As the United States is confronting pervasive issues of racism and injustice, our treatment facility considers this time to be a teachable moment for examining the relationship between racial health disparities and substance abuse.
Health research in the United States shows that people of color—including Black, Hispanic, Latinx, Native American, and Asian Americans—generally have different levels of access to addiction treatment services compared to white Americans. These differences in access to treatment, and health outcomes, vary among racial and ethnic groups.
Disparities in health and access to quality healthcare—including addiction treatment—across racial lines can show up in several ways.
Examples of racial disparities in addiction treatment include differences in:
- access to quality treatment
- receiving an accurate diagnosis
- being diverted to addiction treatment rather than the criminal justice system
- rates for completing treatment programs for drug and alcohol abuse
- length of stay in a treatment program
- recovery rates
While some may prefer to point to individual behaviors to explain why these disparities exist, the reality is that racial health disparities are systemic issues that cannot be treated solely as individual problems.
Understanding the disproportionate ways in which people of color are affected by addiction, and the systems in place to address drug and alcohol abuse, is important. This is true whether you’re a health professional, someone with a history of substance abuse, or the loved one of someone with a substance use disorder
Health disparities among different racial groups are driven primarily by social and economic factors that affect populations, not just individual people who are struggling.
This guide may help explain why it’s important to look at the systems that produce these disparities and how these can show in addiction treatment spaces.
We provide a glance at how addiction treatment facilities can better meet the needs of diverse populations in consideration of the unique struggles imposed by marginalization.
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:
- 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 for experiencing these disparities.
For instance, being a Black American in a low-income bracket, or living with disability in a rural area with lesser access to medical resources, may have a greater impact on a person’s risk for illness, disease, and access to quality care.
Acknowledging the unique struggles that marginalized populations can face in health spaces does not discount the very real and distressing experiences of people who aren’t similarly marginalized.
Struggling with life-threatening issues such as drug and alcohol addiction, or watching a loved one struggle, is painful 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:
- 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 very real physical, mental, and psychological tolls that racism can have 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 wellbeing 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 Abuse 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, 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, are less likely to have the financial resources to pay for treatment, and are more likely to be diverted into the criminal justice system for illicit drug use and other drug-related crimes.
Black Americans And Substance Abuse
Each year, the Substance Abuse and Mental Health Services Administration (SAMHSA) collects national data on substance abuse and addiction in the U.S through the National Survey on Drug Use and Health (NSDUH).
According to 2018 survey data:
- about 2.2 million Black Americans over the age of 18 had a substance use disorder (SUD)
- 1 in 7 Black American adults with substance abuse issues struggled with both alcohol and illicit drug use
- about 1.1 million Black American adults had a mental illness in addition to substance abuse
Compared to white Americans, Black Americans have slightly higher rates of past-month illicit drug and marijuana use, but lower rates of heavy drinking.
National data shows that Black Americans are more likely than other racial groups to seek and receive treatment at a specialty facility. Rates of recovery among Black Americans following treatment, however, are lower than the general population.
Black Americans, Substance Abuse, 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 Abuse In Hispanic And Latinx Communities
According to 2018 national survey data in Hispanic and Latinx communities:
- Hispanics have similar rates of substance use disorders compared to the general population.
- Puerto Ricans have the highest heavy drinking rates among Hispanic Americans, and are three times more likely to develop alcohol use disorder (AUD) compared to non-white, non-Hispanic Americans.
- About 7.1 percent of Hispanics have a substance use disorder (SUD) compared to 7.4 percent of the general population.
Hispanics and Black Americans are more likely to have shorter inpatient stays for substance abuse, 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 Abuse
Native American communities experience some of the highest rates of drug and alcohol abuse among all racial groups, despite making up a small portion of the population.
Factors believed to contribute to this include disproportionate rates of discrimination, access to healthcare, historical trauma, poverty, and high levels of unemployment.
Native Americans are also at increased risk for several other health issues, including high rates of suicide, mental illness, diabetes, and heart disease.
According to 2018 SAMHSA survey data:
- one in 11 Native American adults struggle with a substance use disorder
- rates of alcohol and marijuana abuse among reservation-based Native American students are 3.4 times higher than those of the general U.S. student population
- nearly 25 percent of Native Americans report binge-drinking in the past month
Like Hispanics and Black Americans in treatment settings, Native American patients are more likely to be unemployed and are less likely to complete treatment.
Low 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 Abuse
On a population level, Asian Americans have lower rates of drug and alcohol abuse compared to other racial and ethnic groups.
About 5.3 percent of Asians, Native Hawaiians, and other Pacific Islanders reported having a substance use disorder in 2018. This is lower than the national average.
According to 2018 national survey data:
- Alcohol and drug abuse rates tend to be lower among recent Asian immigrants.
- Within Asian American subgroups, Japanese Americans have the highest rates of heavy drinking.
- Filipino and Vietnamese American adults have the highest rate of illicit drug use (7.9%) among Asian American subgroups.
Despite lower rates of substance abuse 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 around the model minority myth. The model minority myth is 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.
Racial Disparities In Substance Abuse And Addiction Treatment
Creating a healing environment for patients of color in substance abuse and addiction treatment programs requires recognition of the unique barriers and challenges faced by racially marginalized communities.
In addition to substance abuse, communities of color may also experience higher rates of other mental health disorders, such as eating disorders, depression, anxiety, and post-traumatic stress disorder (PTSD). 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.
- 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 struggles and 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.
Addressing Racial Disparities In Addiction Treatment Settings
Recognizing how racial health disparities can show up in addiction treatment spaces is only the first step towards creating a stronger support system 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 who require specialty care. 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 patients 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 low-income patients
- addressing potential language barriers by employing bilingual staff members
Many people who struggle with substance abuse and addiction require weeks, months, or even years of professional support to achieve full recovery. Helping patients 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 abuse 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 being low-income, 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 Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- American Journal of Public Health — Black Lives Matter: A Commentary on Racism and Public Health
- Health Affairs — Blacks and Hispanics Are Less Likely Than Whites To Complete Addiction Treatment, Largely Due To Socioeconomic Factors
- UC Berkeley: Othering & Belonging Institute — Toward the Abolition of Biological Race in Medicine
- NCBI Bookshelf — The State of Health Disparities in the United States - Communities in Action
- Substance Abuse and Mental Health Services Administration (SAMHSA) — National Survey on Drug Use and Health
- The Sentencing Project — Report to the UN on Racial Disparities in the U.S. Criminal Justice System