International Journal of the Addictions
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Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs Milton Argeriou To cite this article: Milton Argeriou (1978) Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs, International Journal of the Addictions, 13:3, 443-459, DOI: 10.3109/10826087809045260 To link to this article: http://dx.doi.org/10.3109/10826087809045260
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The International Journal of the Addictions, 13(3), 443-459, 1978
Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs Milton Argeriou," Ph.D. Services for Traffic Safety Project Boston, Massachusetts 02 I 10
Abstract
The potential of court-enforced treatment of problem drinking drivers in reaching and effectively treating problem drinking Blacks is examined through an analysis of the experience of one such drinking driver program. The findings support the contention that the potential of court-enforced treatment is significant and should not be overlooked in any plan aimed at providing treatment services to the Black community.
INTRO D UCTI 0 N A review of available literature relevant to the use and abuse of alcohol among Black Americans reveals that the quantity of research conducted *To whom requests for reprints should be addressed at Division of Alcoholism, 755 Boylston Street, Boston, Massachusetts 021 16. 443 Copyright 01978 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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ARGERIOU
has not been proportional to the size of the Black population in America nor to the purported frequency and severity of problem drinking among Blacks. Moreover, the greater bulk of these studies have only come within the last 10 years and have usually generated as many questions as answers regarding the use of alcohol in the Black community. Taken together, however, the findings summarized in Table 1 do appear to support the general conclusions that follow. [Sterne (1967) has argued that the lack of systematic study of drinking in the Black community requires that caution be exercised in interpreting the results of studies of alcohol use and abuse among Blacks. In the absence of such systematic study, generalizations about drinking behavior among Blacks. if possible at all, must be viewed as tentative.] While the comparative rates of drinking of Black and White males are questionable (Cahalan et al., 1969; Bailey et al, 1969: Haberman and Sheinberg, 1967; Robins et al., 1968; Stern, 1967), there is more acceptance of the findings that Black females exhibit a higher proportion of abstainers and heavy drinkers than White females (Cahalan et al., 1969; Bailey et al., 1965; Haberman and Sheinberg, 1967; Sterne, 1967); Blacks begin drinking at an earlier age than Whites (Maddox and Williams, 1968; Robins et &I., 1968; Vitols, 1968: Viamontes and Powell, 1974); Blacks begin drinking Izeavily at an earlier age than Whites (Bahn and Chandler, 1961; Maddox and Williams, 1968; Robins et al., 1968; Vitols, 1968; Viamontes and Powell, 1974); and Blacks experience more alcohol-related problems than Whites (e.g., medical, social, legal) [A paradoxical exception to this general statement is the finding that the rate of suicide among Blacks is lower than Whites despite the fact that the Black community is marked by a number of characteristics of social disorganization (e.g., high crime rates, high unemployment? high divorce) known to be associated with high rates of suicide (Goodwin, 1973).] which usually begin earlier in the lives of Blacks than Whites (Malzberg, 1947: Locke et al., 1960; Strayer, 1961; Bahn and Chandler, 1961; Locke and Duvall, 1974; Zax et al., 1964; Bailey et al., 1965; Haberman and Sheinberg, 1967; Barchha et al., 1968; Hyman, 1968; Vitols, 1968; Robins et al., 1968; King et al., 1969; Gorvitz et al., 1970; Cahalan and Room, 1974; Viamontes and Powell, 1974). Given this scope of the alcohol-abuse problem among Blacks, it is particularly disconcerting to discover that Blacks utilize alcoholism treatment facilities less often than Whites (Bahn and Chandler, 1961; Mayer et al., 1965; Vitols, 1968; Nathan et al., 1968; Roy Littlejohn Associates, 1972). In an effort to respond to this issue of underutilization of treatment facilities by Blacks and ensure the provision of alcoholism treatment
1947
1960
1961
1961
1964
Locke et al.
Strayer
Bahn and Chandler
Locke and Duvall
Year of publication
Malzberg
Authors
Sample characteristics
Study technique
3,339 Black and First admissions to public White males and mental hospitals in Ohio, females July 1, 1958-December 31, 1961
Analysis of hospital records
1,077 White males All clients admitted to BridgeAnalysis of 26 Black males port (Connecticut) Clinic over clinic records 187 White females a period of 93 years ending 18 Black females December 1958 2,210 males Maryland residents discharged Analysis of 2,270 females from outpatient psychiatric clinic records Blacks and Whites clinics in Maryland or the District of Columbia during the year ending June 30, 1959
616 Whites First admissions to mental Analysis of 58 Blacks disease hospitals in New York hospital records State for the fiscal year Males and females ending March 31, 1944 1,778 Black and First admissions to public Analysis of White males mental hospitals in O~io, hospital records January 1-June 30, 1948 and females
Sample size and sex
Table 1 Summary of Previous Studies on Alcohol Use among Blacks
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(continued)
Higher rate of alcoholic psychosis among Black males. Lower age of Black males at time of admission Blacks were generally younger at time of admission and had been drinking excessively for a shorter peiod of time Higher rates of excessive drinking and alcoholrelated disorders among Black males and females. Lower age of Blacks exhibiting acute and chronic brain syndromes associated with alcohol abuse Higher rate of alcoholic psychosis among Black males. Lower age of Black males at time of admission
Higher rate of alcoholic psychosis among Black males and females
Major findings
Analysis of intake Patients contacting Peter Bent 181 Whites 12 Blacks Brigham Hospital Alcoholism data gathered Males and females Clinic, Boston, Massachusetts, by telephone and personal January 1 , 1962-December 3 I , I962 interviews
706 Black and Multistagz problem sample designed to be representative White males and females of New York City. Of the 2,118 adults interviewed, 706 were asked questions about personai drinking behavior, and resulting problems, April-October 1963
1965
1967
Mayer et al.
Haberman and Sheinberg
Structured interview
A 2-stage stratified cluster Structured 8,082 Black and sample in which interviews interview White males and female5 were conducted with 4,387 schedule families living in the Washington Heights area of New York City: 1960 = 1961
1965
Bailey et al.
Analysis of police records
Study technique
Subjects accounted for the 3,185 Black and 5,524 arrests for public White males and intoxication in Rochester, females New York, for the year ending, December 31, 1961
Sample characteristics
1964
Year of publication Sample size and sex
Zax et al.
Authors
Table 1 (continued)
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Higher rates of arrest for Black males and females. Age at time of arrest is lower for Black males. Black males develop multiple arrest records earlier than White males Rates of probable alcoholics among Black and White males were similar (i.e., 37/1,000 and 31/1,000, respectively). Black females had a higher rate than White females (i.e., 20/1,000 and S/I,000, respectively) The number of Blacks seeking assistance is not proportional to their representation in the general population nor to their purported incidence of alcoholism The rate of implicative drinkers/1,000 adults was somewhat higher for Black males (119) than for White males (91) but was significantly higher for Black females (97) than White females (23)
Major findings
I968
1968
1968
1968
I968
Barchha et al.
Hyman
Maddox and Williams
Vitols
Robins et al.
All patients admitted to Barnes Hospital, St. Louis, Missouri, during a period of 5 consecutive months
91 % of all freshman entering a state supported Black College in North Carolina, fall 1963 Structured interview
Structured interview, analysis of accident reports
Structured interview, patient records
Black males gave histories suggesting alcoholism twice as frequently as White males. No difference between Black and White females regarding the presence of alcoholism Black males exhibited higher accident vulnerability ratios than Whites at all BAC levels. Blacks showed blood alcohol levels above 0.10% almost five times as frequently as Whites Black students started drinking earlier in life than White students previously studied, drank for effect, and were preoccupied with alcohol Blacks were less often referred to state facilities. Alcoholism started at an earlier age among Blacks
(continued)
907 Whites Blacks and Whites admitted to Hospital and 132 Black Cherry State Hospital in patient records, Males and females North Carolina with a personal diagnosis of alcoholism, interviews July 1, 1965-June 30, 1966 235 Black males 25 year follow-up of Black Structured Higher alcohol consumption school boys born in St. Louis interview, school levels among Blacks. Blacks between 1930-1934. Follow-up began drinking earlier in life. records. Data on data collected June I , 1965Blacks com48 % of Blacks exhibited August 31, 1965 pared to data on social and medical problems related to alcohol as com61 White males pared to only 14% of the similarly selected and previously Whites studied
262 Black males
Data taken from information 2,754 accident collected on 9,353 accident involved drivers involved drivers and 8,008 4,047 control drivers control drivers in Grand Black and White Rapids, Michigan, July 1, males 1962-June 30, 1963
101 White males 83 Black males 97 White females I 1 1 Black females
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1970
Gorvitz et al.
Analysis of hospital records
25 year follow-up of Black Structured interview school boys born in St. Louis between 1430-1934. Sample systematically drawn from a population of 930 boys meeting specific criteria. Interviews conducted 1965-1 966
3,971 White males Admissions to hospitals in 1,127 Non-White Maryland with alcoholism males diagnosis, July 1 , 1961-June 945 White females 30, 1964 389 Non-While females
223 Black males
1969
King et al.
Structured interviews
1,082 White males National sample drawn so as to be representative of 82 Black males 1,429 White females United States population. 118 Black females Interviews conducted between October 1964-March 1965
1969
Study technique
Cahalan et al.
Sample characteristic?
Patients attending Boston City Analysis of intake 107 Whites Hospital Alcoholism Clinic interviews and 21 Blacks clinic records during 6 week period in winter Males and females 1965
Sample size and sex
1968
Year of publication
Nathan et at.
Authors
Table 1 (continuod)
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Blacks were younger than Whites. Blacks were underrepresented in clinic population. Blacks dropped treatment prematurely more often than Whites Little difference in rate of drinking between Black and White males. Black females had more abstainers and heavy drinkers than White females Increasing degree of alcohol use was associated with increasing social deviance. Alcohol abuse is not simply a n adult expression of deviant behavior beginning in childhood. Rather, it may be viewed as a n intervening variable and predictive of a variety of social, economic, and legal troubles Lower age of Black males and females a t time of admissions
Major findings
I974
Cahalan and Room Brunswick and Tarica
Viamontes and Powell
I972
ROY Littlejohn Associates
I974
I974
1971
Robins and Guze 8 year follow-up of Black felons-Missouri State Prison discharged in 1959-1960
Structured interview
Rates of alcoholism among Black and White felons were not significantly different and were similarly high (27 % Black and 47 % White at time of first interview) Respondents were selected from Individual and 1,085 Black Blacks underutilize existing males and facilities. Traditional service the following sites: Gary, group Indiana; Atlanta, Georgia; interviews females network is not reaching the Mississippi; and Manhattan, Black alcoholic. Alcohol New York. Additional agency abuse is a major problem data were collected from among Blacks. New methods 46 agencies to reach Blacks are needed 1.561 males Blacks exhibited high rates of Pool of subjects based on three Structured (97 Blacks) national samples collected in interview problematic drinking be1964-1965, 1967, and 1969 havior 659 Black males Area sample of Personal Drinkers as compared to and females ages households in central Harlem. interviews nondrinkers were more 12-17 Data collected over a 2-year likely to report health period, 1968-1970 problems with younger boys and older girls showing the strongest relationship between drinking and poor health Analysis of patient Blacks began drinking earlier 100 Black males Diagnosed alcoholics records in life than Whites and ex100 Black females hospitalized in Malcolm Bliss Mental Health Center, perienced loss of control St. Louis, January 1, 1970earlier in life. Blacks were younger at time of admission June 30, 1970 which may be related to a greater frequency of alcoholrelated medical and nonmedical problems experienced by Blacks
176 males (51 Blacks)
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scr\ices to the Black community, the National Institute on Alcohol Abuse and Alcoholism ( N I A A A ) prepared and promulgated its Interim Guidelines tor the establishment of Black Alcoholism Projects. According to NIAAA. these projects will focus upon the black community and its residents and will serve as ’’ . . . a vehicle by which Black alcoholic persons and their families can receive encouragement and support together \ k i t h rehabilitation services which take into account their uniqiii‘ economic. social. and educational position w i t h its attendant hazards” ( N I A A A . 1974. p. 1 ) . [The author has commented elsewhere on the possible latent function that these Guidelines may serve in fostering a treatment philosophy which may be detrimental to the achievement of the overriding objective of these special projects; namely, assisting individuals to recover from alcoholism ( Argeriou and Zinkowski, 19761.1 While it is too early to assess the success of these projects, it is clear t h a t all efforts to rectify the situation should be pursued. In this latter connection this paper examines the potential for intervention among problem-drinking Blacks presently contained in programs which prokide treatment services to problem-drinking drivers. Illustration of this potential is provided through a comparative analysis of selected background. treatment process. and treatment outcome variables of a group of White and Black males referred to one such drinking driver program: the Services for Traffic Safety Project.
PROJ ECT D ESCR I PTl ON The Services for Traffic Safety Project was a 3-year demonstration project funded by NIAAA to provide treatment services to indibiduals apprehended for “driving under the influence of liquor” (DUI L ) and subsequently found to be exhibiting problem-drinking behavior. Operntirig in concert with the Boston Alcohol Safety Action Project (ASAP). these two projects utilized the police, the courts, and the therapeutic community to form a complete early intervention system geared specifically to the problem drinking driver. [The Boston Alcohol Safety .4ction Project was a 3-year demonstration project funded by the Department of Transportation, aimed at getting the drinking driver off the road and reducing the number of alcohol-related accidents and fatalities (Livingston. 1975).] Entry into the system began when the individual was arrested for D U I L in the City of Boston. An expressed willingness of the defendant in
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R E A C H I N G P R O B L E M - D R I N K I N G BLACKS
45 I
court to participate in the ASAPjSTS program usually resulted in continuation of the case without a finding and assignment of the defendant to an ASAP probation officer for a period of 1 year. The defendant was made aware that his failure to cooperate with the ASAPISTS program could result in his return to court with a consequent loss of license, fine, and/or imprisonment. (While any defendant could refuse assignment to the ASAPjSTS program, most defendants sought assignment for the simple reason that they usually retained possession of their driver’s license. At the time of ASAP/STS operation, a guilty finding to the charge of DUIL in Massachusetts carried a mandatory I-year license revocation for a first offense.) The ASAPjSTS program consisted of two phases: ( I ) a 7-week. 14hour alcohol reeducation program in which all individuals were required to participate, and (2) an intensive counseling, referral, and monitoring program in which only those individuals diagnosed as problem drinkers were required to participate. [ A complete description of the ASAPiSTS program has been presented elsewhere (Argeriou and Manohar, 1977).1 Classification of individuals as problem drinkers was further refined into two categories: emerging problem and severe problem drinkers. Quite generally, an emerging problem drinker was defined as anyone whose current drinking practices ure beginning to interfere with or cause difficulties in other spheres of his life. A severe problem drinker was defined as anyone who has had r e d und r c p a t d problems caused by his use of alcohol (those problems being physical, financial, marital, legal, etc.). Operationalization of these conceptual definitions and categorization of clients were carried out by the project’s alcoholism counselors through an examination of the client’s reported drinking behavior, his blood alcohol content reading at time of arrest (BAC), and his previous record of alcohol-related offenses. While no specific cut-off points on each of these variables were set out, statistically significant differences between the distributions of emerging problem drinkers and severe problem drinkers on these selected variables makes it clear that the drinking problems of the emerging problem drinkers were less serious than those of the severe problem drinkers and that the counselors were highly consistent in their placement of clients into one category or another. The treatment philosophy which guided Phase 2 intervention efforts was similar to the approach of Alcoholics Anonymous in which the major concern is the individual’s abuse of alcohol and the need to modify this behavior. Counselors were instructed to focus on the client’s use of
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45,
ARGERlOU
alcohol and its effects and to assume an active role in involving the client in treat men t . Length of client involvement in Phase 2 was variable, being determined by the severity of the individual’s drinking problem, his willingness to cooperate with the program, and/or the length of his term of probation. For the individuals under study here, length of involvement in Phase 2 ranged from 1 to 15 months with a mean of 6 months. Given these involvement contingencies, termination of clients generally occurred in one of three ways: ( 1 ) by virtue of the counselor‘s judgment that the client’s treatment plan had been successfully completed (i.e., the client had recognized his abusive use of alcohol, had demonstrated a positive modification of this behavior, and/or had consummated a referral to another community agency for continued treatment involvement), ( 2 ) by virtue of the client’s failure to cooperate with the program (i.e., the client continued to drink and drive, continually failed to keep scheduled appointments, and/or continually refused to examine his drinking behavior), or (3) by completion of the individual’s term of probation prior to the completion of his treatment plan. (While these latter clients were encouraged to continue treatment relations with STS counselors on a voluntary basis after expiration of probation, few chose to do so. In some instances, however, the courts did impose an extension of probation to maintain severe problem drinkers i n treatment.) All counseling was carried out in a suite of offices located on the 9th floor of a professional office building in the financial district of downtown Boston. This physical setting was particularly useful for two reasons: (1) it provided easy access to the ASAP probation officers, located on the 7th floor of the same building, thus insuring immediate probation follow-up of missing and uncooperative clients; and (2) it provided an atmosphere of professionalism without the negative physical features often associated with traditional “alcoholism clinics.” The counseling staff consisted of men and women, Blacks and Whites, and recovered alcoholics and nonalcoholics. (Assignment of clients to counselors was generally carried out in a random fashion with the exception being that female clients were assigned female counselors.) All counselors had prior counseling experience with a problem-drinking population and all had received training in counseling techniques either at the graduate level or through one of two specialized alcoholism counselor training programs which have been described elsewhere (Manohar, 1973; Skuja et al., 1975). Counselor supervision was carried out by a clinical psychologist and a consulting psychiatrist.
REACHING PROBLEM-DRINKING BLACKS
453
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Methodology
The study group ( N = 271) consisted of all Black ( N = 94) and White males ( N = 177) who had entered the STS Project after October 3, 1972 (the project starting date) and whose termination from the project had occurred prior to January 15, 1974. (The decision to limit the study to male clients was based on the lack of sufficient female clients to allow for meaningful analysis. Women constituted only 4% of the total STS caseload.) The data utilized in this report were obtained through a culling and coding of information routinely collected and contained in the treatment record folders of each client. This information included: police arrest data, probation records, clinical evaluation reports, demographic and drinking inventories, attendance reports, treatment plans, counselor notes, summaries of individual and group counseling sessions, and termination reports. To ensure uniformity, all coding was carried out by two coder/judges who worked independently and then jointly to resolve any existing disparate judgments of client data.
R ESU LTS As can be seen from Table 2, statistically significant differences between our groups of White and Black males were discovered on four of the ten background variables selected for study. Briefly, Black males were significantly older than Whites and, as might be expected given their age difference, were more often married or divorced. Although the Blacks had a significantly lower level of education than the Whites, there were no differences between groups in level of income or employment status. Finally, Black males exhibited a significantly higher BAC at the time of arrest than did the Whites. It should be noted, however, that while this latter difference in BAC level may be significant statistically, its practical significance, particularly from a treatment perspective, is far less weighty. The highly elevated BAC levels of both White and Black males clearly indicates the development of a high tolerance to alcohol and the probable presence of a drinking problem requiring treatment intervention. Indeed, the lack of differences between groups on the remaining variables in Table 2 related to alcohol abuse (i.e., previous drunkenness arrests, previous drinking driving arrests, other criminal offenses, and drinking diagnosis) support the conclusion that the presenting problem characterstics of the White and Black males were essentially similar.
A RGERIOlJ
454
Table 2 Background Characteristics of Court- Referred Problem Drinking White and Black Males
Variable (N) Mean SD
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Marital status
Income
Employment status
Breathalyser reading at arrest Previous drunkenness arrests Previous drunk driving arrests Other criminal offenses Drinking diagnosis
a
(N)
Single Married Divorced/separatedlwidowed (N) Mean SD (N) Mean SD (N) Full-time Part-time Unemployed (N)B Mean SD (N) Mean SD (N) Mean SD (N) Mean SD (N) Emerging problem Problem drinker
White males
Black males
(177) 33.24 11.89 (172) 41 % 41 % 18%
(94) 40.47 9.72 (94) 12 % 62 % 26 %
(172) 11.18 2.30 (163) $8,270 $4,738 (172) 68 % 6% 26 % (96) ,200 % .049 % (177) 2.89 4.81 (177) .4124 .8150 (1 77) 1.86 3.75 (177) 42 %
(94) 10.11 3.19 (93) $7,871 $3,561 (94) 72 % 7% 21 % (67) .230 % .065 % (94) 2.38 3.10 (94) .4468 .8752 (94) 2.00 3.38 (94) 38 % 62 %
58 %
t = 5.046, df p < ,001
=
269,
x2 = 24.18, df= 2, p < .001
t = 3.1374, df =
264,p < .01 t = 0.7035, df = 254, p = NS
x2
=
0.7600, df
=:
2,
p = NS
t = 3.3367, df = 161, p < .01
t
= 0.9270, df =
269, p
=
NS
t = 0.3211, df =
269, p
=
f = 0.3014,
269, p
=
NS df =
NS
X* = 0.4216, df = 1,
p = NS
Reduced N’s due to test refusal.
Table 3 examines the length and type of involvement of the White and Black clients in the STS Program. As can be readily seen, management of White and Black clients in the treatment process was, with one exception, ;almost identical. Both groups were involved in the same treatment
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REACHING PROBLEM-DRINKING BLACKS
455
modalities, for the same period of time, and exhibited the same frequency of attendance. The one exception, that fewer Blacks than Whites were referred to Alcoholics Anonymous, apparently reflects the relative lack of all-Black A.A. meetings in the Boston area and the reluctance of STS counselors to make referrals of Blacks to all-White A.A. meetings. (This interpretation is based on discussions between the author and STS counselors regarding the low rate of referral of Blacks to Alcoholics Anonymous.) This finding is disconcerting given the acknowledged success of Alcoholics Anonymous in assisting alcoholic individuals to achieve and maintain sobriety. Table 4 provides an assessment of treatment impact on the drinking behavior and attitudes of the White and Black clients. The data are clear in establishing that not only was this impact equally distributed across groups, but that it was largely positive in nature for both groups. For example, over 60% of both groups had decreased their alcohol intake at time of termination. Of these totals, 29% of the Whites and 2 8 x of the Blacks had achieved abstinence and, at time of termination, had maintained their abstinence for an average of approximately 6 months, Table 3 Comparison of White and Black Males in the Treatment Process
White males
Variable Length of stay (in months) Number of individual counseling sessions attended Assignment to group counseling Number of group counseling sessions attended Referral to other agencies Referral to alcoholics anonymous
(N) Mean SD (N) Mean SD (N) Assigned Not assigned (N) Mean
SD (N) Referred Not referred (N) Referred Not referred
Black males (94) 6.61 3.24 (94) 5.55 4.04 (94) 44% 56 % (42) 7.24 3.95 (94) 33 % 67 % (94) 17% 83 %
t
=
p f
0.1999, df = NS
=
269,
= 0.6631, d j = 269,
p
x2
=
=
NS
0.7548.
d/' = I ,
p = NS
0.3691, df= 126, = NS 1 ' = 2.33, df = I . p = NS t =
p
x2
=
12.54, df
p < .001
I.
-:
ARGERIOU
456
Table 4 Comparison of White and Black Males on Selected Treatment Outcome Measures ~~
White males
Variable
Black males
~-
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Recognition of moblem
Drinking behavior at termination Length of abstinence On weeks) Therapist's perception of client outcome
Client attitude toward treatment at rermination
(N) Total denial Partial denial Partial recognition Total recognition (N) N o change Decreased Abstinent (N) Mean SD (N1 Worsened No change Moderately improved Greatly improved (N) Mostly positive Somewhat positive Indifferent Somewhat negative Mostly negative
(94) 30 % 7% 31 % 32 % (94) 38 % 34 % 28 yo (26) 23.65 13.36 (94) 1% 36% 29 % 34 % (94) 44 % 18%
z L = 0.5430, d/
=
2.
p = NS
t = 0.5259, df = p = NS
/'
75.
- 3 41, d J - 3. p = NS
z2 = 4.46, d/
~
4.
p = NS
1%
13% 24 %
respectively. Comparable levels of improvement among Whites and Blacks were recorded in client attitude toward treatment and client recognition of the problem. Mirroring these changes was the therapist's perception of overall client outcome.
DISCUSSION Court-enforced treatment of problem-drinking drivers has recently been recognized as a valuable mechanism of intervention into the career of the problem drinker (Alcohol and Health, 1974, p. 155). To date, however, little attention has been given to the potential of such programs in reaching and servicing problem-drinking Blacks. The data presented here have shown that this potential is significant and should be profitably
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REACHING PROBLEM-DRINKING BLACKS
457
exploited in any comprehensive plan aimed at providing alcoholism treatment services to the Black community. In marked contrast to current thinking and published reports (Roy Littlejohn Associates, 1972; Davis, 1973; Phelps, 1973), our findings provide little support for the position that alcoholism among Blacks is a distinctive problem which cannot be effectively treated without recognition and proper attention to this distinctiveness. Rather it would appear that treatment can be effective if cast in an appropriate structure and focus upon the primary problem of alcohol abuse is maintained. Our finding that the Black clients were significantly older than the White clients also stands in contrast to the findings of other studies cited earlier. The reasons for this difference are not altogether clear at this point. It may simply be that due to economic differences, possession or access to an automobile, a necessary element for a DUIL arrest, comes later on in life for Blacks than Whites. Some support for this interpretation is provided by our data which show the Black clients to be significantly older than the White clients yet earning essentially the same income. However, as noted earlier (Sterne, 1967), until sufficient systematic research on the use and abuse of alcohol among Blacks has been conducted, interpretations of findings must be considered tentative. ACKNOWLEDGMENT
Appreciation is expressed to Donna Paulino for her invaluable assistance in the initial collection and coding of the data contained in this report. REFERENCES ALCOHOL AND HEALTH (Second Special Report to the U.S. Congress. DHEW Publication). Washington, D.C.: U.S. Government Printing Office, June 1974. ARGERIOU, M., and MANOHAR, V. Treating the problem drinking driver: Some notes on the time required to achieve impact. Br. J. Addict. 72: 331-338, 1977. ARGERIOU, M., and ZINKOWSKI, J. Black alcoholism: A comment upon NIAAA’s plan to combat the problem. J . Alcohol Stud. in press. BAHN, A.K., and CHANDLER, C.A. Alcoholism in psychiatric clinic patients. Q . J . Stud. Alcohol 22: 411-417, 1961. BAILEY, M.B., HABERMAN, P.W., and ALKSENS, H. The epidemiology of alcoholism in an urban residential area. Q. J . Stud. Alcohol 26: 19-40, 1965. BARCHHA, R., STEWART, M.A., and GUZE, S.B. Prevalence of alcoholism among general hospital ward patients. Am. J . Psychiatry 125: 681-684, 1968.
ARGERIOU
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BRUNSWICK. A.F.. and TARICA. C . Drinking and health: A study of urban Black ;-ldolescenta. Addictive Dis. l(10): 21-42. 1974. CAHALAN. D.. CISIN, I.H., and CROSSLEY, H.M. Arnericurr Drinking Pructices: .4 V t i t i ~ r r uStur/v l of Drinking Behavior arid A ttitudes (Monograph No. 6). New Brunswick. New Jersey: Rutgers Center of Alcohol Studies. 1969. CAHALAK.D..and ROOM, R.Prohleni Drinking Amorig Americcm Mcn (Monograph No. 7). New Brunswick, New Jersey: Rutgers Center of Alcohol Studies, 1974. DAVIS. F.T. A l c o h o l i . ~.4morig ~ A n i ~ ~ i c aBlucks. n Alcohol and Drug Problems Association. Selected Papers 24th Annual Meeting. September 23-28, 1973. GOODWIN. D.W. Alcohol in suicide and homicide. Q. J . Slud. A l m h o l 3 4 : 144-156. 1973. GORVITZ. K.. BAHN. A.. WARTHERN, F.J., and COOPER, M . Some epidemiological data on alcoholics in Maryland. Q. J . Stud. Alcohol 31: 423-443, 1970. HAHERMAN, P.W.. and SCHEINBERG, J. Implicative drinking reported in a household suney: A corroborative note on subgroup differences. Q. J . Stud. Akohol28: 538 -543. 1967.
HYMAN, M . M . Accident vulnerability and blood alcohol concentrations of drivers bq demographic characteristics. Q. J . Stud. Alcohol. Suppl. 4: 34-57. 1968. KING. L.J..MURPHY.G.E.. ROBINS. L.N.,and DARVISH, H. Alcoholabuse: Acrucial factor i i i the social problems of Negro men. h i . J . P,yhiarr.v 125: 1682-1690. June IY69.
LIVINGSTON. C.F. Alcohol countermeasures: A status report. Traffic Saf. 73(21: February 1975.
LOC'KE. B.Z.. and DUVALL. H.J. Alcoholism among first admissions to Ohio Public Mental Health Hospital. Q. J . S t u d Alcohol 25: 521-534, 1974. LOCK€. B.Z.. KRAMER, M.. and PASAMANICK, B. Alcoholic psychosis among first admisuons to a public mental health hospital in Ohio. Q. J . Sttrd. Alcohol 21' 452-4'74. 1960.
MADDOX. G.L.. and WILLIAMS. J.R. Drinking behavior of Negro collegians. Q. J . Sttrt/. . 4 / ( ' o h ( ~29: / 117 -129, 1968. MALZBERG, B. A study of first admissions with alcoholic psychosis in Neu York State. 1943- 1944. Q. J . Stiid. .41~0h0/8: 274-295; 1947. MANOHAR. V. Training volunteers as alcoholism treatment counselors. Q. J . S l ~ l A i r ~ ~ h r 34: i l 869 - 877. 1973. MAYER. J., NEEDHAM, M.A., and MYERSON, D.J. Contact and initial attendance at an alcoholism clinic. Q. J . Stud. AlcoAol 26: 480-485. 1965. NPITIONAL INSTITUTE O N ALCOHOL ABUSE AND ALCOHOLISM. RevisedGu&lin(,.s fiir thc Bluck Alcohnlisni Projects. Memo. Division of Special Treatment and Rehabilitation Programs. September 1974. NATHAK. P.E.. LIPSON, A.G.. VETTRAINO, A.P.. and SOLOMON. P. The social ecology of an urban clinic for alcoholism: Racial differences in treatment entry and outcome. lrrr. J . Addict. 3(1): 55-63, 1968. ['HELPS, D. Do Ethnic, Minorities Ncmd Special Alcoholism Tieatnient Programs 1' Paper pi-esented before the National Council on Alcoholism. Shoreham Hotel. Washington. D.C.. April 3. 1973. National Clearinghouse on Alcohol Information. Document No. 0x075.
ROBINS. L.N.. and GUZE, S.B. Drinking practices and problems in urban ghetto populations. In N . K . Mello and J. H . Mendelson (eds.) Recent Advuncer irr Sfrdies 01 Alcoholiwi. Washington, D.C.: U S . Government Printing Office. 1971.
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Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs Milton Argeriou To cite this article: Milton Argeriou (1978) Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs, International Journal of the Addictions, 13:3, 443-459, DOI: 10.3109/10826087809045260 To link to this article: http://dx.doi.org/10.3109/10826087809045260
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The International Journal of the Addictions, 13(3), 443-459, 1978
Reaching Problem-Drinking Blacks: The Unheralded Potential of the Drinking Driver Programs Milton Argeriou," Ph.D. Services for Traffic Safety Project Boston, Massachusetts 02 I 10
Abstract
The potential of court-enforced treatment of problem drinking drivers in reaching and effectively treating problem drinking Blacks is examined through an analysis of the experience of one such drinking driver program. The findings support the contention that the potential of court-enforced treatment is significant and should not be overlooked in any plan aimed at providing treatment services to the Black community.
INTRO D UCTI 0 N A review of available literature relevant to the use and abuse of alcohol among Black Americans reveals that the quantity of research conducted *To whom requests for reprints should be addressed at Division of Alcoholism, 755 Boylston Street, Boston, Massachusetts 021 16. 443 Copyright 01978 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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ARGERIOU
has not been proportional to the size of the Black population in America nor to the purported frequency and severity of problem drinking among Blacks. Moreover, the greater bulk of these studies have only come within the last 10 years and have usually generated as many questions as answers regarding the use of alcohol in the Black community. Taken together, however, the findings summarized in Table 1 do appear to support the general conclusions that follow. [Sterne (1967) has argued that the lack of systematic study of drinking in the Black community requires that caution be exercised in interpreting the results of studies of alcohol use and abuse among Blacks. In the absence of such systematic study, generalizations about drinking behavior among Blacks. if possible at all, must be viewed as tentative.] While the comparative rates of drinking of Black and White males are questionable (Cahalan et al., 1969; Bailey et al, 1969: Haberman and Sheinberg, 1967; Robins et al., 1968; Stern, 1967), there is more acceptance of the findings that Black females exhibit a higher proportion of abstainers and heavy drinkers than White females (Cahalan et al., 1969; Bailey et al., 1965; Haberman and Sheinberg, 1967; Sterne, 1967); Blacks begin drinking at an earlier age than Whites (Maddox and Williams, 1968; Robins et &I., 1968; Vitols, 1968: Viamontes and Powell, 1974); Blacks begin drinking Izeavily at an earlier age than Whites (Bahn and Chandler, 1961; Maddox and Williams, 1968; Robins et al., 1968; Vitols, 1968; Viamontes and Powell, 1974); and Blacks experience more alcohol-related problems than Whites (e.g., medical, social, legal) [A paradoxical exception to this general statement is the finding that the rate of suicide among Blacks is lower than Whites despite the fact that the Black community is marked by a number of characteristics of social disorganization (e.g., high crime rates, high unemployment? high divorce) known to be associated with high rates of suicide (Goodwin, 1973).] which usually begin earlier in the lives of Blacks than Whites (Malzberg, 1947: Locke et al., 1960; Strayer, 1961; Bahn and Chandler, 1961; Locke and Duvall, 1974; Zax et al., 1964; Bailey et al., 1965; Haberman and Sheinberg, 1967; Barchha et al., 1968; Hyman, 1968; Vitols, 1968; Robins et al., 1968; King et al., 1969; Gorvitz et al., 1970; Cahalan and Room, 1974; Viamontes and Powell, 1974). Given this scope of the alcohol-abuse problem among Blacks, it is particularly disconcerting to discover that Blacks utilize alcoholism treatment facilities less often than Whites (Bahn and Chandler, 1961; Mayer et al., 1965; Vitols, 1968; Nathan et al., 1968; Roy Littlejohn Associates, 1972). In an effort to respond to this issue of underutilization of treatment facilities by Blacks and ensure the provision of alcoholism treatment
1947
1960
1961
1961
1964
Locke et al.
Strayer
Bahn and Chandler
Locke and Duvall
Year of publication
Malzberg
Authors
Sample characteristics
Study technique
3,339 Black and First admissions to public White males and mental hospitals in Ohio, females July 1, 1958-December 31, 1961
Analysis of hospital records
1,077 White males All clients admitted to BridgeAnalysis of 26 Black males port (Connecticut) Clinic over clinic records 187 White females a period of 93 years ending 18 Black females December 1958 2,210 males Maryland residents discharged Analysis of 2,270 females from outpatient psychiatric clinic records Blacks and Whites clinics in Maryland or the District of Columbia during the year ending June 30, 1959
616 Whites First admissions to mental Analysis of 58 Blacks disease hospitals in New York hospital records State for the fiscal year Males and females ending March 31, 1944 1,778 Black and First admissions to public Analysis of White males mental hospitals in O~io, hospital records January 1-June 30, 1948 and females
Sample size and sex
Table 1 Summary of Previous Studies on Alcohol Use among Blacks
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(continued)
Higher rate of alcoholic psychosis among Black males. Lower age of Black males at time of admission Blacks were generally younger at time of admission and had been drinking excessively for a shorter peiod of time Higher rates of excessive drinking and alcoholrelated disorders among Black males and females. Lower age of Blacks exhibiting acute and chronic brain syndromes associated with alcohol abuse Higher rate of alcoholic psychosis among Black males. Lower age of Black males at time of admission
Higher rate of alcoholic psychosis among Black males and females
Major findings
Analysis of intake Patients contacting Peter Bent 181 Whites 12 Blacks Brigham Hospital Alcoholism data gathered Males and females Clinic, Boston, Massachusetts, by telephone and personal January 1 , 1962-December 3 I , I962 interviews
706 Black and Multistagz problem sample designed to be representative White males and females of New York City. Of the 2,118 adults interviewed, 706 were asked questions about personai drinking behavior, and resulting problems, April-October 1963
1965
1967
Mayer et al.
Haberman and Sheinberg
Structured interview
A 2-stage stratified cluster Structured 8,082 Black and sample in which interviews interview White males and female5 were conducted with 4,387 schedule families living in the Washington Heights area of New York City: 1960 = 1961
1965
Bailey et al.
Analysis of police records
Study technique
Subjects accounted for the 3,185 Black and 5,524 arrests for public White males and intoxication in Rochester, females New York, for the year ending, December 31, 1961
Sample characteristics
1964
Year of publication Sample size and sex
Zax et al.
Authors
Table 1 (continued)
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Higher rates of arrest for Black males and females. Age at time of arrest is lower for Black males. Black males develop multiple arrest records earlier than White males Rates of probable alcoholics among Black and White males were similar (i.e., 37/1,000 and 31/1,000, respectively). Black females had a higher rate than White females (i.e., 20/1,000 and S/I,000, respectively) The number of Blacks seeking assistance is not proportional to their representation in the general population nor to their purported incidence of alcoholism The rate of implicative drinkers/1,000 adults was somewhat higher for Black males (119) than for White males (91) but was significantly higher for Black females (97) than White females (23)
Major findings
I968
1968
1968
1968
I968
Barchha et al.
Hyman
Maddox and Williams
Vitols
Robins et al.
All patients admitted to Barnes Hospital, St. Louis, Missouri, during a period of 5 consecutive months
91 % of all freshman entering a state supported Black College in North Carolina, fall 1963 Structured interview
Structured interview, analysis of accident reports
Structured interview, patient records
Black males gave histories suggesting alcoholism twice as frequently as White males. No difference between Black and White females regarding the presence of alcoholism Black males exhibited higher accident vulnerability ratios than Whites at all BAC levels. Blacks showed blood alcohol levels above 0.10% almost five times as frequently as Whites Black students started drinking earlier in life than White students previously studied, drank for effect, and were preoccupied with alcohol Blacks were less often referred to state facilities. Alcoholism started at an earlier age among Blacks
(continued)
907 Whites Blacks and Whites admitted to Hospital and 132 Black Cherry State Hospital in patient records, Males and females North Carolina with a personal diagnosis of alcoholism, interviews July 1, 1965-June 30, 1966 235 Black males 25 year follow-up of Black Structured Higher alcohol consumption school boys born in St. Louis interview, school levels among Blacks. Blacks between 1930-1934. Follow-up began drinking earlier in life. records. Data on data collected June I , 1965Blacks com48 % of Blacks exhibited August 31, 1965 pared to data on social and medical problems related to alcohol as com61 White males pared to only 14% of the similarly selected and previously Whites studied
262 Black males
Data taken from information 2,754 accident collected on 9,353 accident involved drivers involved drivers and 8,008 4,047 control drivers control drivers in Grand Black and White Rapids, Michigan, July 1, males 1962-June 30, 1963
101 White males 83 Black males 97 White females I 1 1 Black females
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1970
Gorvitz et al.
Analysis of hospital records
25 year follow-up of Black Structured interview school boys born in St. Louis between 1430-1934. Sample systematically drawn from a population of 930 boys meeting specific criteria. Interviews conducted 1965-1 966
3,971 White males Admissions to hospitals in 1,127 Non-White Maryland with alcoholism males diagnosis, July 1 , 1961-June 945 White females 30, 1964 389 Non-While females
223 Black males
1969
King et al.
Structured interviews
1,082 White males National sample drawn so as to be representative of 82 Black males 1,429 White females United States population. 118 Black females Interviews conducted between October 1964-March 1965
1969
Study technique
Cahalan et al.
Sample characteristic?
Patients attending Boston City Analysis of intake 107 Whites Hospital Alcoholism Clinic interviews and 21 Blacks clinic records during 6 week period in winter Males and females 1965
Sample size and sex
1968
Year of publication
Nathan et at.
Authors
Table 1 (continuod)
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Blacks were younger than Whites. Blacks were underrepresented in clinic population. Blacks dropped treatment prematurely more often than Whites Little difference in rate of drinking between Black and White males. Black females had more abstainers and heavy drinkers than White females Increasing degree of alcohol use was associated with increasing social deviance. Alcohol abuse is not simply a n adult expression of deviant behavior beginning in childhood. Rather, it may be viewed as a n intervening variable and predictive of a variety of social, economic, and legal troubles Lower age of Black males and females a t time of admissions
Major findings
I974
Cahalan and Room Brunswick and Tarica
Viamontes and Powell
I972
ROY Littlejohn Associates
I974
I974
1971
Robins and Guze 8 year follow-up of Black felons-Missouri State Prison discharged in 1959-1960
Structured interview
Rates of alcoholism among Black and White felons were not significantly different and were similarly high (27 % Black and 47 % White at time of first interview) Respondents were selected from Individual and 1,085 Black Blacks underutilize existing males and facilities. Traditional service the following sites: Gary, group Indiana; Atlanta, Georgia; interviews females network is not reaching the Mississippi; and Manhattan, Black alcoholic. Alcohol New York. Additional agency abuse is a major problem data were collected from among Blacks. New methods 46 agencies to reach Blacks are needed 1.561 males Blacks exhibited high rates of Pool of subjects based on three Structured (97 Blacks) national samples collected in interview problematic drinking be1964-1965, 1967, and 1969 havior 659 Black males Area sample of Personal Drinkers as compared to and females ages households in central Harlem. interviews nondrinkers were more 12-17 Data collected over a 2-year likely to report health period, 1968-1970 problems with younger boys and older girls showing the strongest relationship between drinking and poor health Analysis of patient Blacks began drinking earlier 100 Black males Diagnosed alcoholics records in life than Whites and ex100 Black females hospitalized in Malcolm Bliss Mental Health Center, perienced loss of control St. Louis, January 1, 1970earlier in life. Blacks were younger at time of admission June 30, 1970 which may be related to a greater frequency of alcoholrelated medical and nonmedical problems experienced by Blacks
176 males (51 Blacks)
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scr\ices to the Black community, the National Institute on Alcohol Abuse and Alcoholism ( N I A A A ) prepared and promulgated its Interim Guidelines tor the establishment of Black Alcoholism Projects. According to NIAAA. these projects will focus upon the black community and its residents and will serve as ’’ . . . a vehicle by which Black alcoholic persons and their families can receive encouragement and support together \ k i t h rehabilitation services which take into account their uniqiii‘ economic. social. and educational position w i t h its attendant hazards” ( N I A A A . 1974. p. 1 ) . [The author has commented elsewhere on the possible latent function that these Guidelines may serve in fostering a treatment philosophy which may be detrimental to the achievement of the overriding objective of these special projects; namely, assisting individuals to recover from alcoholism ( Argeriou and Zinkowski, 19761.1 While it is too early to assess the success of these projects, it is clear t h a t all efforts to rectify the situation should be pursued. In this latter connection this paper examines the potential for intervention among problem-drinking Blacks presently contained in programs which prokide treatment services to problem-drinking drivers. Illustration of this potential is provided through a comparative analysis of selected background. treatment process. and treatment outcome variables of a group of White and Black males referred to one such drinking driver program: the Services for Traffic Safety Project.
PROJ ECT D ESCR I PTl ON The Services for Traffic Safety Project was a 3-year demonstration project funded by NIAAA to provide treatment services to indibiduals apprehended for “driving under the influence of liquor” (DUI L ) and subsequently found to be exhibiting problem-drinking behavior. Operntirig in concert with the Boston Alcohol Safety Action Project (ASAP). these two projects utilized the police, the courts, and the therapeutic community to form a complete early intervention system geared specifically to the problem drinking driver. [The Boston Alcohol Safety .4ction Project was a 3-year demonstration project funded by the Department of Transportation, aimed at getting the drinking driver off the road and reducing the number of alcohol-related accidents and fatalities (Livingston. 1975).] Entry into the system began when the individual was arrested for D U I L in the City of Boston. An expressed willingness of the defendant in
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R E A C H I N G P R O B L E M - D R I N K I N G BLACKS
45 I
court to participate in the ASAPjSTS program usually resulted in continuation of the case without a finding and assignment of the defendant to an ASAP probation officer for a period of 1 year. The defendant was made aware that his failure to cooperate with the ASAPISTS program could result in his return to court with a consequent loss of license, fine, and/or imprisonment. (While any defendant could refuse assignment to the ASAPjSTS program, most defendants sought assignment for the simple reason that they usually retained possession of their driver’s license. At the time of ASAP/STS operation, a guilty finding to the charge of DUIL in Massachusetts carried a mandatory I-year license revocation for a first offense.) The ASAPjSTS program consisted of two phases: ( I ) a 7-week. 14hour alcohol reeducation program in which all individuals were required to participate, and (2) an intensive counseling, referral, and monitoring program in which only those individuals diagnosed as problem drinkers were required to participate. [ A complete description of the ASAPiSTS program has been presented elsewhere (Argeriou and Manohar, 1977).1 Classification of individuals as problem drinkers was further refined into two categories: emerging problem and severe problem drinkers. Quite generally, an emerging problem drinker was defined as anyone whose current drinking practices ure beginning to interfere with or cause difficulties in other spheres of his life. A severe problem drinker was defined as anyone who has had r e d und r c p a t d problems caused by his use of alcohol (those problems being physical, financial, marital, legal, etc.). Operationalization of these conceptual definitions and categorization of clients were carried out by the project’s alcoholism counselors through an examination of the client’s reported drinking behavior, his blood alcohol content reading at time of arrest (BAC), and his previous record of alcohol-related offenses. While no specific cut-off points on each of these variables were set out, statistically significant differences between the distributions of emerging problem drinkers and severe problem drinkers on these selected variables makes it clear that the drinking problems of the emerging problem drinkers were less serious than those of the severe problem drinkers and that the counselors were highly consistent in their placement of clients into one category or another. The treatment philosophy which guided Phase 2 intervention efforts was similar to the approach of Alcoholics Anonymous in which the major concern is the individual’s abuse of alcohol and the need to modify this behavior. Counselors were instructed to focus on the client’s use of
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45,
ARGERlOU
alcohol and its effects and to assume an active role in involving the client in treat men t . Length of client involvement in Phase 2 was variable, being determined by the severity of the individual’s drinking problem, his willingness to cooperate with the program, and/or the length of his term of probation. For the individuals under study here, length of involvement in Phase 2 ranged from 1 to 15 months with a mean of 6 months. Given these involvement contingencies, termination of clients generally occurred in one of three ways: ( 1 ) by virtue of the counselor‘s judgment that the client’s treatment plan had been successfully completed (i.e., the client had recognized his abusive use of alcohol, had demonstrated a positive modification of this behavior, and/or had consummated a referral to another community agency for continued treatment involvement), ( 2 ) by virtue of the client’s failure to cooperate with the program (i.e., the client continued to drink and drive, continually failed to keep scheduled appointments, and/or continually refused to examine his drinking behavior), or (3) by completion of the individual’s term of probation prior to the completion of his treatment plan. (While these latter clients were encouraged to continue treatment relations with STS counselors on a voluntary basis after expiration of probation, few chose to do so. In some instances, however, the courts did impose an extension of probation to maintain severe problem drinkers i n treatment.) All counseling was carried out in a suite of offices located on the 9th floor of a professional office building in the financial district of downtown Boston. This physical setting was particularly useful for two reasons: (1) it provided easy access to the ASAP probation officers, located on the 7th floor of the same building, thus insuring immediate probation follow-up of missing and uncooperative clients; and (2) it provided an atmosphere of professionalism without the negative physical features often associated with traditional “alcoholism clinics.” The counseling staff consisted of men and women, Blacks and Whites, and recovered alcoholics and nonalcoholics. (Assignment of clients to counselors was generally carried out in a random fashion with the exception being that female clients were assigned female counselors.) All counselors had prior counseling experience with a problem-drinking population and all had received training in counseling techniques either at the graduate level or through one of two specialized alcoholism counselor training programs which have been described elsewhere (Manohar, 1973; Skuja et al., 1975). Counselor supervision was carried out by a clinical psychologist and a consulting psychiatrist.
REACHING PROBLEM-DRINKING BLACKS
453
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Methodology
The study group ( N = 271) consisted of all Black ( N = 94) and White males ( N = 177) who had entered the STS Project after October 3, 1972 (the project starting date) and whose termination from the project had occurred prior to January 15, 1974. (The decision to limit the study to male clients was based on the lack of sufficient female clients to allow for meaningful analysis. Women constituted only 4% of the total STS caseload.) The data utilized in this report were obtained through a culling and coding of information routinely collected and contained in the treatment record folders of each client. This information included: police arrest data, probation records, clinical evaluation reports, demographic and drinking inventories, attendance reports, treatment plans, counselor notes, summaries of individual and group counseling sessions, and termination reports. To ensure uniformity, all coding was carried out by two coder/judges who worked independently and then jointly to resolve any existing disparate judgments of client data.
R ESU LTS As can be seen from Table 2, statistically significant differences between our groups of White and Black males were discovered on four of the ten background variables selected for study. Briefly, Black males were significantly older than Whites and, as might be expected given their age difference, were more often married or divorced. Although the Blacks had a significantly lower level of education than the Whites, there were no differences between groups in level of income or employment status. Finally, Black males exhibited a significantly higher BAC at the time of arrest than did the Whites. It should be noted, however, that while this latter difference in BAC level may be significant statistically, its practical significance, particularly from a treatment perspective, is far less weighty. The highly elevated BAC levels of both White and Black males clearly indicates the development of a high tolerance to alcohol and the probable presence of a drinking problem requiring treatment intervention. Indeed, the lack of differences between groups on the remaining variables in Table 2 related to alcohol abuse (i.e., previous drunkenness arrests, previous drinking driving arrests, other criminal offenses, and drinking diagnosis) support the conclusion that the presenting problem characterstics of the White and Black males were essentially similar.
A RGERIOlJ
454
Table 2 Background Characteristics of Court- Referred Problem Drinking White and Black Males
Variable (N) Mean SD
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Marital status
Income
Employment status
Breathalyser reading at arrest Previous drunkenness arrests Previous drunk driving arrests Other criminal offenses Drinking diagnosis
a
(N)
Single Married Divorced/separatedlwidowed (N) Mean SD (N) Mean SD (N) Full-time Part-time Unemployed (N)B Mean SD (N) Mean SD (N) Mean SD (N) Mean SD (N) Emerging problem Problem drinker
White males
Black males
(177) 33.24 11.89 (172) 41 % 41 % 18%
(94) 40.47 9.72 (94) 12 % 62 % 26 %
(172) 11.18 2.30 (163) $8,270 $4,738 (172) 68 % 6% 26 % (96) ,200 % .049 % (177) 2.89 4.81 (177) .4124 .8150 (1 77) 1.86 3.75 (177) 42 %
(94) 10.11 3.19 (93) $7,871 $3,561 (94) 72 % 7% 21 % (67) .230 % .065 % (94) 2.38 3.10 (94) .4468 .8752 (94) 2.00 3.38 (94) 38 % 62 %
58 %
t = 5.046, df p < ,001
=
269,
x2 = 24.18, df= 2, p < .001
t = 3.1374, df =
264,p < .01 t = 0.7035, df = 254, p = NS
x2
=
0.7600, df
=:
2,
p = NS
t = 3.3367, df = 161, p < .01
t
= 0.9270, df =
269, p
=
NS
t = 0.3211, df =
269, p
=
f = 0.3014,
269, p
=
NS df =
NS
X* = 0.4216, df = 1,
p = NS
Reduced N’s due to test refusal.
Table 3 examines the length and type of involvement of the White and Black clients in the STS Program. As can be readily seen, management of White and Black clients in the treatment process was, with one exception, ;almost identical. Both groups were involved in the same treatment
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REACHING PROBLEM-DRINKING BLACKS
455
modalities, for the same period of time, and exhibited the same frequency of attendance. The one exception, that fewer Blacks than Whites were referred to Alcoholics Anonymous, apparently reflects the relative lack of all-Black A.A. meetings in the Boston area and the reluctance of STS counselors to make referrals of Blacks to all-White A.A. meetings. (This interpretation is based on discussions between the author and STS counselors regarding the low rate of referral of Blacks to Alcoholics Anonymous.) This finding is disconcerting given the acknowledged success of Alcoholics Anonymous in assisting alcoholic individuals to achieve and maintain sobriety. Table 4 provides an assessment of treatment impact on the drinking behavior and attitudes of the White and Black clients. The data are clear in establishing that not only was this impact equally distributed across groups, but that it was largely positive in nature for both groups. For example, over 60% of both groups had decreased their alcohol intake at time of termination. Of these totals, 29% of the Whites and 2 8 x of the Blacks had achieved abstinence and, at time of termination, had maintained their abstinence for an average of approximately 6 months, Table 3 Comparison of White and Black Males in the Treatment Process
White males
Variable Length of stay (in months) Number of individual counseling sessions attended Assignment to group counseling Number of group counseling sessions attended Referral to other agencies Referral to alcoholics anonymous
(N) Mean SD (N) Mean SD (N) Assigned Not assigned (N) Mean
SD (N) Referred Not referred (N) Referred Not referred
Black males (94) 6.61 3.24 (94) 5.55 4.04 (94) 44% 56 % (42) 7.24 3.95 (94) 33 % 67 % (94) 17% 83 %
t
=
p f
0.1999, df = NS
=
269,
= 0.6631, d j = 269,
p
x2
=
=
NS
0.7548.
d/' = I ,
p = NS
0.3691, df= 126, = NS 1 ' = 2.33, df = I . p = NS t =
p
x2
=
12.54, df
p < .001
I.
-:
ARGERIOU
456
Table 4 Comparison of White and Black Males on Selected Treatment Outcome Measures ~~
White males
Variable
Black males
~-
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Recognition of moblem
Drinking behavior at termination Length of abstinence On weeks) Therapist's perception of client outcome
Client attitude toward treatment at rermination
(N) Total denial Partial denial Partial recognition Total recognition (N) N o change Decreased Abstinent (N) Mean SD (N1 Worsened No change Moderately improved Greatly improved (N) Mostly positive Somewhat positive Indifferent Somewhat negative Mostly negative
(94) 30 % 7% 31 % 32 % (94) 38 % 34 % 28 yo (26) 23.65 13.36 (94) 1% 36% 29 % 34 % (94) 44 % 18%
z L = 0.5430, d/
=
2.
p = NS
t = 0.5259, df = p = NS
/'
75.
- 3 41, d J - 3. p = NS
z2 = 4.46, d/
~
4.
p = NS
1%
13% 24 %
respectively. Comparable levels of improvement among Whites and Blacks were recorded in client attitude toward treatment and client recognition of the problem. Mirroring these changes was the therapist's perception of overall client outcome.
DISCUSSION Court-enforced treatment of problem-drinking drivers has recently been recognized as a valuable mechanism of intervention into the career of the problem drinker (Alcohol and Health, 1974, p. 155). To date, however, little attention has been given to the potential of such programs in reaching and servicing problem-drinking Blacks. The data presented here have shown that this potential is significant and should be profitably
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exploited in any comprehensive plan aimed at providing alcoholism treatment services to the Black community. In marked contrast to current thinking and published reports (Roy Littlejohn Associates, 1972; Davis, 1973; Phelps, 1973), our findings provide little support for the position that alcoholism among Blacks is a distinctive problem which cannot be effectively treated without recognition and proper attention to this distinctiveness. Rather it would appear that treatment can be effective if cast in an appropriate structure and focus upon the primary problem of alcohol abuse is maintained. Our finding that the Black clients were significantly older than the White clients also stands in contrast to the findings of other studies cited earlier. The reasons for this difference are not altogether clear at this point. It may simply be that due to economic differences, possession or access to an automobile, a necessary element for a DUIL arrest, comes later on in life for Blacks than Whites. Some support for this interpretation is provided by our data which show the Black clients to be significantly older than the White clients yet earning essentially the same income. However, as noted earlier (Sterne, 1967), until sufficient systematic research on the use and abuse of alcohol among Blacks has been conducted, interpretations of findings must be considered tentative. ACKNOWLEDGMENT
Appreciation is expressed to Donna Paulino for her invaluable assistance in the initial collection and coding of the data contained in this report. REFERENCES ALCOHOL AND HEALTH (Second Special Report to the U.S. Congress. DHEW Publication). Washington, D.C.: U.S. Government Printing Office, June 1974. ARGERIOU, M., and MANOHAR, V. Treating the problem drinking driver: Some notes on the time required to achieve impact. Br. J. Addict. 72: 331-338, 1977. ARGERIOU, M., and ZINKOWSKI, J. Black alcoholism: A comment upon NIAAA’s plan to combat the problem. J . Alcohol Stud. in press. BAHN, A.K., and CHANDLER, C.A. Alcoholism in psychiatric clinic patients. Q . J . Stud. Alcohol 22: 411-417, 1961. BAILEY, M.B., HABERMAN, P.W., and ALKSENS, H. The epidemiology of alcoholism in an urban residential area. Q. J . Stud. Alcohol 26: 19-40, 1965. BARCHHA, R., STEWART, M.A., and GUZE, S.B. Prevalence of alcoholism among general hospital ward patients. Am. J . Psychiatry 125: 681-684, 1968.
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