Are there racial/ethnic differences in indigent inner-city clients with dual diagnoses?

Objective: This is an exploratory, cross-sectional study that examined personal, clinical, and treatment characteristics among non-Hispanic Caucasian, non-Hispanic African American, and Hispanic indigent inner-city clients with co-occurring disorders. Methods: Men and women aged 20 to 50 years who met DSM-IV criteria for concurrent mood and substance use disorders were eligible. Inpatients, persons in detoxification programs, and incarcerated inmates were excluded. Assessments covered sociodemographic characteristics, clinical diagnoses, substance use, psychosocial variables, health care utilization and treatment history. Results: Two hundred volunteers were screened, and 145 were eligible to enroll. Racial/ethnic group differences in the distribution of mood and substance use disorders and medical diseases were evident. Receiving psychiatric treatment and psychiatric medications significantly differed among racial/ethnic groups, with Caucasians more likely to receive these services than African Americans or Hispanics. African Americans and Hispanics were also more likely than Caucasians to have positive screening results for their drug of choice and for other drugs as well. Serious medical illnesses were evident in about half of the sample, and the distributions of these illnesses significantly differed among racial/ethnic groups. There were no significant differences in hospitalization or emergency department visits among racial/ethnic groups. Conclusions: Indigent inner-city clients have multiple psychiatric and medical problems that warrant continuity of care. However, few doctor's visits for medical illnesses, lack of psychotropic medications, staggering unemployment, and homelessness were common in our sample. These results present health care and social service professionals with potentially serious treatment challenges. Better recognition and understanding of racial/ethnic needs in those with co-occurring disorders are needed.