In the United States in 2022, we face a problem: drug misuse, drug addiction, and drug overdose. Most of us know about the opioid epidemic and opioid overdose crisis. We’ve published over 40 articles on this topic over the past several years. This article addresses a subject we’re touched on – see the two articles below on overdose among black men – but have not explored in detail: the impact of race-related bias and stigma on treatment for alcohol use disorder (AUD), substance use disorder (SUD).
To browse those articles and get an idea about what the opioid crisis is, please navigate to this page:
Pinnacle Treatment Centers Blog: The Opioid Crisis in America
Choose an article and start reading: we’ve shared a great deal of information from reputable sources, and included the frightening statistics and reports on the hard work people in communities around the country do every day to mitigate the harm caused by the overdose/opioid epidemic. We’ve published articles specific to states like Pennsylvania and Ohio, articles on how communities respond to the crisis, and articles on the astounding increase in opioid overdose among older Black men, and non-Hispanic Black men in Kentucky.
Let’s contextualize this conversation by sharing the general statistics everyone needs to know: the most recent rates of drug overdose in the U.S.:
- 2019:
- 67,697 overdose deaths
- 50,178 opioid-related overdose deaths
- 2020:
- 78,056 overdose deaths
- 69,061 opioid-related overdose deaths
- 2021:
- 107,622 overdose deaths
- 80,826 opioid-related overdose deaths
That’s the big picture. Overdose deaths are increasing in general, but the percentage of drug overdose deaths attributed to opioids is decreasing overall. That appears to be a small ray of hope, but that needs context, too: among Black men, opioid overdose is increasing. We’ll address that situation, and discuss the significant barriers to care that Black, Indigenous, and People of Color (BIPOC) face when seeking treatment for alcohol or substance use disorder (AUD/SUD).
Drug Use in the U.S. by Origin/Race: Facts and Figures
The following three lists contain the latest statistics on drug and alcohol use rates, AUD and SUD rates, and rates of treatment for AUD and SUD among people of various races/origins in the U.S. In most of our articles, we speak of addiction and addiction treatment in the simplest terms possible: we talk about people with AUD, SUD, or OUD. However, in some cases, that approach limits us from addressing problems that exist within the AUD, SUD, and OUD treatment system with regards to race and origin.
As you read these statistics, you’ll notice that the highest rates of drug misuse, AUD, and SUD appear in the American Indian and Alaskan Native demographic groups. You’ll also notice that rates of drug use, AUD, and SUD are remarkably similar between Black/African Americans and Non-Hispanic/Non-Latino Whites.
As you read these figures, consider this fact: although rates of drug and alcohol use are similar, Black/African Americans experience greater rates of race based stigma related to SUD than Non-Hispanic/Non-Latino Whites, and experience greater barriers to care than their non-Hispanic/Non-Latino White peers.
Why?
We’ll discuss that after we share these statistics:
Drug Use and Alcohol Use by Origin/Race: 2020
American Indian & Alaska Natives:
- 8% misused illicit drugs
- 20% used marijuana in 2019 (2020 data not available)
- 7% misused opioids
- 6% reported heavy alcohol use in 2019 (2020 data not available)
Black or African Americans:
- 24% misused illicit drugs
- 21% used marijuana
- 3% misused opioids
- 4% reported heavy alcohol use
Hispanic or Latinos:
- 20% misused illicit drugs
- 16% used marijuana
- 4% misused opioids
- 1% (1.9 million) reported heavy alcohol use
Non-Hispanic or Latino Whites:
- 23% misused illicit drugs
- 19% used marijuana
- 4% misused opioids
- 7% reported heavy alcohol use
That’s the first place we see similarities: contrary to the dominant narrative, rates of drug use are remarkably similar among Blacks and Non-Hispanic Whites – and both use alcohol and drugs more often than Hispanic or Latino individuals, and less than American Indian & Alaskan Natives.
Alcohol and Substance Use Disorder by Origin/Race: 2020
American Indian & Alaska Natives:
- 14% reported AUD
- 17% reported SUD
Black or African Americans:
- 11% reported AUD
- 7% reported SUD
Hispanic or Latinos:
- 10% reported AUD
- 6% reported SUD
Non-Hispanic or Latino Whites:
- 11% reported AUD
- 7% reported SUD
Again, stereotypes break down: above we see AUD and SUD rates that are similar, with the exception of American Indian and Alaskan Native people.
Received Treatment for Alcohol and Substance Use Disorder by Origin/Race: 2020
American Indian & Alaska Natives:
- 2.1% received AUD treatment
- 1% received SUD treatment
Black or African Americans:
- 8% received AUD treatment
- The same rate as 2019
- 7% received SUD treatment
Hispanic or Latinos:
- 5% received AUD treatment
- 7%% received SUD treatment
Non-Hispanic or Latino Whites:
- 8% received AUD treatment
- Down from 1.1% in 2019
- 1% received SUD treatment
This is where we start to see disparity: although these percentage difference appear small, we need to remember that we’re talking about a large nationwide population. When we look at the treatment numbers for Black/African Americans as compared to Non-Hispanic White American, we learn that while rates of use are similar, rates of treatment vary a great deal.
That’s where race and stigma related to SUD start to appear.
In 2019, 2.5 million Black/African Americans received AUD treatment, while 17 million Non-Hispanic White Americans received AUD treatment. In addition, we learn that in 2020, 17 million Non-Hispanic White Americans received SUD treatment, while 2.1 million Black/African Americans received SUD treatment.
Now we’re ready to talk about why we see these disparities.
According to leading experts, the primary cause is systemic inequality and bias that manifests in the social determinants of health.
Treatment for AUD/SUD: The Consequences of Treatment Disparities
We need to make a critical point here: rates of drug and alcohol use are similar across demographic origin/race, with Native American/Alaskan experiencing higher rates of use than all other groups. We see treatment rates are different between groups. Before we discuss the barriers to care experience by the BIPOC community, let’s look at one of the consequences of the difference in treatment rates between these demographic groups: fatal overdose.
These figures appear in the Centers for Disease Control (CDC) publication “Overdose death rates increased significantly for Black, American Indian/Alaska Native People in 2020,” released in July 2022.
Overdose by Race/Ethnicity: 2019-2020
- Black/African American
- 2019: 27 deaths per 100,000
- 2020: 39 deaths per 100,000
44% increase
- American Indian/Alaskan Native
- 2019: 26 deaths per 100,000
- 2020: 36 deaths per 100,000
38% increase.
- Non-Hispanic/Non-Latino White
- 2019: 25 deaths per 100,000
- 2020: 31 deaths per 100,000
24% increase.
- Hispanic
- 2019: 17 deaths per 100,000
- 2020: 21 deaths per 100,000
23% increase.
That’s one thing that can happen when a serious substance use disorder goes untreated: escalation, overdose, and death. It does not happen in every case. Everyone with SUD does not escalate to fatal overdose. However, the data above connects untreated SUD in the BIPOC population with increased rates of fatal overdose.
It’s now time to discuss the inequalities in care.
Treatment Outcomes for BIPOC
Two research articles help us understand this the topic of race and stigma in SUD treatment with greater clarity. First, the 2020 paper “Systemic Racism and Substance Use Disorders” addresses the consequences of racism in the development and treatment of substance use disorder. Second, the publication “Race and Addiction: How Bias and Stigma Affect Treatment Access and Outcomes” discusses specific components of structural inequalities in SUD treatment, race and stigma in SUD treatment, and offers suggestions for how we can rectify these inequalities moving forward.
Experts on the interaction between race and stigma in SUD treatment identify the following structural factors that contribute to racial inequality in SUD treatment:
- Housing
- Education
- Employment
- Healthcare
- Financial institutions
- Criminal justice
Inequality in one, several, or all of these areas can lead to circumstances that directly contribute to the development of SUD, and impact engagement in SUD treatment. For instance, inequality in housing and education can lead to disparities in employment and access to both healthcare and the benefits of financial institutions – e.g. business loans, home loans, credit – which can, in turn, increase risk of SUD and prevent access to SUD treatment.
Also, criminal justice disparity has a disproportionate impact: although rates of substance use are almost identical across demographics, consider this statement by Dr. Emily Einstein, head of Science Policy at the National Institute on Drug Abuse (NIDA) :
“Even though they use cannabis at similar rates, for instance, Black people were nearly four times more likely to be arrested for cannabis possession than white people in 2018. Of the 277,000 people imprisoned nationwide for a drug offense in 2013, more than half (56%) were African American or Latino even though together those groups accounted for about a quarter of the US population.”
With regards to SUD treatment, stigma, and race specifically – aside from the large-scale structural factors that contribute to inequality – the following factors impact treatment outcomes for BIPOC:
- Gaps in screening and intervention:
- In primary care settings, evidence shows BIPOC people are screened less often for AUD/SUD.
- Lack of screening means no diagnosis, which means no referral to treatment, which most often results in no treatment
- Trauma:
- Experiencing racism and discrimination – on personal and structural levels – is traumatic.
- Trauma is associated with SUD
- Complex trauma is associated with treatment difficulty, and can impair treatment progress and outcomes
- Stigma:
- There is significant cultural and family stigma around mental health and mental health treatment in BIPOC communities
- Stigma can prevent treatment
- Untreated mental health issues can lead to SUD
- There is significant cultural and family stigma around SUD treatment, which perpetuates and exacerbates the cycle described in the three preceding bullet points
- Barriers to Medication-Assisted Treatment (MAT):
- Evidence shows the following factors impact access to MAT:
- Race/ethnicity
- Financial resources
- Location
- Discriminatory policies and regulations
- Buprenorphine treatment programs – the least restrictive MAT programs – are more common in rural areas and white neighborhoods than urban or Black and Hispanic neighborhoods
- Methadone programs – the most restrictive, most stigmatized MAT programs – are more common in urban, Black, or Hispanic neighborhoods than suburban White neighborhoods
- Evidence shows the following factors impact access to MAT:
That last series of bullet points offers a partial explanation for the disproportionate increase in overdose deaths among BIPOC people in the last two years. MAT is the gold standard treatment for opioid use disorder (OUD), yet structural inequities impact access: this is a prime example of changes we can make that are well within our reach.
How We Can Create Equity Moving Forward
Experts on the intersection of race, healthcare, SUD treatment, and structural inequality identify a series of clear, actionable steps we can take to address the disparities in SUD care that disproportionately affect BIPOC.
Removing Disparities in SUD Care: Action Steps
- Removing regulations and policies that prevent access to SUD treatment
- Improving clinician training in the following areas:
- Stigma
- Implicit bias
- Cultural competency
- Improving clinician training on substance misuse and addiction
- Most improvement is needed in the primary care setting
- Raising awareness among clinicians about the best available treatment options in their area
- Clinicians can be trained to get people into treatment right now, or as soon as possible, rather than navigating the traditional, complex, referral system
- Attracting clinicians of color to work in behavioral health
- In both urban and rural areas
- Educating the general public about mental health disorders, substance use disorders, and treatment for both, in order to reduce stigma, raise awareness, and encourage more BIPOC to step forward and seek professional help and support
We live by the motto any door is the right door for a person who wants to enter treatment. What we mean is that we meet people where they are: if they need treatment for SUD, we offer it to them in the way that works best for them. We extend this motto, and humanize it, to let BIPOC know we are here for them: if you need treatment for SUD, any background, ethnicity, or origin is the right background, ethnicity, or origin. If you need treatment – whether you’re a Black American, a Latino American, or a recent immigrant from South America or Southeast Asia – we’ll meet you where you are, learn about your cultural needs and how they impact your treatment needs, and offer you the best available treatment we can.
We’ll give you the tools you need to start your journey on the road to recovery, and we’ll walk that road right next to you, no matter how you are or where you came from.
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