Policy and practice recommendations for residential addiction treatment: a qualitative investigation on increasing equity in treatment for Black patients

BACKGROUND: Addiction treatment in the US is less effective for Black patients compared to their White peers. Barriers to appealing, effective, and equitable treatment exist both outside and within and treatment settings. Residential treatment is an important part of the continuum of care and is associated with improvement across substance use and life domains. However, this setting can be particularly uncomfortable for Black patients because it requires them to live in an environment that may not adequately support them. METHODS: Building on a multi-year community-engaged project to improve addiction treatment for Black patients, we explored how to improve residential treatment for this population. We conducted interviews and focus groups to understand the elements of residential treatment that could be modified and to identify specific recommendations. First, we interviewed seven experts who were patients and/or treatment providers in residential treatment programs focused on Black patients. Next, we conducted five focus groups with leadership, staff, and Black patients in a short-term residential treatment facility to generate recommendations for practice at this site. RESULTS: We organized policy recommendations into five domains: (1) Enhance representation of Black people and people with lived experience in treatment settings; (2) Conduct staff training to effectively support Black patients in treatment; (3) Create accountability across organizational structures; (4) Increase awareness and responsiveness to trauma; and (5) Create a welcoming treatment environment, utilizing strength-based behavioral reinforcement and culturally tailored programming. DISCUSSION: Our recommendations span multiple aspects of treatment, including hiring protocols, facilities, and clinical approaches. Our work adds to the literature by providing a set of policy recommendations that address the unique features of residential treatment. Manifestations of anti-Black racism in the US within and outside of the medical system make these changes particularly salient for Black patients. Pilot studies are needed to evaluate recommendations' effectiveness for key treatment metrics, including treatment continuity, substance use and related consequences, patient-provider trust, and discrimination.