Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Abstract

Objective Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. Methods Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. Results Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models. Conclusions The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.

Racial and Ethnic Differences in Substance Use Diagnoses, Comorbid Psychiatric Disorders, and Treatment Initiation among HIV-Positive and HIV-Negative Women in an Integrated Health Plan

“…The finding that black women are less likely to initiate SUD treatment is consistent with Satre et al's (2010) findings among women with provider-assigned SUDs. However, findings are in contrast to findings of a large community-based sample of women which found black women were significantly more likely to initiate SUD treatment than were white women, however these differences were no longer significant in models adjusting for involvement in the criminal justice system and socioeconomic status (Cook & Alegria, 2011). The current findings suggest that given equal availability of SUD treatment, black women may be less likely to initiate treatment.…”

“…These women may be more likely to initiate SUD treatment in community based samples, likely due to higher likelihood of interaction with the criminal justice system and/or lower socioeconomic status (Cook & Alegria, 2011). Our results indicate that black women may be less likely to initiate SUD treatment within an integrated healthcare system.…”

“…Based on prior studies, we suspected that there would be differences in substances of abuse among women based on HIV-status (e.g., higher rate of opiate use disorder among HIV-positive women) and higher rate of comorbidity of depressive and anxiety disorders among HIV-positive women we expected to find higher rates of alcohol disorder among white women and higher rates of cocaine and cannabis disorders among black women irrespective of HIV-status (Cook & Alegria, 2011). We suspected that women with comorbid anxiety disorder and/or depressive disorder would be more likely to initiate SUD treatment as these disorders likely indicate higher levels of distress and/or problems in daily functioning (Greenfield et al, 2007; Satre, Campbell, Gordon, & Weisner, 2010), and lower rates of SUD treatment initiation among black women (Acevedo et al, 2012; Weisner, 1993).…”

Whose Stress is Making Me Sick? Network-stress and Emotional Distress in African-American Women

“…African-American men are incarcerated at a rate more than six times higher than non-Hispanic European-American men (U.S. Department of Justice, 2010). In addition, African-Americans disproportionally experience chronic disease morbidity (including heart disease, cancer, stroke, and diabetes; Heron, 2013), and Downloaded by [University Of South Australia Library] at 11:07 10 October 2015 are less likely to receive treatment for substance abuse conditions compared to their European-American counterparts when adjusted for criminal history and Medicaid enrollment (Lê Cook & Alegria, 2011). These facts illustrate the potential sources of network-stress exposure among African-American women.…”

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

“…Substance use treatment is underutilized by members of all racial-ethnic groups (Cook & Alegria, 2011), with some variability. African American patients tend to have higher rates of specialty substance use care than White patients, but Hispanic patients have lower rates than non-Hispanic White patients (U.S.…”