To our knowledge, we are one of the few prospective cross-sectional studies to explore sociodemographic characteristics, clinical diagnoses, substance use, psychosocial variables, health care utilization and treatment history among Caucasian, African American, and Hispanic inner-city clients with co-occurring disorders. We found significant differences among African Americans, Caucasians, and Hispanics in mood and substance use disorders, currently receiving psychotropic medications, medical disease, and the number of office visits clients had within the past year. Like others before us, our results suggest that African Americans and Hispanics were five times more unlikely to receive psychotropic medications than Caucasians. In addition, African Americans were almost four times and Hispanics were six times more unlikely to receive psychiatric treatment than Caucasians. Similar to Elwy et al (2008)
and Keyes et al (2008)
, we found no addiction treatment differences among racial ethnic groups.
Besides racial ethnicity, women were more likely to receive psychotropic medications than men (). One reason for these results may be the higher number of Caucasian women in the sample. Here, it seems that Caucasian women may be more vigilant in taking care of their mental health than those in other racial ethnic groups. Supporting this rationale are the substantial mean differences in Caucasians with higher T-scores in health vigilance than African Americans (). In contrast, African Americans relied on spiritual help significantly more often than any other group. Knowing about these racial ethnic differences in psychiatric treatments, medication use, health vigilance and spiritual help highlight the importance for clinicians to understand culturally sensitive needs. Healthcare professionals that educate their patients about mood symptoms, understanding the benefits of psychotropic use, and those clinicians who can be open-minded about patients' spiritual needs may go a long way in improving minority health.
Based on urine drug screens, African Americans and Hispanics were more likely to use their drug of choice and other drugs currently. In light of the fact that most clients were on probation or parole, continued drug use will surely lead to recidivism in the justice system. As most of our subjects were living in shelter or community housing, we found that living arrangements was no guarantee of drug abstinence, although there was the suggestion that these settings were more protective than independent living. Any drug use in the shelter or community housing environment is not only a detriment to those who use, but it may jeopardize the sobriety of other residents. Thus, housing managers may find random urine drug screens beneficial in promoting drug abstinence and improving mental health and addiction treatment compliance.
Study Limitations and Strengths
Data interpretations should be viewed with caution due to the small sample size, unequal sample of racial ethnic groups, and the homogeneous sample of indigent, inner-city clients recruited from community-based social service agencies. However, this research was a preliminary exploration of racial ethnic differences in co-occurring mood and substance use disorders to generate hypotheses for larger investigations. The available data from large national studies are decades old, and indigent, homeless, and Hispanic clients with dual-diagnoses are not well-represented. Our strength is that we examined racial ethnic differences in a dual-diagnosis population within a real-world environment that included Hispanic clients. To our knowledge, we are one of a handful of recent studies whose data may shed light on how clinicians and case managers may improve mental health outcomes in minority clients. More research in this population is needed.
We found that indigent, inner-city clients have multiple psychiatric, substance use, and medical problems that seem to be under-treated. Few doctor's visits, few receiving psychotropic medications, staggering unemployment and homelessness were common in our sample, especially in minority groups. The overall picture of this indigent, inner-city sample shows an early middle-aged population of mostly minority men who are unemployed, homeless, and still using their drug of choice regardless of their legal status and opportunity to receive no-cost addiction treatment. These results suggest that healthcare and social service professionals have potentially serious challenges to improve mental health and addiction outcomes in African American and Hispanic clients with co-occurring disorders.