Introduction
Substance use disorder (SUD) is a treatable and “complex condition that involves a problematic pattern of substance use”. Recovery services are important to treating substance use disorders and for positive behavior change. These services can include detoxification, cognitive or behavioral therapy, and medication-assisted therapy in an inpatient, outpatient, or long-term sober living community setting.
National Recovery Month has been held every September since 1989 to support evidence-based treatment for SUD. The Substance Abuse and Mental Health Services Administration (SAMHSA) works with private and public partners during Recovery Month to raise awareness about SUD, introduce relevant initiatives, and support those who are in long-term recovery.
Substance Use as a Critical Health Issue
The National Survey on Drug Use and Health (NSDUH) has been conducted annually by SAMHSA since 1971, and captures information on mental health, substance use, and treatment for these conditions among people around the United States. The three most recent surveys found that 3.4% of people in the U.S. misused opioids in 2021, 3.2% did so in 2022, and 3.1% did in 2023. About 1 in 4 people who needed substance use treatment in 2023 received it in the past year.
Other findings from the 2023 survey showed that 134.7 million people used alcohol in 2023, of which 45.6% engaged in binge drinking in the past month. 21.8% of people 12 or older used marijuana in the past year, which was the most used illicit drug.
Racial Disparities in the Treatment of SUD
The 2021-2023 NSDUH asked participants about treatment in the year before they were interviewed. The survey found that among the total population, 32.8% of non-Hispanic American Indians or Alaska Natives needed substance use treatment, 10.7% of non-Hispanic Asians needed it, with other groups falling somewhere in between. Among those who needed substance use treatment, non-Hispanic American Indians or Alaska Natives were most likely to receive it at 29.3%, while non-Hispanic Black Americans were least likely to have received treatment at 19.4%.
Racial disparities in outpatient treatment differ depending on the substance. An analysis of NSDUH data from 2015-2017 indicated that “Latinos and Blacks significantly underutilized specialty treatment relative to whites.”
One study examined whether there are disparities in SUD treatment based on the participants’ communities’ characteristics. They found that “Black and American Indian clients were less likely to initiate or engage in treatment compared to non-Latino white clients, and American Indian clients living in economically disadvantaged communities were at even greater risk of not initiating treatment.”
Disparities in SUD Treatment for LGBTQI+ People
LGBTQI+ people have historically been underrepresented in addiction research, though researchers have been addressing this gap in the past few decades. Research has shown that LGBTQI+ people have significantly higher rates of substance use than their cisgender and heterosexual peers. Disparities in substance use for LGBTQI+ people may be due to stressors such as self-stigma, expectations of rejection, interpersonal, or structural discrimination such as bullying, family conflict, or hate crimes.
Advancing Health Equity in Substance Use Disorder Treatment
Culturally appropriate treatment programs are needed to improve outcomes for people with SUD and reduce disparities. The U.S. Centers for Disease Control and Prevention provides information on key actions to address unequal access to treatment which can include:
- Increase telehealth access to reduce barriers to care. Remote health care can make important treatment services more accessible, especially to those who experience barriers like unstable housing, lack of childcare, or inaccessible transportation.
- Advocate for coverage of treatment and recovery in insurance plans. This can make treatment possible where systemic inequities make treatment unaffordable. This can help address the impact of social determinants of health on SUD.
- Include spiritual, religious, cultural and traditional practices in SUD treatment where appropriate. Evidence-based treatment for SUD can be provided in languages other than English. Culturally appropriate strategies can help with retention for gender, racial, and ethnic minorities. Supporting cultural practices can facilitate resilience.
- Engage people affected by SUD in support groups. These can reduce stigma and facilitate trust among people in treatment. Mental health resources and social support may mitigate negative effects of stigma or discrimination, improve knowledge of overdose prevention, and facilitate access to naloxone.
- Support initiatives that provide housing, transportation, and childcare which can make treatment more accessible. Lack of access to these services can prevent treatment. Making sure they are available may make it easier.
- Treat substance use as a public health issue rather than one deserving of criminal penalties. Public health and public safety can partner to provide medication for opioid use disorder in jails, facilitate access to treatment services to people emerging from the justice system, and increase access to naloxone to prevent overdose deaths.
- Offer peer support navigators and provide different settings for treatment. Trust in clinicians and health systems supports SUD treatment. Connecting patients with peers can facilitate understanding, while designing recovery systems in collaboration with peer supporters can make for better treatment programs.
- Support programs which reduce past and future trauma and other substance abuse risk factors. Adverse childhood experiences can increase the risk of SUD. Preventing harm early in life can reduce substance use disorders later in life.
- Employ best practices when offering SUD treatment and support to LGBTQI+ individuals. This can include a separate and welcoming unit for LGBTQI+ individuals, gender affirming staff, and specialized treatment tailored to the substance or type of addiction.
- Use SAMHSA’s Recovery Month Toolkit for outreach this September. The toolkit provides key messages, weekly themes, social media content to tailor and share with your audience, stickers, posters, and other digital tools.
Interested in learning more?
- For more on disparities in treatment for SUD, check out P4HE’s partner organization HealthHIV. HealthHIV provides information on adapting HIV treatment for people with substance use disorder, PrEP to prevent HIV infection in people who inject drugs, and integrated bupreprenorphine treatment for those living with HIV and opioid use disorder.
- SAMHSA has evidence-based resources available on substance use for health care providers, those assisting with recovery, and patients affected by SUD.