Racial Disparities in Addiction Treatment
By: Halcyon Health
Tags: Addiction, Addiction Recovery, Racism, Race, BlackLivesMatter

Photo by Adam Nieścioruk on Unsplash

Racial minorities disproportionately suffer the negative consequences of Substance Use Disorder. Studies have shown that Black people are much more likely to have a negative opinion of their treatment program, attend fewer treatment visits, and have higher dropout rates.

National data has estimated that Black and Hispanic individuals were about 3.5–8.1% less likely to complete treatment for alcohol and drug use despite constituting 40% of the admissions in publicly funded substance abuse treatment programs. The disparities can largely be explained by the barriers to treatment that minority groups experience. However, it has also been well-discussed that a one-size-fits-all treatment approach is not right for everyone and this is the case when it comes to addressing minority treatment options as well. Minority groups often face stereotypes in the general population, which may foster biased behavior towards them.

These kinds of challenges affect whether members of minority groups decide to seek treatment and how they interact with their treatment if they do. There are wide differences in world-views, cultural traditions, and upbringing that have consequences for how individuals of different backgrounds will interact with their treatment. The healthcare community must identify interventions that are best suited for specific challenges faced by minority groups.

Background

A recent study used the Institute of Medicine’s framework to calculate disparities in treatment access and found that greater rates of criminal history, higher Medicaid enrollment, and lower-income disproportionately affected access to treatment. Given that those are factors, which disproportionately affect minority groups, it is important to study their effects.

The same study reported that Black people, Hispanic people, and Native Americans generally had higher levels of socioeconomic disadvantages than whites. For instance, Black and Hispanic individuals were more likely to be homeless. In the study’s analysis, the researchers reported that the largest disparity using need adjustment was between white and Black individuals(7.9 percent), but when adjusting this for socioeconomic factors the disparity was cut in half. For all ethnic and racial backgrounds completion rates differed based on the type of substance, use of medication-assisted treatment, and other clinical factors. However, disparities persisted even after the above factors were accounted for.

Disparities Affecting Access and Experience in Treatment

Estimates show that about 1 in 3 people who needed treatment did not receive it and they reported a lack of healthcare coverage and not being able to afford the cost as the main reasons. While publicly-funded programs can oftentimes be substantially cheaper or even free, not everyone is eligible for them and even if they are, the wait times can be extremely long.

A study that looked at treatment completion rates across racial and ethnic groups based on substance found that Black and Hispanic people were significantly less likely than white people to complete treatment for all substances except opiates.

When looking at treatment completion rates based on treatment settings (residential, intensive outpatient-alcohol, and non intensive outpatient) it was found that Black and Hispanic individuals were less likely to complete treatment across all settings. However, when adjusting for socioeconomic status, the completion gap between white and Black patients narrowed for both drug and alcohol treatment. This suggests that housing instability, unemployment and income are important barriers to treatment.

Unfortunately, even though Black people only account for 12.5% of illicit drug users, 33% of people incarcerated for drugs are black.While incarcerated, access to treatment options is limited. For instance, medication-assisted treatment for opioid use disorder is considered the holy-grail treatment. However, most prisons do not offer this treatment. In fact, in 2016, Rhode Island became the first state to offer all three FDA-approved OUD medications (Buprenorphine, Methadone and Naltrexone) to their entire detainee population. This led to a decrease in post-incarceration deaths by 61 percent compared to the previous year.

Minorities living in poverty are likely to be receiving treatment in an environment with weak social support and few economic opportunities.

Black clients reported a lack of transportation as one of the top barriers to treatment. While there is a shortage of treatment facilities across the nation, providing programs in areas that are easily accessible should be a top priority.

There is evidence to show that Black patients benefit from having a person of color on their treatment team. This highlights the importance of addressing cultural differences between providers and patients. Developing a more culturally competent treatment landscape is a promising approach for improving patient engagement.

Systemic Factors Contributing to the Disparity

Given that a large percentage of treatment received by minorities and low-income persons comes in the form of publicly funded programs, the below explores some of the aspects of the care system that have contributed to racial disparities:

Funding: Publicly funded substance abuse treatment centers are invaluable. Unfortunately, their services remain fragmented, underfunded and difficult to access. Accessibility: Many state-funded programs ask for things like proof of residence and proof of income status. These factors alone drastically reduce the amount of people who are encouraged to seek treatment. Homelessness and unemployment among Black and Hispanic people living with substance use disorder is much more prevalent than in White and Asian populations. Long Waiting Times: State-funded treatment is often limited, but very in demand. There are often very long waiting times to access treatment. Additionally, some people are often given priority like pregnant women, which can make the waiting period even longer. Limited Treatment Options: Funding again proves to be an issue in regard to the services state-funded programs provide. Keeping up with the latest technologies, therapies, and treatments is both time-consuming and expensive. Of course, some treatment is better than no treatment, so focusing on being able to provide some form of care to those who need it is essential. However, the fact that this can compromise quality and access is troubling. Duration of Treatment: Because of the high demand and insufficient funding from local, state and federal governments there has been a trend towards shorter average stays.

Bottom Line

There is significant evidence that individualized treatment with a solid support network dramatically improves outcomes for those living with SUD, but such treatment is difficult to access. According to statistics from the US Department of Justice, 21 million people over the age of 12 needed substance use treatment in the year 2016. Of those 21 million people, only 3.8 million got treatment. Treatment Episode Data Set reported that between 2002–2012 60% of people admitted into treatment programs were white, while 20% were black and 13% were Hispanic. Going forward, it is essential that the reasons for these huge gaps in treatment are addressed.

Future reforms should focus on the disparities in treatment completion across minority groups. For example, homelessness and unemployment are huge barriers for Black and Hispanic patients. Improving access to inpatient treatment, supported housing and vocational training should be further explored to test effectiveness. Equally important is increasing cultural awareness and equipping providers with the skills to treat people from all different backgrounds.

On top of the barriers that exist for access to treatment, there is evidence that the quality of programs that serve predominantly Black communities differs from those that service primarily white communities. A study found that programs serving primarily white people had longer staff tenure, more favorable ratings of physical space, and better staff ratings of treatment climate.

While engagement in treatment is also dependent on the individual and other organizational factors, there are clear disparities in access to treatment that must be addressed. There is no one-size-fits-all treatment, but there are various reforms that have potential to improve outcomes for minority populations.

Sources:

Blacks And Hispanics Are Less Likely Than Whites To Complete Addiction Treatment, Largely Due To Socioeconomic Factors

Racial Disparities in Substance Abuse Treatment and the Ecological Fallacy

Advances in Substance Abuse Prevention and Treatment Interventions Among Racial, Ethnic, and Sexual Minority Populations

The State of Working America

Income and Poverty in the United States: 2018

NAACP Criminal Justice Fact Sheet

Opioid Use Disorder Treatment in Jails and Prisons

Receipt of Services for Behavioral Health Problems:

Results from the 2014 National Survey on Drug Use and Health

Treatment Episode Data Set (TEDS) 2002–2012 National Admissions to Substance Abuse Treatment Services

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