Racism, Health Inequities, and What it Means for Black People with Substance Use Disorders

How Racism Impacts Health and Treatment Among Black People

Over the last several years, there has been increasing evidence indicating that structural factors are the fundamental cause of health inequities, which result in poor health outcomes among racial and ethnic minorities. Black people as well as other racial and ethnic minorities with a substance use disorder, the clinical term for a drug or alcohol addiction, have endured discrimination and stigmatization for decades and suffered alarming death rates, especially during the Covid-19 pandemic. In 2020, overdose death rates increased 44% among Black people.¹

Research demonstrates that Black communities have been made vulnerable to disease and psychological stressors that can last for generations.² Studies indicate that the adverse effects of racism stem primarily from the stress of chronic exposure to forms of “everyday racism,” such as being treated with less respect than others, being stopped by the police for no apparent reason, or being monitored by salespeople. The continual feeling of having to be prepared to contend with these seemingly minor insults and assaults causes stress and takes a toll on their mental and physical health. Evidence suggests that the implications of these chronic stressors may contribute to conditions that include hypertension, birth-related outcomes, mental health issues, and substance use behaviors.³

Additionally, multiple studies show that the Black population struggle with anxiety, depression, and symptoms of PTSD at markedly higher rates than white individuals.⁴ This is significant, as relapse has a strong correlation with co-occurring mental health concerns. In addition, receiving mental health treatment before a crisis point is more common amongst white individuals. With socioeconomic circumstance that begets a lack of resources, the lower rates of sustained recovery are all but baked into foreseeable scenarios.

Black people also experience a unique relationship with addiction and treatment. In 2022, 54.6 million people aged 12 or older needed substance use treatment. Black individuals made up over 20% of that number. Unfortunately, most of these individuals did not receive treatment. In fact, only 4.6% of the Black individuals who needed substance use treatment received it. That’s roughly 502,000 individuals of the more than 10 million Black people who had a substance use disorder.⁵

Unfortunately, even those Black individuals who do seek medical help following substance use may not be referred to a treatment program. Data shows that emergency departments all over the country provide care for an increasing number of individuals who visit following an opioid overdose. However, few of these individuals transition to a treatment program following a nonfatal overdose. In fact, Black patients, who had not received substance treatment prior to their overdose were half as likely to obtain treatment compared to non-Hispanic white patients.⁶

How Drug Laws May Negatively Affect the Black Population

For decades, the primary policy approach to drug use in the United States has been to arrest, prosecute, and incarcerate as many people as possible for as long as possible. However, this approach has been ineffective in its ultimate goal of reducing drug use. Instead, this approach has been associated with an increase in drug-related harms including nonfatal and fatal overdoses. One case study suggests that even Good Samaritan Laws, designed to protect individuals who report overdose, may negatively and disproportionately impact Black individuals. For instance, as of 2021, 22 of the 48 jurisdictions that have Good Samaritan Laws do not not provide protections for individuals in violation of probation or parole, meaning calling for help in an overdose situation could lead to incarceration for them. And research suggests that, independent of drug use, Black individuals are more likely to have prior criminal or legal interactions than white individuals.⁷

Importance of Cultural Competence in Addiction Treatment

Studies indicate that neglecting to bridge the racial and cultural divide and take a more holistic approach to treatment may contribute to Black individuals and other people of color leaving treatment prematurely. And this all begins well before treatment starts. For instance, health communication campaigns on opioid misuse and opioid use disorder in the Black community need to include messages of hope and recovery, on naloxone education and distribution, and incorporate individuals who look like the people in those communities.⁸

Much like gender-specific rehab centers, facilities that provide a culturally responsive and respectful component for Black individuals during treatment have shown to increase success rates. The cultural differences between provider and client can work to disenfranchise a patient who would benefit from empathy and experiential recognition. Simple considerations such as connecting Black individuals with culturally similar support groups, incorporating aspects of their spirituality, or providing transportation to and from an outpatient program can be key in their recovery success.

We talk all the time about how effective treatment is not a one-size-fits-all solution. Once an individual starts treatment, they should not only receive the standard of care tailored to their unique needs, but they should should receive care that is responsive and respectful to their cultural, psycho-behavioral, and social needs as well.⁸