Written by Misha Afnani, Edited by Olivia McCollum, MPH, Edited by Courtney Coleman
Racial and ethnic disparities often result in unequal access to healthcare services, including substance use recovery programs. Minority populations face barriers such as lower-quality healthcare treatments, limited access to services, and cultural stigma that may discourage seeking care. Addressing disparities that impact minoritized communities ensures that all individuals can access treatment when needed, regardless of their background.
Cultural stigma surrounding substance use treatment further exacerbates the disparities faced by minority populations. Many individuals from racial and ethnic minority groups experience the impacts of cultural beliefs and social norms that view addiction as a personal failure or moral shortcoming rather than a medical condition requiring comprehensive treatment. In communities that are significantly engaged in traditional and cultural practices, seeking help for substance use may be seen as shameful or as bringing dishonor to one’s family, leading individuals to hide their struggles or avoid professional help altogether. These stigmatizing beliefs are often compounded by language barriers, mistrust in the healthcare system, and a lack of culturally competent care that considers the unique experiences and challenges faced by minority communities.
Black communities often experience poorer outcomes due to delayed treatment or inadequate interventions. A critical component of the structural racism in substance use treatment is healthcare accessibility. Medicaid, the largest payer of mental health services, has expanded across the nation; however, 12 states haven't accepted the expansion. These states are also home to the majority of the United States' Black population, further isolating Black individuals from accessible healthcare services, including substance use disorder treatment plans and programs. USC’s Center for Health Policy and Economics research on racial disparities in accessing treatment for substance use showed strong evidence to suggest that once states have Medicaid, they have increased rates of admission into substance abuse treatments compared to states not included in the Affordable Care Act's Medicaid expansion.
Racial inequities in healthcare access and quality have been extensively studied and documented, which proves that discrimination persists even when socioeconomic status is accounted for. Fiscella et al. , in their research surrounding healthcare utilization trends, state that Black patients are less likely than white patients to receive proper medical screening and are more likely to be seen by medical professionals with lower levels of experience. This similarly applies to substance use treatment; Black Americans who enter substance use treatment are more likely to leave treatment prematurely or terminate treatment compared to their white counterparts. Yale School of Medicine recently studied the impact of racial inequality in the treatment of addictive disorders. The researchers concluded that in 2018 approximately 90% of Black people in North America who were diagnosed with a substance use disorder did not receive addiction treatment.
Previous involvement with the criminal legal system is another contribution to the racial disparities that have been studied in substance abuse treatments. In their 2022 historical research paper, Grooms and Ortega found that despite similar rates of substance use across racial and ethnic groups, Black Americans face disproportionately higher rates of drug-related arrests. Although cannabis use is equally as common among Black and white individuals, Black individuals are 3.64 times more likely to be arrested for possession of marijuana. When it comes to addiction treatment, Yale School of Medicine did a study conducted on privately insured people who had suffered an overdose, and their research showed that Black individuals, even with private insurance, were half as likely to receive any treatment for an overdose in an emergency room compared to their white counterparts. Even outside of hospital settings, discrimination prevails. Black people are 70% less likely to obtain a prescription for narcotics such as buprenorphine, which is used to treat addiction.
The public should aim to take steps towards increasing the number of healthcare professionals trained in culturally sensitive approaches to care for marginalized communities and individuals experiencing substance use disorders. Expanding Medicaid, improving healthcare provider training, and eliminating racial biases in clinical settings are essential steps toward closing the treatment gap. Studies at leading institutions such as Yale and Boston University have shown promising initiatives in this area, with Yale creating REACH (Recognizing and Eliminating Disparities in Addiction through Culturally Informed Healthcare), a one-year program for medical students, fellows/residents, and nurse practitioner trainees. Similarly, Boston School of Medicine started its ACCESS initiative (Achieving Culturally Competent and Equitable Substance Use Services) for psychiatry trainees to treat people with mental illness and SUDs at local health centers. Only through targeted reforms can we ensure that all individuals, regardless of race or background, receive the care they need to treat substance use disorders and lead healthier lives.
References:
Grooms, J., & Ortega, A. (2022, December 20). Racial disparities in accessing treatment for substance use highlights work to be done. USC Schaeffer. https://healthpolicy.usc.edu/evidence-base/racial-disparities-in-accessing-treatment-for-substance-use-highlights-work-to-be-done/
Grooms J, Ortega A. Substance use disorders among older populations: What role do race and ethnicity play in treatment and completion?. J Subst Abuse Treat. 2022;132:108443. doi:10.1016/j.jsat.2021.108443
Arbelo Cruz F. Racial Inequities in Treatments of Addictive Disorders. medicine.yale.edu. Published October 1, 2021. https://medicine.yale.edu/news-article/racial-inequities-in-treatments-of-addictive-disorders/
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on December 24, 2024.
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