Despite having comparable or lower rates of cocaine use compared to other racial and ethnic groups (Substance Abuse and Mental Health Services Administration, 2022), Black people experience more use-related consequences, such as a higher prevalence of cocaine use disorder (Cano et al., 2022, Nicholson and Ford, 2019). Moreover, in 2018, Black adults experienced twice the rate of and the largest relative increase in cocaine-involved overdose deaths compared to non-Hispanic White counterparts (Cano et al., 2020). The treatment of cocaine use disorder is notoriously difficult, with high nonresponse and dropout rates and limited periods of abstinence (Kampman, 2019). Thus, identifying the most effective treatments for Black adults who use cocaine is imperative for promoting health equity.

The National Drug Abuse Treatment Clinical Trials Network (CTN) conducts multi-site clinical trials to test the effectiveness of behavioral and pharmacological treatments for substance use disorders (SUD; Tai et al., 2021). However, despite strong evidence of the effectiveness of several psychosocial treatments for SUDs (Dutra et al., 2008), little is known about whether outcomes differ among Black people across evidence-based SUD treatment models (Montgomery et al., 2020). A scoping review found that only a few CTN studies reported substance use outcomes specific to Black adults (Montgomery et al., 2020). This limited data on SUD outcomes is due in part to small samples of Black participants within any single trial, which precludes the examination of within-group variation in treatment efficacy among Black participants. Integrative data analysis (IDA) can overcome sample size challenges by pooling data for Black participants across multiple trials, thereby increasing the analytical sample size and consequently allowing for a more robust estimation of treatment effectiveness for Black people (Bauer and Hussong, 2009, Cole et al., 2023).

Experiences of racism and discrimination have led to disproportionate exposure to adverse social-contextual factors (e.g., trauma, challenges in family/social relationships, reduced social support) among Black people (Boyd et al., 2020). These adverse experiences affect how individuals view themselves, how connected they feel to their communities, and negatively impact their vulnerability when engaging in substance use. Social-contextual interventions may lead to better immediate and long-term effects because they address the motives and stressors that Black people who use substances may have experienced. The inattention to examining the added benefit of addressing such social-contextual factors in interventions for Black people who use substances is a gap in understanding the end-of-treatment and long-term effects of treatments.

Using IDA, propensity score weighting (PSW), and individual-level analyses from nine CTN clinical trials, we created a “virtual clinical trial” model to investigate the comparative effectiveness of behavioral treatments among Black adults who use cocaine and/or opioids. Our analyses examined the comparative effectiveness of 1a) treatments that address social-contextual factors along with substance use; 1b) treatments that focus solely on substance use [e.g., contingency management (CM)] versus 2) treatment-as-usual or behavioral control conditions on cocaine, opioid use, and overall substance use (i.e., cocaine, heroin, and non-heroin opioids). We also examined the variations in treatment effects within each treatment category. We hypothesized that the reductions in substance use in social-contextual interventions relative to TAU/control at the end of treatment and follow-up would be greater than those focused solely on substance use (e.g., CM) relative to TAU/control.