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. Author manuscript; available in PMC: 2023 May 1.
Published in final edited form as: J Subst Abuse Treat. 2021 Nov 20;136:108662. doi: 10.1016/j.jsat.2021.108662

The role of self-help groups on successful substance use treatment completion for opioid use: An intersectional analysis of race/ethnicity and sex

Madeline R Stenersen a, Kathryn Thomas a, Cara Struble a, Kelly E Moore b, Catherine Burke a, Sherry McKee a
PMCID: PMC8940633  NIHMSID: NIHMS1759893  PMID: 34840040

Abstract

Introduction.

Race/ethnicity and sex disparities in substance use and substance use treatment completion are well documented in the literature. Previous literature has shown that participation in self-help groups is associated with higher rates of substance use treatment completion. While most of this research has focused on the completion of treatment for alcohol and stimulant use, research examining this relationship using an intersectional approach for individuals in treatment for opioid use is limited.

Methods.

Thus, the current study utilized responses from the Treatment Episodes Data Set–Discharges, 2015–2017 to examine disparities in the relationship between participation in self-help groups and substance use treatment completion for individuals undergoing treatment for opioid use based on sex, race, and ethnicity.

Results.

Results revealed a positive association between participation in self-help groups and treatment completion among those in treatment for opioid use across race, ethnicity, and sex. Further, the study found several differences in this association based on one’s race, ethnicity, and sex. When compared to men of other races/ethnicities, the association between self-help group participation and treatment completion was highest among Black men.

Conclusions.

The results of the current study extend the knowledge-base about self-help participation’s role in promoting successful substance use treatment completion to individuals in treatment for opioid use. Results also highlight the need to examine treatment outcomes with an intersectional lens.

Keywords: Substance use treatment, Disparities, Self-help, Opioid use, Health equity

1. Introduction

Race, ethnicity, and sex disparities in substance use and substance use treatment completion are well documented in the current literature. Particularly, even when controlling for various environmental factors, people of color and women continue to experience significant barriers to successful completion of substance use treatment when compared to their White and/or male counterparts (Acevedo et al., 2015; Kelly, 2003; Mennis et al., 2019; Montgomery et al., 2012; Saloner & Cook, 2013). The literature on the impact of self-help involvement during substance use treatment has focused largely on rates of participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) among Black and White individuals presenting with alcohol and/or stimulant use (Humphreys et al., 1994; Peavy et al., 2017; Redmond et al., 2017; Zemore et al., 2021). Despite a growing focus on individuals with opioid use in the United States, literature on the role of self-help groups in facilitating substance use treatment for opioid use remains sparse (Zemore et al., 2021). Further, limited research has examined the impact of intersectionality on substance use and substance use treatment. Thus, the current study uses an intersectional approach to better understand the relationship between self-help group participation and substance use treatment completion among individuals in treatment for opioid use.

The concept of intersectionality was first introduced by Kimberlé Crenshaw in 1989, and seeks to understand how the lives of individuals from historically marginalized groups are affected by multiple factors, including their race, ethnicity, class, and sex (Crenshaw, 1991, Redmond et al., 2020). Further, the use of intersectionality in academic research emphasizes understanding lived experience, not by examining, for instance, race/ethnicity or sex, but instead seeking to understand ways in which holding multiple social identities shapes individual lives (Museus & Griffin, 2009). More recently, Redmond and colleagues (2020) used the concept of intersectionality to better understand the experiences of Black women in substance use treatment. Though multiple researchers have encouraged the use of intersectionality (Gunn et al., 2018; Mereish & Bradford, 2014; Rogers & Kelly, 2011), little scholarly work has used an intersectional lens when examining factors, such as self-help groups, that can influence one’s ability to complete substance use treatment.

Involvement in self-help groups can be a powerful tool for individuals in substance use treatment. Literature in this area has most frequently focused on the impact of 12-step group participation (e.g., AA, NA) for individuals with alcohol and stimulant use. Studies have shown that participation in these groups is associated with increased rates of abstinence (Donovan & Wells, 2007; Kelly, 2003; Witbrodt et al., 2014; Zemore et al., 2021), and an increase in reported social supports (Lookatch, et al., 2019; Moos & Moos, 2006). Though limited, literature regarding self-help participation among individuals with opioid use has shown similar benefits, including increased rates of abstinence (Gossop et al., 2007), sustained remission (Shiraly & Taghva, 2018), and adherence to medication for addiction treatment (MAT; Parran et al., 2010).

Nonetheless, evidence suggests that individuals with opioid use exhibit low rates of participation in self-help groups compared to other treatment methods (Rhee & Rosenheck, 2019). Further, those in MAT often experience a sense of exclusion from traditional NA and AA groups, which may promote a medication-free path to abstinence (Krawczyk, et al., 2018; Monico et al., 2015; Parren et al., 2010; Ronel et al., 2011; Sokol et al., 2018). In their 2015 study regarding African Americans in buprenorphine maintenance treatment (BMT), Monico and colleagues found that although 12-step meeting attendance showed some positive benefits in treatment, participants also reported stress related to negotiating messages promoting abstinence with their participation in BMT. The authors of this study also noted that this negotiation appeared to get less strenuous as more 12-step members were willing to accept those in MAT. The emergence of a new 12-step group, Methadone Anonymous, occurred largely in response to these tensions and has shown preliminarily positive results (Gilman et al., 2001; Kelly, 2003). As the rate of self-help group participation among those in treatment for opioid use disorder increases (Saloner & Karthikeyan, 2015), research that examines self-help’s impact on and experiences of participants of different races, ethnicities, and sex becomes imperative.

The presence of racial, ethnic, and sex disparities in self-help group participation while in substance use treatment is clear from scholarly literature. Examinations of race and ethnicity in self-help group participation have focused largely on the comparison of African American/Black participants compared to White participants (Kaskutas et al., 1999; Peavy, et al., 2017; Zemore et al., 2021). In contrast to the notion that 12-step meetings are exclusively for White, middle-class men (Peavy, et al., 2017; Smith et al., 1993; Venner et al., 2012), attendance and engagement in self-help groups are similar among African American men and women compared to their White counterparts (Hillhouse & Fiorentine, 2001). In their 2013 longitudinal study of the experiences of American Indian individuals in self-help groups for substance use treatment, Tonigan and colleagues found similar benefits and more engagement among American Indian participants compared to their non-Hispanic White counterparts.

Research regarding the experience of women in 12-step and other substance use self-help groups remains limited. Women encompass about 30% of all admissions to substance use treatment (Substance Abuse and Mental Health Services Administration, 2007). Some researchers have expressed concerns that the comparatively small population of women in AA and other self-help groups may inhibit the discussion of women-specific issues in those groups (Kelly, 2003). In their 2001 chapter examining the Sex MATCH hypothesis, Del Boca and Mattson found that attendance at 12-step meetings was comparable across sexes and that in aftercare, women reported a higher level of engagement and attendance at meetings compared to men. Conversely, recent literature has found that women were less likely to utilize self-help groups compared to their male counterparts (Gilbert et al., 2019). However, these studies did not examine or report intersectional differences among women of different races and ethnicities.

1.1. The current study

The current study used an intersectional approach to understand the impact of race/ethnicity and sex on the relationship between self-help group participation and substance use treatment completion among individuals discharged from outpatient treatment for opioid use. Specifically, the current study had two primary objectives:

  • Objective 1: Investigate the relationship between self-help group participation and successful treatment completion among individuals in treatment for opioid use.

  • Objective 2: Examine whether sex, and race/ethnicity effectively moderated the relationship between self-help group participation and successful treatment completion.

2. Materials and methods

2.1. Data

The current study utilized data from the 2015–2017 Treatment Episode Dataset–Discharge (TEDS-D). The TEDS-D is a nationwide dataset that the Substance Abuse and Mental Health Services Administration (SAMSHA) collects, which provides information on characteristics and outcomes of individuals discharged from substance use treatment. TEDS-D data are collected from licensed substance use treatment facilities across the United States that receive state funds for their operations. Data from the 2015–2017 TEDS-D reflect cases that were discharged during the 2015, 2016, and 2017 calendar years, regardless of whether participants were admitted during that year (SAMSHA, 2019).

2.2. Participants

The current study used adult participants who indicated either successful or unsuccessful discharge, whose service setting was either outpatient or intensive outpatient (IOP) at admission, and who reported their primary substance of use at admission as opioids (e.g., heroin and/or other opioids/synthetics). The stdy excluded participants if their cases contained any missing data among the variables of interest, if they indicated a treatment setting other than outpatient or IOP (e.g., residential), reported a length of treatment fewer than 30 days, and/or indicated a primary substance of use other than opioids. As a result, the current analysis contains responses from 199,779 individuals and includes no missing data. Table 1 lists full demographic characteristics.

Table 1.

Sample Demographic Characteristics (N = 199,779)

Variables N % % Participated in SHa groups % Successful Treatment Completion
Age
 18–24 years 31027 15.3
 25–34 years 89795 44.2
 35–44 years 42186 20.8
 45–54 years 26800 13.1
 55–64 years 11970 5.9
 65 years and older 1345 0.7
Race/Sex
 White Men 88242 43.4 29.6 40.9
 White Women 67342 33.2 29.5 38.4
 Black Men 16062 7.9 23.7 28.7
 Black Women 8778 4.3 20.8 23.4
 AI/ANb Men 1306 0.6 25.6 31.2
 AI/ANb Women 1626 0.8 27.4 27.1
 Asian/PIc Men 538 0.3 29.0 39.2
 Asian/PIc Women 253 0.1 26.1 33.6
 Hispanic Men 9924 4.9 28.1 37.5
 Hispanic Women 5708 2.8 26.3 34.3
Education Level
 8 years or less 8704 4.3
 9–11 years 40666 20.0
 12 years or GED 98360 48.4
 13–15 years 44464 21.9
 16 or more 10929 5.4
Length of Stay in Treatment
 30–60 days 45209 22.2
 61–90 days 31053 15.3
 91–120 days 24880 12.2
 121–180 days 30062 14.8
 181–365 days 38253 18.8
 More than 1 year 33666 16.6
Employment Status at Discharge
 Full Time 51612 25.4
 Part Time 23037 11.3
 Unemployed 72023 35.5
 Not in Labor Force 56451 27.8
Discharge Status Total
 Successful Discharge 76446 37.6
 Unsuccessful Discharge 126677 62.4
Self Help Group Participation
 Yes 58046 28.6
 No 145077 71.4
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Note:

a

SH = Self-Help

b

AI AN = American Indian/Alaska Native

c

PI = Pacific Islander.

2.3. Measures

2.3.1. Demographics.

The study collected information regarding participants’ age, education level, ethnicity, race, and sex. The TEDS-D utilizes either Hispanic or non-Hispanic to indicate ethnicity. Consistent with an intersectional approach, the current study created a race/ethnicity and sex variable to group participants by both sex and racial/ethnic identity, which resulted in a total of 10 comparison groups made up of White men, White women, Black men, Black women, American Indian/Alaska Native (AI/AN) men, AI/AN women, Asian/Pacific Islander (PI) men, Asian/PI women, Hispanic men, and Hispanic women. Hispanic men and women include individuals of all racial identities who indicated their ethnicity as Hispanic. Individuals in all other racial categories include individuals who indicated their ethnicity as non-Hispanic.

2.3.2. Treatment characteristics/self-help participation.

Regarding treatment characteristics, responses include the length of stay in treatment for the current episode (in days), and the treatment service setting. To capture the unique role of self-help groups for individuals living in their communities (as opposed to residential treatment settings), the study used responses from only participants in ambulatory outpatient treatment, and ambulatory intensive outpatient treatment (IOP) settings who indicated no prior episodes of treatment.

The current study also used responses from participants’ primary substance of use at admission. The current analyses include only participants who indicated either “heroin” or “other opiates and synthetics” as their primary substance of use. To assess self-help participation, the study asked respondents, “Did the participant participate in self-help groups in the 30 days prior to discharge?” To understand the impact of self-help group participation on successful treatment completion, the study dichotomized self-help participation with participants indicating any level of self-help group participation designated as “yes” for participation and those with no attendance designated as “no”. Given that the study inquired about self-help participation 30 days prior to discharge, and to capture participants who participated in self-help groups in the course of treatment, the current analysis includes only participants who indicated a length of stay in treatment of 30 days or longer.

2.3.3. Discharge status.

The current study used substance use treatment discharge status as the outcome variable. Discharge status options included treatment completed, dropped out of treatment, terminated by facility, transferred to another treatment program or facility, incarcerated, death, or other. For our purposes, the current study defined successful discharge if a participant was discharged as “treatment completed”. The study defined treatment completed as “all parts of the treatment plan or program were completed” (SAMSHA, 2019). Unsuccessful discharge included only those participants who were discharged due to “dropped out of treatment” or “terminated by facility”. The study excluded participants with all other discharge types.

2.4. Statistical analyses

First, to examine the relationship between self-help participation and treatment completion across race/ethnicity and sex (Objective 1), the research team conducted ANOVA analyses. Specifically, the study conducted sex-stratified analyses to examine differences in the estimated marginal mean (EMM) of successful treatment outcome within each racial/ethnic group, comparing those who did not participate in self-help groups with those who did. The team coded successful treatment outcome as 1 and unsuccessful treatment outcome as 0. As such, higher means indicated a greater proportion of group members successfully completing treatment.

Next, to investigate whether race/ethnicity and sex moderate the effects of participation in self-help groups on substance use treatment completion (Objective 2), the research team performed a series of logistic regression analyses. First, we performed a hierarchical logistic regression in which the first two steps examined the covariates and main effects of participation in self-help groups, race/ethnicity, and sex on treatment completion (see steps 1 and 2 in Table 2). The next two steps examined the unadjusted and adjusted interaction models (see steps 3 and 4 Table 2) to determine if race/ethnicity and/or sex might moderate the effects of participation in self-help groups on treatment completion. This first logistic regression used White and men as the reference group for race/ethnicity and sex categories. Finally, the study performed additional adjusted hierarchical logistic regressions, stratified by sex, and each identical to the last except for the reference category for race. Covariates in the adjusted models include age, ethnicity, education level, length of stay in treatment, and employment at discharge. These additional analyses compared each racial group to one another, in effect taking into consideration the unique experiences of each group in the analyses.

Table 2:

Adjusted Moderation Analysis with Substance Use Treatment Outcome predicted by SH Group Attendance Moderated by Race and Sex

Variable B S.E. Wald Sig. Exp(B) Lower CI Upper CI
Step 1: Covariates Only
 Education 0.027 0.005 29.857 <.001 1.027 1.017 1.037
 Length of stay in treatment (days) 0.017 0.000 1796.645 <.001 1.018 1.017 1.018
 Employment status at discharge −0.263 0.004 4522.131 <.001 0.769 0.763 0.775
 Age at admission −0.026 0.002 133.784 <.001 0.974 0.970 0.979
 Marital status 142.964 <.001
Step 2: Main Effects Model <.001
 Education 0.005 0.005 0.826 0.363 1.005 0.995 1.015
 Length of stay in treatment (days) 0.018 0.000 1684.890 <.001 1.018 1.017 1.019
 Employment status at discharge −0.223 0.004 2760.772 <.001 0.800 0.794 0.807
 Age at admission 0.009 0.003 12.897 <.001 1.009 1.004 1.015
 Marital status 110.950 <.001
 Self-Help Group Participation 1.541 0.010 24644.118 <.001 4.667 4.578 4.758
 Race/Ethnicitya 1046.974 <.001
 Sexb −0.045 0.010 22.460 <.001 0.956 0.938 0.974
Step 3: Unadjusted Interaction Model <.001
 Education 0.006 0.005 1.176 0.278 1.006 0.995 1.016
 Length of stay in treatment (days) 0.018 0.000 1689.294 <.001 1.018 1.017 1.019
 Employment status at discharge −0.222 0.004 2739.171 <.001 0.801 0.794 0.807
 Age at admission 0.010 0.003 14.011 <.001 1.010 1.005 1.015
 Marital status 111.886 <.001
 Self-Help Group Participation 1.524 0.014 12252.961 <.001 4.588 4.466 4.714
 Race/Ethnicitya 1109.358 <.001
 Sexb −0.010 0.011 0.787 0.375 0.990 0.968 1.012
 Race/Ethnicitya*Self-Help 225.651 <.001
 Group Participation Sexb*Self-Help Group Participation −0.106 0.020 28.300 <.001 0.899 0.865 0.935
Step 4: Adjusted Interaction Model
 Education 0.006 0.005 1.136 0.287 1.006 0.995 1.016
 Length of stay in treatment (days) 0.018 0.000 1690.458 <.001 1.018 1.017 1.019
 Employment status at discharge −0.222 0.004 2739.613 <.001 0.801 0.794 0.807
 Age at admission 0.010 0.003 13.836 <.001 1.010 1.005 1.015
 Marital status 109.864 <.001
 Self-Help Group Participation 1.511 0.014 11491.339 <.001 4.533 4.410 4.660
 Racea 1108.827 <.001
 Sexb −0.010 0.011 0.776 0.379 0.990 0.968 1.012
 Race/Ethnicitya*Self-Help Group Participation 226.132 <.001
 Sexb*Self-Help Group Participation −0.078 0.021 13.574 <.001 0.925 0.887 0.964
 Race/Ethnicitya*Sexb*Self-Help Group Participation 21.884 <.001
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Note:

a

Reference = White.

b

Reference = Men. Covariates = age, education level, length of stay in treatment, employment status at discharge.

Significance values are largely a non-reliable indication of significance given the large sample size and should be interpreted as such. Instead, analyses report both odds ratios and Cohen’s D effect sizes as reliable indicators of effect. The study team calculated the odds ratio to Cohen’s D effect size conversion according to Lenhard & Lenhard (2016).

3. Results

3.1. Self-help group participation and treatment completion (Objective 1)

As Figures 1, 2, and 3 outline, participants across race/ethnic and sex groups who participated in self-help groups were significantly more likely to complete treatment compared to those without self-help participation. This result demonstrates the positive relationship between self-help group participation and substance use treatment completion across race/ethnicity and sex.

Figure 1: Effects of Self-Help Group Participation on Prediction of Treatment Completion - All Sexes.

Figure 1:

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Note: aEMM = Estimated Marginal Mean; bSH = Self-Help; cAI AN = American Indian/Alaska Native; dPI = Pacific Islander * p<.001

Figure 2: Effects of Self-Help Group Participation on Prediction of Treatment Completion – Women.

Figure 2:

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Note: aEMM = Estimated Marginal Mean; bSH = Self-Help; cAI AN = American Indian/Alaska Native; dPI = Pacific Islander * p<.001

Figure 3: Effects of Self-Help Group Participation on Prediction of Treatment Completion - Men.

Figure 3:

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Note: aEMM = Estimated Marginal Mean; bSH = Self-Help; cAI AN = American Indian/Alaska Native; dPI = Pacific Islander * p<.001

3.2. Intersectional examination of self-help group participation and treatment completion (Objective 2)

Adjusted regression results revealed that, with White men as the comparison group, significant interactions exist between 1) sex and self-help participation (p<.001); 2) race/ethnicity and self-help participation (p<.001); and 3) sex, race/ethnicity, self-help group participation (p<.001). These significant interactions suggest that self-help group participation has a different relationship with treatment completion depending on one’s race/ethnicity and sex. Table 2 presents full results.

To probe the magnitude of these differences, the study performed a subsequent series of adjusted logistic regressions, stratified by sex, to further investigate the extent to which membership in each race/ethnicity group moderated the relationship between self-help group participation and treatment completion compared to other race/ethnicity groups. As Table 3 outlines, the greatest effect of race/ethnicity on self-help participation to treatment completion relationship came when examining Black men compared to men of other races/ethnicities. In particular, with the exception of Asian/PI men, Black men showed the largest positive association between self-help group participation and treatment completion. In comparison to White men, the relationship between self-help participation and treatment completion was approximately 50% stronger for Black Men (OR = 1.663, D = 0.280). However, absolute levels of treatment completion remained highest in White men.

Table 3 –

Intersectional examination of the relationship between self-help attendance and substance use treatment completion (adjusted interaction effects only)

WOMEN
Reference Group B SE Wald Sig. Exp(B) Lower Upper ESc
White Women Black/AAa Women 0.333 0.057 34.688 <.001 1.396 1.249 1.559 0.184
American Indian/Alaska −0.049 0.122 0.161 0.689 0.952 0.750 1.210 −0.027
Native Women
Asian/PIb Women 0.199 0.288 0.477 0.490 1.220 0.694 2.143 0.11
Hispanic Women 0.293 0.073 16.265 <.001 1.341 1.163 1.546 0.162
Black/AAa American Indian/Alaska −0.382 0.133 8.314 0.004 0.682 0.526 0.885 −0.211
Women Native Women*
Asian/PIb Women −0.135 0.292 0.212 0.645 0.874 0.493 1.549 −0.074
Hispanic Women −0.040 0.089 0.201 0.654 0.961 0.807 1.144 −0.022
American Asian/PIb Women 0.248 0.311 0.632 0.427 1.281 0.696 2.359 0.137
Indian/Alaska
Native Women
Hispanic Women 0.342 0.140 5.959 0.015 1.408 1.070 1.853 0.189
Asian/PIb Women Hispanic Women 0.095 0.296 0.103 0.749 1.099 0.616 1.962 0.052
MEN
Reference Group B SE Wald Sig. Exp(B) Lower Upper ES
White Men Black/AAa Men* 0.509 0.040 158.577 <.001 1.663 1.536 1.800 0.280
American Indian/Alaska −0.290 0.127 5.258 0.022 0.748 0.584 0.959 −0.16
Native Men
Asian/PIb Men* 0.396 0.193 4.226 0.040 1.486 1.019 2.169 0.218
Hispanic Men 0.279 0.054 27.082 <.001 1.322 1.190 1.468 0.154
Black/AAa Men American Indian/Alaska −0.799 0.131 37.001 <.001 0.450 0.348 0.582 −0.44
Native Men
Asian/PIb Men −0.112 0.196 0.328 0.567 0.894 0.609 1.312 −0.062
Hispanic Men −0.230 0.064 12.846 <.001 0.795 0.701 0.901 −0.126
American Asian/PIb Men* 0.687 0.230 8.929 0.003 1.987 1.267 3.117 0.379
Indian/Alaska
Native Men
Asian/PIb Men Hispanic Men* 0.569 0.136 17.527 <.001 1.767 1.354 2.307 0.314
Hispanic Men −0.117 0.199 0.347 0.556 0.889 0.602 1.314 −0.065
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Note:

*

= Small Effect Size. Covariates = age, education level, length of stay in treatment, employment status at discharge.

a

AA = African American

b

PI = Pacific Islander

c

ES = Effect Size.

In contrast, AI/AN men showed a significantly smaller association between self-help group participation in comparison to Black men (OR = 0.450, D = −0.440), Asian/PI men (OR = 1.987, D = 0.379), and Hispanic men (OR = 1.767, D = 0.314).

Among women, the greatest effect of race/ethnicity was seen when examining Black women compared to AI/AN women. In this case, the association between self-help participation and successful treatment outcome was approximately 47% larger for Black women (OR(converted) = 1.466, D = .211). Table 3 outlines full results.

4. Discussion

Using an intersectional approach, the current study aimed to examine the relationship between participation in self-help groups and substance use treatment completion among individuals with opioid use. Consistent with previous research, the current results solidify the overall benefits of self-help group participation for individuals across race/ethnicity and sex (Zemore et al., 2021). In particular, individuals who participated in self-help groups while in treatment were significantly more likely to successfully complete treatment compared to individuals with no self-help group participation.

Though White men (29.6%) and White women (29.5%) reported the highest level of participation in self-help groups, results revealed significant differences in the association between self-help participation and treatment completion based on one’s sex and race/ethnicity. For example, Black men with self-help participation were significantly more likely to complete treatment compared to Black men without self-help participation. This difference within one’s own race/ethnicity group was largest for Black men compared to men of all other races/ethnicities and may have remained unrecognized without the use of an intersectional lens. This finding is also consistent with literature regarding AA/NA engagement among individuals with stimulant use disorder (Peavy et al., 2017). Specifically, in 2017, Peavy and colleagues found that, although Caucasian participants were more likely to report future involvement in AA/NA, African American participants reported higher levels of engagement, and commitment to the self-help group. The current study extends this line of inquiry by showing that among those with opioid use, engagement in self-help groups can be particularly beneficial for Black men.

Overall, the nonsignificant effects of race/ethnicity and sex on the relationship between self-help group participation and treatment completion also provide valuable knowledge. Specifically, the current results imply that the benefits of self-help group participation do not extend only to White men but instead further solidify the benefits of self-help group participation across individuals of varying sex and race/ethnicity. Despite these benefits, participation in self-help groups remained highest among White men and women. Barriers such as lack of access, stigma, and discrimination continue to contribute to the lower level of participation in self-help groups among people of color (Cummings et al., 2011; Zemore et al., 2014). Taken together, these findings highlight the continued need for efforts aimed at increasing access and decreasing barriers to self-help participation among people and communities of color.

Finally, this study further solidifies the utility of an intersectional approach when seeking to understand the lived experience of individuals in substance use treatment. By examining the relationship of both race/ethnicity and sex with substance use treatment completion, the current study was able to denote several unique differences within racial/ethnic and sex groups that would have otherwise gone unnoticed. Ultimately, knowledge of these experiences and the benefits of self-help groups for individuals in treatment for opioid use can help to inform appropriate and effective clinical interventions.

5. Limitations

The current study is not without limitations. Since the study coded participation in self-help groups as a dichotomous variable, more detailed information regarding the characteristics, location, and/or frequency of self-help groups was limited. Future research should expand on the current findings to examine characteristics of self-help groups that may benefit individuals of different races, ethnicities, and sex. Additionally, the Hispanic group included individuals of all racial groups who also identified their ethnicity as Hispanic. As the TEDS-D data do not include information regarding ethnicities outside of Hispanic or non-Hispanic, the current analysis was unable to delineate the impact of additional ethnic identities within racial groups (e.g., Caribbean Black, Korean American, etc.). Relatedly, as the current study gave participants the options of man or woman for identification of sex, the current results exclude the influence of nonbinary gender identity on study outcomes. The current data are from 2015–2017. Therefore, the use of more recent data may impact results given the current political and economic landscape as well as recent public perceptions of opioid use and misuse. Finally, the data represent only treatment facilities that receive state and federal funding as part of their operations. As such, the current results are not generalizable to privately funded treatment programs.

6. Future directions

Despite the positive association between participation in self-help groups and treatment completion, only 28.6% of individuals participated in self-help groups while in outpatient treatment for opioid use. This finding is consistent with previous literature that indicates low rates of self-help group participation among individuals who use opioids (Kelly, 2003; Krawczyk, et al., 2018). Given the multitude of benefits to those in substance use treatment, including those outlined in the current study, future research and clinical interventions should focus on the barriers to participation in self-help groups, such as feeling unwelcome, and on barriers related to accessing necessary self-help support services. Relatedly, future research should examine the impact of the size, setting, and structure of self-help groups on individuals who participate in them.

Highlights.

  • Demographic disparities exist in substance use and substance use treatment outcomes

  • Self-help participation has a positive impact on treatment outcome for opioid use

  • Race/ethnicity and sex differences exist in benefits of self-help participation

  • Self-help participation has the potential to decrease treatment disparities

Acknowledgments

Support provided by NIH grants T32DA019426 and U54AA027989.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

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