Not Equal: Racial Disparities In Addiction/Substance Use Treatment

Across the United States, research consistently shows that Black, Hispanic, Latinx, Native American, Indigenous, and Asian Americans face significant barriers when it comes to accessing quality addiction treatment. Compared to white Americans, people of color are less likely to receive an accurate diagnosis, less likely to be connected to treatment rather than the criminal legal system, and more likely to have shorter stays in treatment programs with lower completion rates. These gaps in care have real consequences for recovery outcomes.

It is important to understand that these disparities are not the result of individual choices or behaviors. They are rooted in systemic and structural issues, including poverty, lack of insurance, geographic barriers, and a history of racism within healthcare systems that has eroded trust among many communities of color. Addressing these disparities requires looking honestly at the systems and policies that produce them, not placing the burden of explanation on the individuals they affect.

This guide takes a closer look at how racial disparities show up in addiction treatment and what can be done to address them.

What Are Racial Health Disparities?

Having a meaningful conversation about the intersection of race, racism, and substance abuse first requires explaining what is meant by the term “racial health disparities”.

The Kaiser Family Foundation defines racial health disparities as the “higher burden of illness, injury, disability, or mortality experienced by one (politically and socially constructed) population group relative to another.”

Health disparities can also exist across other dimensions, such as:

• age
• gender identity
• sexual orientation
• disability status
• socioeconomic status (SES)
• geographic location

Experiencing marginalization across several of these dimensions may even further increase or decrease a person’s risk of experiencing these disparities. Being a Black American in a low-income bracket or living with a disability in a rural area with limited access to medical resources are examples of disparities. These disparities may have a greater impact on a person’s risk for illness, disease, and access to quality care.

Acknowledging the unique issues that marginalized populations can face in health spaces does not discount the distressing experiences of people who aren’t similarly marginalized. Life-threatening issues such as drug and alcohol addiction are painful to experience regardless of racial and ethnic background. Recognizing the ways non-white Americans are disproportionately affected by these health disparities, however, can build a pathway to greater understanding and developing solutions.

Causes Of Racial Health Disparities

The existence of racial health disparities in the U.S. cannot be linked to a single cause. The reality of how these disparities came to be and why they still exist in a country with the largest economy in the world is complex. Health disparities may often be affected by factors such as geographic location, the safety and public health infrastructure of communities, and, to a lesser extent, family medical history.

Many health conditions, including drug and alcohol abuse, run in families. However, the role that biology and genetics play in health differences among racial groups has been increasingly challenged in recent years. With greater research into health disparities, many health researchers now argue that these disparities are driven primarily by inequalities in wealth and power across society.

Understanding The Difference: Race Versus Racism

In discussions about race and health, it’s important to create a distinction between race and racism. Public health professionals warn against conflating the two. Health scholars, Jennifer Jee-Lyn García, Ph.D., and Mienah Zulfacar Sharif, MPH, assert that race “is a social construction with no biological basis, whereas racism refers to a social system that reinforces racial group inequity.”

Misinterpreting the role that race has to play in the underlying causes of health disparities does a disservice to the process of meaningfully addressing health-related inequalities. Additionally, pointing to race as a driver of health disparities could be interpreted as a form of “victim-blaming.” According to a growing body of research, the fact that physical and mental health outcomes tend to be poorer in communities of color is largely driven by social and economic conditions. In the field of public health, these are known as social determinants of health.

Social determinants of health that contribute to health disparities include:

• income
• job security
• safe housing
• availability of treatment services
• health insurance
• social connections
• access to a variety of foods (i.e., food security)
• quality education

Health disparities can also be influenced by the physical, mental, and psychological tolls that racism can take on communities of color. Stress, for instance, can have major effects on all aspects of health.

Stress And Trauma

Everyone has stress about one thing or another. However, there are some forms of stress that can be unique to certain populations. Racial prejudice, discrimination, and microaggressions, for instance, can cause acute and chronic stress for communities of color. This can appear in the workplace, medical settings, education, and by way of microaggressions in other social settings. Additionally, intergenerational or historical trauma is another form of stress that disproportionately affects the health and well-being of people of color.

This refers to the effects of discrimination and marginalization that can occur within families across generations. Intergenerational trauma has been associated with a number of physical, mental, and psychological conditions, including substance abuse and post-traumatic stress disorder (PTSD).

Substance Use And Addiction Rates Among People Of Color

Drug and alcohol abuse affects millions of people in the United States each year, according to data compiled by U.S. federal health agencies. Both substance abuse and acute withdrawal from drugs and alcohol can have life-threatening consequences for people without access to quality treatment and a social safety net.

People of all racial and ethnic backgrounds may share common risk factors, such as a family history of substance abuse, co-occurring mental illness, and early exposure to drugs and alcohol. However, people of color (POC), especially those who are low-income and would be good candidates for a free rehab program, are more likely to experience disparities in access to care compared to their white counterparts.

Several factors can influence this, including:

• racial bias
• inadequate financial resources (including lack of health insurance)
• stigma in communities of color
• the disproportionate criminalization of drug and alcohol use in Black and brown communities

Non-white populations are less likely to be referred to addiction treatment and are less likely to have the financial resources to pay for treatment. But they are more likely to be diverted into the criminal legal system for illicit drug use and other drug-related crimes.

Black Americans And Substance Use

Each year, SAMHSA collects national data on substance use and mental health through the National Survey on Drug Use and Health (NSDUH). The most recent available data highlights both the scope of addiction among Black Americans and the persistent gaps in treatment access.

Findings include:

• approximately 3.4 million Black or African American people aged 12 and older had an alcohol use disorder in the past year, representing 9.6% of that population, according to the 2024 NSDUH
• Data gathered from the 2021 to 2023 NSDUH surveys show that about 3 in 10 white adults received mental health treatment, compared to significantly lower rates among Black adults
• black Americans are more likely than many other racial groups to seek treatment at a specialty facility, yet recovery rates following treatment remain lower than the general population
• rates of mental health treatment among Black Americans with any mental illness continue to lag behind those of white Americans with similar diagnoses

These gaps in care are not simply a reflection of individual choices. They are rooted in systemic barriers including lack of insurance coverage, limited access to culturally responsive care, historical distrust of healthcare systems, and a criminal legal system that has disproportionately criminalized drug use among Black Americans rather than connecting them with treatment. Addressing these disparities requires systemic change at every level of the healthcare system.

Black Americans, Substance Use, And The Criminal Justice System

Black Americans are more likely than other racial groups to be referred to inpatient addiction treatment through criminal justice settings. Black Americans make up 33 percent of drug-related incarcerations despite representing only 12.5 percent of those who use illicit drugs.

Black Americans are more likely to be arrested, convicted, and incarcerated for drug-related crimes than white Americans, despite having similar rates of illicit drug use. Access to financial resources and legal protections may be important contributors to this. These disproportionate rates of arrests and incarceration are significant, considering the effects incarceration can have on health and livelihood.

Incarceration can lead to poverty, poor health, repeat offenses, violence, and lower quality of life.

Substance Use In Hispanic And Latinx Communities

National survey data consistently shows that Hispanic and Latinx Americans face unique challenges when it comes to addiction and access to mental health and treatment services.

According to 2023 national survey data on Hispanic and Latinx communities:

• 15.7% of Hispanic Americans aged 12 or older had a substance use disorder (SUD) in the past year, which was lower than white Americans (17.8%)
• Past-year illicit drug use among Hispanic Americans was 21.6%, lower than white, Black, and Multiracial populations
• Past-month alcohol use among Hispanic Americans was 41.2%, and past-month binge drinking rates were similar across most racial/ethnic groups (with Asian Americans having the lowest rate at 10.7%)
• Among Hispanic adults with any mental illness, only 47.4% received mental health treatment in the past year, compared to 58.7% of white adults
• Among those who needed substance use treatment, 25.3% of Hispanic Americans received it, the highest rate among all racial/ethnic groups

Hispanic and Black Americans are more likely to have shorter inpatient stays for substance use, and tend to fare worse after treatment. Hispanics are also incarcerated at disproportionately high rates and have less access to specialty treatment services, especially those that are culturally competent.

According to SAMHSA, nearly 90 percent of Hispanic Americans with substance abuse issues are unable to receive the specialized treatment they need. Among those in treatment for substance abuse, Hispanics are more likely to be houseless. Housing instability, unemployment, and low socioeconomic status can be major barriers to completing addiction treatment programs.

Native Americans And Substance Use

American Indian and Alaska Native communities continue to face some of the most significant addiction-related disparities of any racial or ethnic group in the United States.

Here is what the most recent available data shows:

• according to the 2024 NSDUH, approximately 134,000 American Indian or Alaska Native people aged 12 and older had an alcohol use disorder in the past year, representing 9.8% of that population
• pooled data from the 2021 to 2023 NSDUH surveys found that about 1 in 3 American Indian or Alaska Native people used tobacco products or vaped nicotine in the past month, the highest rate of any racial or ethnic group
• american Indian and Alaska Native people report serious psychological distress at 2.5 times the rate of the general population, and have the highest rates of suicide of any minority group in the United States
• drug overdose death rates were highest for non-Hispanic American Indian and Alaska Native people, and from 2019 to 2020, overdose death rates in this population increased by 39%
• significant barriers to treatment remain, including geographic isolation, lack of insurance, shortage of culturally responsive care, and distrust of Western healthcare systems rooted in historical trauma

Like Hispanic and Black Americans in treatment settings, Native American patients are more likely to be unemployed and are less likely to complete treatment. Limited access to culturally competent treatment services, as well as economic and geographic barriers, are believed to contribute to poorer treatment outcomes.

Asian Americans And Substance Use

While Asian Americans have among the lowest rates of substance use and substance use disorders of any racial or ethnic group in the United States, significant disparities in mental health treatment access tell a more complex story.

Here is what the most recent available data shows:

• according to the 2024 NSDUH, approximately 1 million Asian people aged 12 and older had an alcohol use disorder in the past year, representing 5.5% of that population, the lowest rate among all racial and ethnic groups
• past-month alcohol use among Asian Americans was 32.5%, lower than white, Black, Hispanic, and multiracial populations
• asian people were less likely to use tobacco products or vape nicotine in the past month than people in any other racial or ethnic group
• despite lower rates of substance use, 2023 survey data found that Asian adults were among the least likely of any racial or ethnic group to receive mental health services in the past year
• data from the 2021 to 2023 NSDUH surveys found that Asian adolescents were among the least likely of any group to have had both a major depressive episode and a substance use disorder in the past year

Despite lower rates of substance use and addiction, there are several obstacles Asian Americans who do seek treatment might face within a treatment setting. These include a lack of culturally competent treatment services and bias based on the model minority myth, a harmful stereotype that imposes exceedingly high expectations on all Asian individuals as high achievers destined for success.

Expectations imposed by this stereotype may also affect Asian Americans’ likelihood of seeking treatment for mental health and substance abuse issues. The ethnic diversity within the umbrella term “Asian Americans” may also disguise or make it more difficult to identify the specific risk factors and rates of addiction among ethnic subgroups.

Pacific Islanders And Substance Use

Pacific Islanders are often grouped together with Asian Americans, but when the two groups are separated, Pacific Islanders show a higher rate of substance abuse than white Americans, according to one study. This is especially true of adolescent Native Hawaiians. In a 2019 to 2020 study, 14% of students surveyed were high risk for substance abuse. An additional 11% likely had a substance use disorder.

The need for treatment among Hawaiian students doubled between junior high (about 7%) and high school (about 15% for seniors). Pacific Islanders in the U.S. also report a higher instance of mental illness than other racial groups, including Asian Americans. A study by the Centers for Disease Control and Prevention (CDC) found that 4.1% of Pacific Islanders reported psychological distress in the previous 30 days compared to 1.5% of Chinese Americans and 1.1% of Japanese Americans.

Additionally, Pacific Islanders report the lowest access rates to mental healthcare services when compared to Hispanic, Black, Asian American, and white populations. In the past year, about 46% of white populations with a mental illness used mental health services, while only 18% of Pacific Islanders with a mental illness accessed these services.

Racial Disparities In Substance Use And Addiction Treatment

Creating a healing environment for clients of color in substance abuse and addiction treatment programs requires recognition of the unique barriers marginalized communities face. In addition to substance abuse, communities of color may also experience higher rates of other mental health disorders, such as eating disorders, depression, and anxiety disorders. These commonly co-occur with drug and alcohol abuse.

Access to specialty treatment for addiction is only one of many disparities that can occur across racial lines. Racial health disparities in substance abuse and addiction treatment settings can show up in a variety of ways.

These include:

• access to a full continuum of care
• referrals to addiction treatment
• receiving a substance abuse diagnosis
• perceived need for treatment
• length of inpatient treatment stays
• criminalization of drug use behaviors

Understanding the unique barriers faced by communities of color is an important milestone in ensuring a just and equitable health system for all people struggling with drug and alcohol use.

Recent Progress And Persistent Challenges

Recent national survey data shows some encouraging signs when it comes to substance use treatment access across racial and ethnic groups, but significant gaps in mental health care remain. According to 2023 NSDUH data, white and multiracial adults were more likely to receive mental health services in the past year than Black, Hispanic, and Asian adults. Among adults who reported fair or poor mental health, white adults were more likely to say they received mental health services in the past three years compared with Black and Hispanic adults.

Asian, Black, and Hispanic adults are more likely than white adults to report difficulty finding a provider who can understand their background and experiences, and Hispanic adults are more likely to say they did not seek care because they did not know how to find a provider or felt afraid or embarrassed to do so. Research tracking trends from 2005 to 2019 found that the magnitude of mental health treatment disparities between white Americans and most racial and ethnic minority groups did not meaningfully change over that period, underlining the need for systemic solutions rather than incremental fixes.

Addressing Racial Disparities In Addiction Treatment Settings

Recognizing how racial health disparities can show up in addiction treatment spaces is only the first step toward creating better access for people of color seeking addiction recovery. Addiction treatment centers must also take concrete steps to create treatment environments that are inclusive, culturally competent, and accessible to communities of color.

There are several strategies alcohol and drug rehab centers can implement to make this happen.

Within a treatment center, strategies to achieve this goal might include:

• hiring treatment providers of color who may be uniquely capable of identifying the needs of racially marginalized clients and effective treatment approaches
• offering a wide array of traditional and holistic treatment services
• incorporating diverse cultural values into treatment programs, such as considerations for spirituality, religion, and cultural identity
• expanding access to specialty treatment services for clients with low incomes
• addressing potential language barriers by employing bilingual staff members

Many people facing addiction require weeks, months, or even years of professional support to achieve full recovery. Helping clients of color achieve addiction recovery may also require addressing barriers that can extend beyond a 30- to 90-day treatment program.

While entering an inpatient or residential treatment setting for substance use disorder can be critical for immediate stabilization, healing from addiction is not a quick process. Having access to a full continuum of care, including outpatient support, can be very important for supporting people on their recovery journeys.

Unfortunately, there are many economic barriers to this that can make it difficult for people to access the long-term care they may need. These barriers can include earning a lower income, experiencing housing instability, or lacking transportation. Addressing racial disparities in addiction treatment settings requires a real effort to work with all patients to help them succeed within a treatment program and in their lives beyond.

Addiction Treatment Resources For People Of Color (POC)

Below are resources for people of color who need access to addiction treatment.

Addressing Racial Disparities In Substance Abuse Treatment

• Racial Disparities in Accessing Treatment for Substance Use Highlights Work to Be Done: This article from the University of Southern California’s Leonard D. Schaeffer Center for Health Policy & Economics offers ways to address untreated addictions among POC.
• Position Statement on Addressing Racial and Ethnic Health Disparities in Substance Use Disorder Treatment in the Justice System: This position statement from the American Psychiatric Association (APA) offers insight into how to eliminate racial and ethnic disparities in access to treatment among people involved in the legal system.

Culturally Sensitive Treatment

• Cultural Considerations in Addiction Treatment: From the Association for Addiction Professionals, this article describes what culturally sensitive addiction treatment looks like and how to implement it.
• Culturally Sensitive Therapy: Psychology Today touches on the importance of providing culturally sensitive mental health treatment.
• National CLAS Standards: The U.S. Department of Health and Human Services Office of Minority Health provides the National Culturally and Linguistically Appropriate Services (CLAS) Standards, a framework to help healthcare organizations provide equitable care to diverse populations.

Foreign Language Addiction Treatment Resources

• SAMHSA’s National Helpline: The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources in English, Spanish, Tagalog, and many other languages.
• National Center on Substance Abuse and Child Welfare: This website offers information for families and children battling substance abuse as well as hotline numbers for treatment and child abuse reporting (interpreters available).

Overdose Information And Resources

• Drug Overdose Deaths Rise, Disparities Widen: The Centers for Disease Control and Prevention (CDC) explains how various disparities are affecting the rise in drug overdose deaths.
• Next Distro: A harm reduction organization that provides naloxone access, safe use supplies, and addiction resources with a focus on underserved and marginalized communities.

Resources For LGBTQ+ People Of Color

• National Queer and Trans Therapists of Color Network (NQTTCN): This organization maintains a directory of queer and trans therapists of color who provide mental health and substance use support to LGBTQ+ POC.
• The Trevor Project (1-866-488-7386): Provides crisis intervention and suicide prevention services for LGBTQ+ youth, with particular attention to the needs of young people of color.
• LGBT National Help Center (1-888-843-4564): Offers peer support and local resources for LGBTQ+ individuals, including those seeking addiction treatment and mental health services.
• National Black Justice Coalition: Advocates for Black LGBTQ+ individuals and provides resources and referrals for those seeking affirming mental health and addiction care.

Resources For Other Marginalized Communities Of Color

• Indian Health Service (IHS) Behavioral Health: Provides culturally grounded mental health and substance use treatment services for American Indian and Alaska Native communities.
• Asian Mental Health Collective: Offers a therapist directory and mental health resources specifically for Asian Americans, including those dealing with substance use concerns.
• National Alliance for Hispanic Health (Salud America): Provides health resources and advocacy for Hispanic and Latinx communities, including information on accessing addiction treatment.
• Office of Minority Health Resource Center (1-800-444-6472): A federally funded resource that connects people of color with culturally appropriate health and behavioral health services across the country.

Written by the Addiction Resource Editorial Staff