Unmet need for treatment for substance use disorders across race and ethnicity

Abstract

Background The objective was to analyze disparities in unmet need for substance use treatment and to observe variation across different definitions of need for treatment. Methods Data were analyzed from the 2002-2005 National Survey of Drug Use and Health and the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regressions estimated the likelihood of specialty substance use treatment across the two data sets. Parallel variables for specialty, informal and any substance abuse treatment were created. Perceived need and normative need for substance use treatment were defined, with normative need stratified across lifetime disorder, past twelve month disorder, and heavy alcohol/any illicit drug use. Treatment rates were analyzed, comparing Blacks, Asians and Latinos to non-Latino whites across need definitions, and adjusting for age, sex, household income, marital status, education and insurance. Results Asians with past year substance use disorder had a higher likelihood of unmet need for specialty treatment than whites. Blacks with past year disorder and with heavy drinking/illicit drug use had significantly lower likelihood of unmet need. Latinos with past year disorder had a higher likelihood of unmet need for specialty substance abuse treatment. Asians with heavy drinking/illicit drug use had lower likelihood of unmet need. Conclusions The findings suggest that pathways to substance abuse treatment differ across groups. Given high rates of unmet need, a broad approach to defining need for treatment is warranted. Future research to disentangle social and systemic factors from factors based on diagnostic criteria is necessary in the identification of need for treatment.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

“…Treatment utilization was low in whites [326] and all Latino subgroups [312,327]. Longer duration and comorbidity predicted treatment [328,329].…”

“…Longer duration and comorbidity predicted treatment [328,329]. Nonwhites were more likely than whites to perceive a need for treatment [328] and to receive treatment [318,319,326,327], often from 12-step groups or clergy [326]. Again, attitudinal barriers were important: participants perceiving a need for treatment were more likely to use services than others, while among participants perceiving a need, those with pessimistic attitudes about treatment outcomes were less likely to use services [330], supporting the need for public education.…”

Racial and Ethnic Disparities in the Quality of Health Care

“…Robust evidence indicates that minority populations use behavioral health services, including mental and substance use disorder treatment, less often than do non-Latino whites (6,98,104,105,126). Insurance, costs, cultural attitudes, and language barriers represent key drivers of these disparities (108,145).…”

Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs

“…It is impossible to put a cost on the considerable human suffering due to substance abuse. High rates of unmet need for substance use treatment across all racial and ethnic groups (Mulvaney-Day, DeAngelo, Chen, Cook, & Alegria, 2012) point to the potential benefit of universal screening. Screening, brief intervention, and referral to treatment (SBIRT) for substance use problems is a cost-effective, comprehensive, and integrated approach to the delivery of early intervention and treatment services for individuals who use tobacco, alcohol, or other drugs (Babor et al, 2007).…”