minority groups are more eager to drop-out and are less likely to complete treatment successfully. This observation includes an unfavourable prognosis for successful outcomes after treatment.
Since little information is available in Belgium about the representation of ethnic minorities in various health care and social welfare services, we want to study whether alcohol and drug abusers from ethnic minority groups make less and/or in a different way use of the existing services. We will test the plausibility of following hypotheses: “dual exclusion or isolation”; “competition between preventive and supportive efforts concerning substance abuse problems by (self-) organisations and mosques on the hand, and by ‘regular’ treatment services on the other”; and “cultural blindness”.

2. Aims

A first aim of this research is the comparison of the treatment trajectories of substance abusers from ethnic minorities and the ‘native Belgian’ population and the identification of differences concerning treatment access, participation and retention in medical and specialized substance abuse services. Once these differences concerning the treatment trajectories have been studied, we want to identify which factors and mechanisms (may) hinder or stimulate the treatment trajectory of ethnic minority groups, and to which extent. The third objective of this study consists of the formulation of concrete recommendations, pathways and solutions for countering the difficulties concerning the accessibility and trajectory of ethnic minority groups.

3. Methodology

The project consists of three parts: a study of the literature, a quantitative and a qualitative study.

The research will start with a literature study, which aims at assessing the (under)representation of ethnic minority groups in substance abuse treatment and possible explanations and solutions for this under-representation. In order to formulate recommendations about appropriate methods and strategies to counter this under-representation, some examples of “good practice” from abroad will be studied based on an on-site study visit.

Concerning the quantitative research part, various shortcomings can be observed in relation to the registration of intake and discharge data in Belgian substance abuse treatment. Although several efforts have been done to improve the quality of collected data, registration is not yet standardized and is fragmented between sectors and regions. Additional difficulties are encountered concerning the registration of ethnic minority groups.
Since most available databases (e.g. MPG (psychiatric hospitals), VVBV (specialised treatment centres in Flanders), TOXIBASE (specialised centres in the French community)) consist exclusively of data for specific sectors or regions and use different criteria for registering the ethnic origin of clients, these data cannot be used for the purpose of this study. Long-term analyses of treatment trajectories across services and sectors are impossible with such fragmented data. Therefore, we decided to use the original databases of health insurances that refund (partially) medical interventions by general practitioners, (psychiatric) hospitals and specialized treatment services. Treatment trajectories of a cohort of alcohol and drug abusers (both from ethnic minorities and the “Belgian” population) will be monitored and compared over a 24-month period. As outlined in the call for proposals, the ethnic origin of patients will be determined based on the name of the patient (cf. Lodewyckx et al., 2005), in combination with information about the “nationality” and/or “country of birth”.
Since the databases of the health insurances only concern medical interventions and few data on clients’ socio-cultural background, these databases will be complemented by a secondary analysis of data collected during previous research. On the one hand, we plan a secondary analysis of data from a study in drug and alcohol treatment agencies in the province of Antwerp. On the other hand, EuropASI-interviews with clients from a large treatment centre (De Sleutel) will be analysed, comparing drug abusers from ethnic minorities with the rest of the sample concerning severity of addiction and related problems.

With the qualitative study we want to interpret the data from the quantitative analysis and to look for factors and processes that may hinder treatment access and other aspects of the treatment trajectory. Based on the assumption that persons who experience the above-mentioned problems daily are best placed to contribute to the solution of these problems, these persons will be involved in the qualitative part of the study. Since we solely focussed on persons who contact regular (medical) treatment services during the quantitative study, we will meet this potential bias by involving representatives of clubs and (self-)organisations of ethnic minority groups (focus groups) and alcohol and drug abusers who have no or few contacts with treatment services (interviews).
- Semi-structured interviews with alcohol and drug abusers from ethnic minority groups: In 4 major cities (Antwerp, Brussels, Charleroi, and Ghent) at least 10 alcohol or drug abusers from ethnic minority groups will be interviewed about their treatment needs, service utilization and accessibility of treatment services. The composition of the sample will represent the main ethnic groups among the “non-Belgian” substance abusing population.
- Focus groups with key-persons: In the focus groups, representatives of ‘regular’ services and of clubs and (self-) organisations of ethnic minorities will discuss the main findings of the study. We will select experts from in- and outpatient alcohol and drug treatment services (e.g. psychiatric hospitals, methadone treatment centres, detoxification centres, day care centres). Also, other organisations that have regular contact with substance abusers from ethnic minority groups (e.g. police, community health care centres, shelters for the homeless, social welfare offices, (self-) organisations …) will be involved in the study. During this focus-group, the findings from the previous phases of the study will be presented as statements. The objective of these focus-groups is to formulate recommendations in order to counter the barriers that ethnic minorities experience when contacting treatment services.

Ultimately, this research project should result in a final report that describes the representation of ethnic minorities in the health care and social welfare system, including the difficulties encountered by these groups and the mechanisms that cause in- or exclusion. Further, the researchers intend to develop a manual with practical guidelines and recommendations for professionals working with ethnic minorities. Finally, the results of this study will be spread through publication in journals and presentations at symposia and conferences.

Documentation :

Zorgtrajecten van druggebruikers uit etnisch-culturele minderheden ; samenvatting    Brussel : Federaal Wetenschapsbeleid, 2008 (SP1895)
[To download

Trajectoires de soins des usagers de drogues d'origine étrangère : résumé    Bruxelles : Politique scientifique fédérale, 2008 (SP1896)
[To download

Treatment trajectories of drug users from ethnic minority groups : summary    Brussels : Belgian Science Policy, 2008 (SP1897)
[To download

Etnisch-culturele minderheden in de verslavingszorg : eindrapport = Les minorités ethnico-culturelles et le traitement des problèmes de drogues : rapport final    Brussel : Federaal Wetenschapsbeleid, 2010 (SP2171)
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