During Minority Mental Health Awareness Month (MHAM), we work to raise awareness about mental health and mental health treatment among minority groups, which includes raising awareness about alcohol and substance use and alcohol and substance use treatment among minority groups.
Alcohol and Substance Use Disorders: A New Paradigm
July is Minority Mental Health Awareness Month in the U.S. At Pinnacle Treatment Centers, we work actively to dismantle stigma, reduce barriers to care, address the social determinants of health, and offer evidence-based alcohol and substance use treatment to members of minority groups and traditionally underserved populations.
To learn more about mental health issues among minority groups, please navigate to the blog section of our website and read this article:
Minority Mental Health Awareness Month: Culture, Community, and Connection
This article will address alcohol and substance use among minority groups. We’ll start with a brief review of how we approach alcohol and substance use treatment, which has changed a great deal over the past twenty years.
The new paradigm we refer to above is a change in the way we think about, talk about, and support people with alcohol or substance use problems. The first thing to understand is that in the 21st century, we embrace the medical model of addiction. This means we consider addiction – which we now refer to as the disordered use of alcohol or substances, i.e., alcohol use disorder (AUD) or substance use disorder (SUD) – to be a chronic medical condition that responds to evidence-based treatment. In that way, AUD or SUD is the same as other chronic medical conditions, such as hypertension or diabetes.
The next thing to understand is that we’ve changed the way we talk about people with AUD or SUD. Instead of stigmatizing words like junkie or addict or alcoholic, we say a person with a [alcohol or substance] use disorder.
Finally, it’s important to understand there are as many paths to recovery as there are to the disordered use of alcohol or substances. Some involve lifestyle changes and peer support. Others involve medication and formal treatment with professional therapists or counselors. Still others involve a harm-reduction approach. The unifying concept is this: if a person works toward reducing or abstaining from alcohol or substance use and takes proactive steps every day to counter the negative effects of alcohol or substance in their lives, then they’re in recovery.
With the idea that alcohol and substance use disorders are a subset of mental health disorders, and a valid topic for MMHAM, we’ll now discuss AUD, SUD, and treatment for AUD/SUD among minorities.
Alcohol Use and Substance Use Among Minority Groups: Facts and Figures
In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a retrospective analysis called “Racial/Ethnic Differences in Substance Use, Substance Use Disorders, and Substance Use Treatment Among People Aged 12 and Older (2015-2019).” We’ll use the data and analysis from that report throughout this article, alongside information from the Minority Mental Health Awareness Month Toolkit published by Mental Health America (MHA).
For this article, we prefer this publication to single-year data reports, since it reports average percentages tabulated over a five-year period. This allows for a deeper and broader understanding or the prevalence rates of alcohol and substance use, since a single year can be an outlier. For instance if we only used data from 2020 or 2021 to report rates of anxiety, depression, alcohol use, and drug use, those figures would – in all likelihood – be impacted by the COVID-19 pandemic. And while valuable, what we’re looking at here is the big picture, rather than focusing on one year.
With that said, we’ll start by looking at overall rates of alcohol and drug use in the past year, averaged over 2015-2019.
Here’s the data on various types of drug and alcohol use.
Past Year Illicit Drug Use
- Black: 20.8%
- American Indian or Alaska Native: 25.9%
- Native Hawaiian or Other Pacific Islander: 16.9%
- Asian: 9.8%
- Hispanic: 17.4%
- Multiracial: 28.5%
- White: 19.6%
In this small set of data, we recognize a trend from the data we share in our article on MHAM: rates for multiracial people are significantly greater than all other groups, followed by American Indian/Alaskan Natives.
Past Year Alcohol Use
- Black: 56.8%
- American Indian or Alaska Native: 53.2%
- Native Hawaiian or Other Pacific Islander: 52.7%
- Asian: 51.7%
- Hispanic: 58.7%
- Multiracial: 61.4%
- White: 70.3%
This is the only category of drug or alcohol use that shows White people engage in use, on average, more frequently than multiracial people.
Past Year Marijuana Use
- Black: 17.6%
- American Indian or Alaska Native: 21.0%
- Native Hawaiian or Other Pacific Islander: 14.1%
- Asian: 7.2%
- Hispanic: 13.2%
- Multiracial: 24.1%
- White: 15.7%
In this category, we’ll note that the trend toward decriminalization/legalization of marijuana for recreational use for people over age 21, which began in 2012, has resulted in modest increases in marijuana use among adults in states that chose legalization. However, the fears about the impact on young people are not reflected in this data: the overall trend in marijuana use among youth and teens has decreased over the past twenty years, and stabilized since the legalization movement began. To quote a report called “The Effect of State Marijuana Legalizations: 2021 Update”:
“The available data show no obvious effect of legalization on youth marijuana use.”
Now we’ll look at methamphetamine use, widely considered as a primary driver of the increases in fatal drug overdose observed between 2020 and 2022.
Past Year Methamphetamine Use
- Black: 0.2%
- American Indian or Alaska Native: 2.4%
- Native Hawaiian or Other Pacific Islander: 1.1%
- Asian: 0.2%
- Hispanic: 0.6%
- Multiracial: 1.1%
- White: 0.7%
While these prevalence rates are statistically low, methamphetamine causes a disproportionate amount of harm among people who use drugs. The presence of fentanyl in methamphetamine dramatically increases the risk of fatal overdose. We’ll also note that rates of methamphetamine use among multiracial and American Indian/Alaskan Natives groups is far higher than for all other demographics, highlighting the need for increased treatment outreach, awareness, and support in traditionally underserved groups and locations.
That’s the end of the alcohol and substance use data. The main takeaway: with the exception of alcohol use, multiracial people and American Indian/Alaskan Natives show the highest rates of use among all demographic groups across all the substances in the report.
Substance Use Disorder, Alcohol Use Disorder, and SUD/AUD Treatment: Facts and Figures
Experts on addiction agree that increased use is associated with increased rates of disordered use, a.k.a. addiction. As we share these numbers, we’ll learn whether that hold true here: do multiracial people and American Indian/Alaskan Natives show greater rates of use, compared to other demographic groups?
Let’s find out.
Past Year Substance Use Disorder
- Black: 7.1%
- American Indian or Alaska Native: 11.2%
- Native Hawaiian or Other Pacific Islander: 6.8%
- Asian: 4.1%
- Hispanic: 7.1%
- Multiracial: 9.9%
- White: 7.8%
Past Year Alcohol Use Disorder
- Black: 4.8%
- American Indian or Alaska Native: 8.3%
- Native Hawaiian or Other Pacific Islander: 4.9%
- Asian: 3.3%
- Hispanic: 5.2%
- Multiracial: 6.6%
- White: 5.8%
The data confirms the general hypothesis: greater rates of use translate to greater rates of disordered use. However, this data tells us that American Indian/Alaskan Natives experience the highest rates of SUD and AUD among all demographic groups, with multiracial people experiencing the second highest rates of SUD and AUD among demographic groups.
Next – and for our penultimate datasets – we’ll share rates of treatment for people who needed treatment. In this context, needed treatment means individuals met clinical criteria for addiction/disordered use as defined by the Diagnostic and Statistical Manual of Behavioral Disorders, Volume 4 (DSM-IV). Researchers used these criteria, rather than DSM-V criteria, for consistency in diagnostic criteria over time.
Let’s take a look at the data.
Past Year Illicit Drug Use Disorder Treatment: People Who Needed Treatment
- Black: 18.6%
- American Indian or Alaska Native: 24.9%
- Native Hawaiian or Other Pacific Islander: 8.3%
- Asian: 8.3%
- Hispanic: 17.6%
- Multiracial: 20.6%
- White: 23.5%
Past Year Alcohol Use Disorder Treatment: People Who Needed Treatment
- Black: 14.6%
- American Indian or Alaska Native: 22.4%
- Native Hawaiian or Other Pacific Islander: (data not available)
- Asian: 4.4%
- Hispanic: 10.5%
- Multiracial: 15.3%
- White: 10.9%
We read these figures the opposite way we read prevalence data. In other words, the higher the figure, the better. Here we see a difference in trends. Treatment-wise, American Indian/Alaskan Natives show the highest treatment rates, followed by White people (for SUD treatment) and multiracial people (for AUD) treatment. With the general caveat that these treatment rates are far too low overall, we observe that the high rate of treatment among American Indian/Alaskan Native is encouraging, since there is significant stigma against treatment in that demographic group. This represents initial evidence that awareness and advocacy of and for increased treatment among underserved demographic groups is finally reflected in nationwide data. Despite the low treatment rates overall, that’s a positive development.
Why Didn’t People Who Need Treatment Seek Treatment?
This is the last dataset we’ll share – and it contains results that surprised us. For instance, our expectation was that people in minority groups would report they didn’t seek treatment because of structural barriers to care, prejudice/discrimination, or insurance and cost. That’s not exactly what the data analysts found.
Reasons for Not Seeking Treatment: Minorities with SUD/AUD
- Cost/No Insurance:
- White: 35%
- Black: (incomplete/imprecise data)
- Hispanic: 37.6%
- Low Perceived Need
- White: 16.2%
- Black: 9.1%
- Hispanic: 12.5%
- Prejudice/Discrimination
- White: 30.1%
- Black: 14.0%
- Hispanic: 23.5%
- Structural Barriers
- White: 36.7%
- Black: (incomplete/imprecise data)
- Hispanic: 35.2%
- Not Ready to Stop
- White: 40%
- Black: (incomplete/imprecise data)
- Hispanic: 35.7%
- Thought Treatment Wouldn’t Help
- White: 3.7%
- Black: 2.0%
- Hispanic: 3.4%
- Other Reason
- White: 3.0%
- Black: 2.0%
- Hispanic: 3.5%
What surprises us here is that in two categories – cost/insurance and structural barriers – researchers observed no statistically significant differences between a majority demographic and a minority demographic, i.e. between White people and Hispanic people, respectively. What’s more surprising is the data on prejudice/discrimination. The demographic group in the majority – White people – cited prejudice and discrimination as reasons for not seeking treatment at rates 28 percent greater than Hispanic people and 115 percent greater than Black people.
We definitely did not expect to see that result. However, it teaches us something tangential to our discussion of minority mental health and alcohol/substance use: fear of stigma and discrimination around alcohol and substance use treatment is still so prevalent it affects all demographic groups, not just the groups we might expect.
How We Can All Help: Minority Mental Health Month
The biggest, most impactful thing we can all do to support minority mental health and address issues facing minority groups with regards to alcohol and substance use and treatment is to educate ourselves on the facts about mental health and mental health treatment. That broad umbrella includes alcohol/substance use and treatment for AUD and SUD.
When people know the facts, they can help affect positive change in themselves, their families, and communities. How? By sharing what we know with people who need to know what we know. Here are three tips for how we can all do that:
- Kindness and respect. In whatever way you choose to share your knowledge and advocate for increased awareness about mental health among minorities, lead with kindness and respect. When you start here, people are more likely to listen.
- Create or share online content. You can share articles like this one, or visit the Mental Health America website and download the MHAM toolkit, which includes well-designed and informative infographics perfect for sharing on social media.
- Engage with friends and neighbors. We’re not saying you need to be all advocacy, all the time, but when these topics come up in conversation, we encourage you to share what you know. And while you do, you’ll show people that it’s okay – and helpful – to share information on these topics.
We’ll close by reiterating the importance of that last tip. You may know a friend or neighbor who needs support, but doesn’t know how to ask for help or where to find it. If you share one resource, one positive insight, or one recovery success story, you might be the reason that friend or neighbor seeks treatment for a mental health or alcohol/substance use disorder. And when they do, there lives might change for the better – thanks to your honesty and willingness to be both an ally and advocate.
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