1. Introduction There is a growing body of literature supporting the 12- step approach for stimulant users (see Donovan & Wells 1 for a review). Important differences may exist between African American and Caucasian substance abusers regarding involvement in 12-step programs. Research has shown that, compared to Caucasians, African Americans: were more likely to attend 12-step groups at 6-month follow-up in a sample of treated substance abusers. 2 had higher rates of lifetime 12-step meeting attendance; were more likely to report a “spiritual awakening” as a result of AA; were more likely to have performed service work at a meeting within the past year; and reported feeling a part of AA. 3 reported more affiliation with 12-step than Caucasians in an inpatient treatment sample. 4 In the current study, we used a large sample from a multisite, randomized clinical trial conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN) to examine race in the context of the STAGE-12 intervention (Stimulant Abuser Groups to Engage in 12- Step Programs). 5 STAGE-12 is a combined group and individual 12-step facilitative treatment targeting stimulant abusers. Hypotheses: African American participants will endorse more interest in becoming involved in 12-step groups, as well as a more favorable view of 12-step groups than their Caucasian counterparts. The African American group will score more positively on the instrument measuring spiritual involvement and beliefs than the Caucasian group. Methods Participants: 471 stimulant abusers recruited from 10 substance abuse outpatient community treatment programs (see Table 1). Participants were randomized into one of two conditions: Treatment as usual (TAU): 2 sessions and 5-15 hours of weekly outpatient therapy as typically provided STAGE-12: 5 group sessions based on the adaptation of Twelve-step Facilitation for a group format by Brown and colleagues, 6 and 3 individual STAGE-12 sessions replaced 5 group and 3 individual TAU sessions. Participants were categorized into African American (n=171) or Caucasian (n=224) groups based on their self- reported race; individuals endorsing more than one race were not included in these analyses. Results+ Racial Differences of Stimulant Abusers’ Prior Experiences, Expectations, and Readiness to Engage in 12-Step Programs K. Michelle Peavy, PhD, Sharon B. Garrett, MPH, Suzanne R. Doyle, PhD, & Dennis M. Donovan, PhD University of Washington, Alcohol & Drug Abuse Institute 1.Donovan, D., & Wells, E. ‘Tweaking 12-step’: the potential role of 12-step self-help group involvement in methamphetamine recovery. Addiction, 2007. 102: p. 121-129. 2.Humphreys, K., B. Mavis, and B. Stofflemayr, FACTORS PREDICTING ATTENDANCE AT SELF-HELP GROUPS AFTER SUBSTANCE-ABUSE TREATMENT - PRELIMINARY FINDINGS. Journal of Consulting and Clinical Psychology, 1991. 59(4): p. 591-593. 3.Kaskutas, L., & Weisner, C. Alcoholics Anonymous affiliation at treatment intake among white and black Americans. Journal of Studies on Alcohol, 1999. 60: p. 810. 4.Kingree, J. Measuring Affiliation with 12-step Groups. Substance Use & Misuse, 1997. 32(2): p. 181-194. 5.Donovan, D.M., et al., Stimulant Abuser Groups to Engage in 12-Step (STAGE-12): A Multisite Trial in the NIDA Clinical Trials Network. Journal of Substance Abuse Treatment, in press. 6.Brown, T. G., Seraganian, P., Tremblay, J., & Annis, H. Process and outcome changes with relapse prevention versus 12- Step aftercare programs for substance abusers. Addiction, 2002. 97(6): p. 677-689. 7.McLellan, A.T., et al., THE 5TH EDITION OF THE ADDICTION SEVERITY INDEX. Journal of Substance Abuse Treatment, 1992. 9(3): p. 199-213. 8.Kingree, J.B., et al., The development and initial evaluation of the Survey of Readiness for Alcoholics Anonymous Participation. Psychology of Addictive Behaviors, 2006. 20(4): p. 453-462. 9.Humphreys, K., M. A. Greenbaum, et al., Reliability, validity, and normative data for a short version of the Understanding of Alcoholism Scale. Psychology of Addictive Behaviors, 1996. 10(1): 38-44. 10.Hatch, R.L., et al., The spiritual involvement and beliefs scale - Development and testing of a new instrument. Journal of Family Practice, 1998. 46(6): p. 476-486. 11.Kramer, T.L., et al., Childhood Conduct Problems and Other Early Risk Factors in Rural Adult Stimulant Users. Journal of Rural Health, 2009. 25(1): p. 50-57. 12.Booth, B.M., et al., Correlates of rural methamphetamine and cocaine users: Results from a multistate community study. Journal of Studies on Alcohol, 2006. 67(4): p. 493-501. 13.Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2008) The DASIS Report: Primary Methamphetamine/Amphetamine Admissions to Substance Abuse Treatment: 2005. Rockville, MD. Retrieved from http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdf http://www.oas.samhsa.gov/2k8/methamphetamineTX/meth.pdf 14.Krentzman, A.R., K.J. Farkas, and A.L. Townsend, Spirituality, Religiousness, and Alcoholism Treatment Outcomes: A Comparison between Black and White Participants. Alcoholism Treatment Quarterly, 2010. 28(2): p. 128-150. Acknowledgements References African Americans tended to be older, and they were more likely to report cocaine as their primary substance than Caucasians. These results are consistent with the literature. 11,12,13 Caucasian participants reported a higher likelihood of attending 12-step groups. However, African Americans reported more perceived benefit from meeting attendance than Caucasians. The two groups were similar in terms of the model by which they understand addiction. However, the Caucasian group exhibited a higher score on the eclectic model scale, which is less consistent with the STAGE-12 intervention than the disease model. The African American group reported more spirituality (as measured by SIBS-R) than Caucasians, which is consistent with previous research. 14 This is important because spirituality is an important part of the 12-step model. Racial differences here could be related to specific features of African-American culture, for example the important role of church in the African American community. Implications: Encouragement to attend 12-step groups may be appropriate for substance abuse clients of both races. African Americans may be more open to the spiritual aspects of the 12-step philosophy than Caucasians. Future research: Studies to determine how racial differences might translate into actual 12-Step participation and attendance. Inclusion of multivariate analysis statistically controlling for age, primary drug use to determine whether racial differences are due to these variables. Measurement equivalence analysis to determine whether racial differences are attributable to differences in measurement rather than differences in the study variables. Total Sample N (%) M (SD) African American N (%) M (SD) Caucasian N (%) M (SD) N395171 (43.3)224 (56.7) Age39.1 (9.8)42.7 (8.7)36.3 (9.8)* Gender (Female)232 (58.7)91 (53.2)141 (63.0) Mean years of education12.1 (1.6)12.07 (1.49)12.16 (1.73) Primary Drug Amphetamines2 (0.51)02 (0.89) Methamphetamine95 (24.1)1 (0.58)94 (42.0)* Cocaine223 (56.5)142 (63.7)81 (36.2)* Alcohol40 (10.1)20 (11.7)20 (8.9) Marijuana12 (3.0)4 (2.3)8 (3.6) Opiates22 (5.6)4 (2.3)18 (8.0) Other1 (0.25)01 (0.45) ASI Drug Composite Score (Baseline) 0.16 (0.09)0.15 (0.09)0.16 (0.09) Methods (cont). Measures: Addiction Severity Index-Lite 7 (ASI-Lite) 12-Step Experiences and Expectations (TSEE) Survey of Readiness for Alcoholics Anonymous Participation 8 (SYRAAP) Understanding of Alcoholism and Drug Addiction 9 (SUSS); three subscales: 1) disease model; 2) psychosocial model; and 3) eclectic orientation. Spiritual Involvement and Beliefs Scale- Revised 10 (SIBS–R); includes a total score and four subscales: 1.Core Spirituality (connection, meaning, faith, involvement, and experience) 2.Spiritual Perspective/Existential 3.Personal Application/Humility 4.Acceptance/Insight (i.e., insight into futility of focusing attention on things that cannot be changed) Table 1. * TSEE: Caucasian participants indicated a greater likelihood to get involved in self-help groups (Z=3.49, p=.0005) than African American participants. There were no differences between groups in terms of prior experiences with 12-step. SYRAAP: African Americans scored higher on a scale measuring the perceived benefits of 12-step groups (Z=2.35, p=.019). Groups did not differ on the perceived severity or barriers subscales. SUSS: Caucasian participants reported higher scores on the eclectic subscale reflecting participants’ beliefs about the treatment and etiology of addiction (F1,338 = 11.21, p =.0009). Groups were not significantly different in terms of ratings on the other two subscales (i.e., disease and psychosocial) measuring participants’ understand about the treatment and etiology of addiction. SIBS-R: African American participants had higher scores than Caucasian participants on: the Core Spirituality subscale (F1,329 = 18.71, p <.0001), the Personal Application/Humility subscale (F1,374 = 10.88, p =.0011) Total SIBS-R measure of spirituality (F1,317 = 14.45, p =.0002). *p<.0001 This study was supported by the National Institute on Drug Abuse (NIDA; U10-DA013714 Clinical Trials Network – Pacific Northwest Node; Dennis M. Donovan, PI). The authors would like to thank the many clinical and research involved in the STAGE-12 study, as well as the treatment participants who volunteered to take part in the study. Conclusions