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Published Online: November 2011

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Benjamin Lê Cook, Ph.D., M.P.H. [email protected], and Margarita Alegría, Ph.D. [email protected]Authors Info & Affiliations
Publication: Psychiatric Services
Volume 62, Number 11
https://doi.org/10.1176/ps.62.11.pss6211_1273
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Abstract

Objective:

Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities.

Methods:

Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt.

Results:

Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models.

Conclusions:

The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion. (Psychiatric Services 62:1273–1281, 2011)

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Figures and Tables

Figure 1 Criminal history of individuals who received any substance abuse treatment in the past year (N=3,561)
Table 1 Characteristics of 25,159 adult respondents to the 2005–2009 National Survey of Drug Use and Health with any illicit drug or alcohol dependence or abuse, by racial-ethnic group (in percentages)
Table 2 Logistic regression models of receipt of any substance abuse treatment among adult respondents with a substance use disorder in the 2005–2009 National Survey of Drug Use and Health
Table 3 Logistic regression models of receipt of specialty substance abuse treatment among adult respondents with a substance use disorder in the 2005–2009 National Survey of Drug Use and Health

Information & Authors

Information

Published In

Go to Psychiatric Services
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Psychiatric Services
Volume 62 • Number 11 • November 2011
Pages: 1273 - 1281
PubMed: 22211205

History

Published in print: November 2011
Published online: 13 January 2015

Authors

Affiliations

Benjamin Lê Cook, Ph.D., M.P.H. [email protected]
The authors are affiliated with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, 120 Beacon St., 4th Floor, Somerville, MA 02143 (e-mail: [email protected]).
Dr. Cook is also with the Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts.
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Margarita Alegría, Ph.D. [email protected]
The authors are affiliated with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, 120 Beacon St., 4th Floor, Somerville, MA 02143 (e-mail: [email protected]).
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