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Substance Abuse Treatment, Prevention, and Policy

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Open Access 01-12-2009 | Research

Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders

Authors: Brian E Perron, Orion P Mowbray, Joseph E Glass, Jorge Delva, Michael G Vaughn, Mathew Owen Howard

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2009

Abstract

Background

Treatment for drug use disorders (DUD) can be effective, but only a small proportion of people with DUD seek or receive treatment. Research on racial and ethnic treatment differences and disparities remains unclear. Understanding racial and ethnic differences and disparities in drug treatment is necessary in order to develop a more effective referral system and to improve the accessibility of treatment. The purpose of the current study was to explore the role of race and ethnicity in service utilization.

Methods

Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), this study examined racial and ethnic differences in use of 14 types of treatment services for DUD and 27 different treatment barriers among persons who met lifetime criteria for a DUD. Multivariate logistic regression analyses were used to examine service utilization and barriers among the racial and ethnic groups, while adjusting for other sociodemographic and clinical variables.

Results and discussion

Among Blacks, Hispanics and Whites in the overall NESARC sample, approximately 10.5% met criteria for at least one lifetime drug use disorder. Approximately 16.2% of persons with a lifetime DUD received at least one type of service. Overall, this study indicated that Whites were less likely to report receiving help for drug-related problems than Blacks, Blacks used a greater number of different types of services, and no racial and ethnic differences were observed with respect to perceived barriers to drug treatment. However, by examining types of services separately, a complex picture of racial and ethnic differences emerges. Most notably, Whites were most likely to use professional services, whereas Blacks were most likely to use 12-step and clergy. The service use pattern of Hispanics most resembled that of Whites.

Conclusion

While structural barriers to accessing treatment were observed, broad-based educational programs and interventions that are appropriately targeted to racial and ethnic groups remains an important area for prevention and treatment.

D'Onofrio G: Treatment for alcohol and other drug problems: Closing the gap. Ann Emerg Med. 2003, 41: 814-817. 10.1067/mem.2003.190.CrossRefPubMed

Andrews G, Henderson S: Unmet Need in Psychiatry: Problems, Resources, Responses. 2000, Cambridge University PressCrossRef

Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D, Ortega AN: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv. 2002, 53: 1547-1555. 10.1176/appi.ps.53.12.1547.CrossRefPubMed

Wells K, Klap R, Koike A, Sherbourne C: Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry. 2001, 158: 2027-2032. 10.1176/appi.ajp.158.12.2027.CrossRefPubMed

Sue S, Fujino DC, Hu LT, Takeuchi DT, Zane NW: Community mental health services for ethnic minority groups: a test of the cultural responsiveness hypothesis. J Consult Clin Psychol. 1991, 59: 533-540. 10.1037/0022-006X.59.4.533.CrossRefPubMed

Wang PS, Demler O, Kessler RC: Adequacy of treatment for serious mental illness in the United States. Am J Public Health. 2002, 92: 92-98. 10.2105/AJPH.92.1.92.PubMedCentralCrossRefPubMed

Wang PS, Berglund PA, Olfson M, Kessler RC: Delays in initial treatment contact after first onset of a mental disorder. Health Serv Res. 2004, 39: 393-415. 10.1111/j.1475-6773.2004.00234.x.PubMedCentralCrossRefPubMed

MacMaster SA: Experiences with and perceptions of, barriers to substance abuse and HIV services among African American women who use crack cocaine. J Ethn Subst Abuse. 2005, 4: 53-75. 10.1300/J233v04n01_05.CrossRefPubMed

Department of Health and Human Services: Treatment Data Episode Set (TEDS). (Author ed. Washington, DC;). 2004

10.

Department of Health and Human Services: Drug and Alcohol Service Information System (DASIS): Black Admissions to Substance Abuse Treatment: 1999. (Author ed. Washington, DC). 2002

11.

Saunders SM, Zygowicz KM, D'Angelo BR: Person-related and treatment-related barriers to alcohol treatment. J Subst Abuse Treat. 2006, 30: 261-270. 10.1016/j.jsat.2006.01.003.CrossRefPubMed

12.

Campbell CI, Weisner C, Sterling S: Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention. J Adolesc Health. 2006, 38: 343-350. 10.1016/j.jadohealth.2005.05.028.CrossRefPubMed

13.

Turner WL, Wallace B: African American Substance Use: Epidemiology, Prevention, and Treatment. Violence Against Women. 2003, 9: 576-589. 10.1177/1077801202250452.CrossRef

14.

Kang SY, Goldstein MF, Deren S: Health care utilization and risk behaviors among HIV positive minority drug users. J Health Care Poor Underserved. 2006, 17: 265-275. 10.1353/hpu.2006.0063.CrossRefPubMed

15.

Ward JW, Duchin JS: The epidemiology of HIV and AIDS in the United States. AIDS Clin Rev. 1997, 1-45.

16.

Boyd CJ, Blow F, Orgain LS: Gender differences among African-American substance abusers. J Psychoactive Drugs. 1993, 25: 301-305.CrossRefPubMed

17.

Schmidt L, Greenfield T, Mulia N: Unequal treatment: racial and ethnic disparities in alcoholism treatment services. Alcohol Res Health. 2006, 29: 49-54.PubMed

18.

Blanco C, Patel SR, Liu L, Jiang H, Lewis-Fernandez R, Schmidt AB, Liebowitz MR, Olfson M: National trends in ethnic disparities in mental health care. Med Care. 2007, 45: 1012-1019. 10.1097/MLR.0b013e3180ca95d3.CrossRefPubMed

19.

Wagstaff A, van Doorslaer E: Income inequality and health: what does the literature tell us?. Annu Rev Public Health. 2000, 21: 543-567. 10.1146/annurev.publhealth.21.1.543.CrossRefPubMed

20.

Abe-Kim J, Takeuchi DT, Hong S, Zane N, Sue S, Spencer MS, Appel H, Nicdao E, Alegria M: Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American Study. Am J Public Health. 2007, 97: 91-98. 10.2105/AJPH.2006.098541.PubMedCentralCrossRefPubMed

21.

Harris KM, Edlund MJ: Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatr Serv. 2005, 56: 954-959. 10.1176/appi.ps.56.8.954.CrossRefPubMed

22.

Williams DR, Rucker TD: Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000, 21: 75-90.PubMedCentralPubMed

23.

US Surgeon General: Mental health: A report of the Surgeon General. 1999

24.

Ayalon L, Alvidrez J: The experience of Black consumers in the mental health system – identifying barriers to and facilitators of mental health treatment using the consumers' perspective. Issues Ment Health Nurs. 2007, 28: 1323-1340. 10.1080/01612840701651454.CrossRefPubMed

25.

Neale J, Tompkins C, Sheard L: Barriers to accessing generic health and social care services: a qualitative study of injecting drug users. Health Soc Care Community. 2008, 16: 147-154.CrossRefPubMed

26.

Mojtabai R: Use of specialty substance abuse and mental health services in adults with substance use disorders in the community. Drug Alcohol Depend. 2005, 78: 345-354. 10.1016/j.drugalcdep.2004.12.003.CrossRefPubMed

27.

Schmidt LA, Ye Y, Greenfield TK, Bond J: Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey. Alcohol Clin Exp Res. 2007, 31: 48-56. 10.1111/j.1530-0277.2006.00263.x.CrossRefPubMed

28.

Cohen E, Feinn R, Arias A, Kranzler HR: Alcohol treatment utilization: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2007, 86: 214-221. 10.1016/j.drugalcdep.2006.06.008.CrossRefPubMed

29.

Breton AR, Taira DA, Burns E, O'Leary J, Chung RS: Follow-up services after an emergency department visit for substance abuse. Am J Manag Care. 2007, 13: 497-505.PubMed

30.

Tucker JA, Foushee HR, Simpson CA: Increasing the appeal and utilization of services for alcohol and drug problems: What consumers and their social networks prefer. Int J Drug Policy. 2007, 20: 76-84. 10.1016/j.drugpo.2007.11.004.CrossRefPubMed

31.

Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP: Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004, 61: 361-368. 10.1001/archpsyc.61.4.361.CrossRefPubMed

32.

Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R: The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend. 2003, 71: 7-16. 10.1016/S0376-8716(03)00070-X.CrossRefPubMed

33.

Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP: The Alcohol Use Disorder and Associated Disabilities Interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend. 1995, 39: 37-44. 10.1016/0376-8716(95)01134-K.CrossRefPubMed

34.

Institute RT: SUDAAN Language Manual, Release 9.0. 2004, Research Triangle Park, NC: Research Triangle Institute

35.

Hatzenbuehler ML, Keyes KM, Narrow WE, Grant BF, Hasin DS: Racial/ethnic disparities in service utilization for individuals with co-occurring mental health and substance use disorders in the general population: results from the national epidemiologic survey on alcohol and related conditions. The journal of clinical psychiatry. 2008, 69: 1112-1121.PubMedCentralCrossRefPubMed

36.

Keyes KM, Hatzenbuehler ML, Alberti P, Narrow WE, Grant BF, Hasin DS: Service utilization differences for Axis I psychiatric and substance use disorders between white and black adults. Psychiatr Serv. 2008, 59: 893-901. 10.1176/appi.ps.59.8.893.PubMedCentralCrossRefPubMed

37.

Velez MB, Campos-Holland AL, Arndt S: City's racial composition shapes treatment center characteristics and services. J Ethn Subst Abuse. 2008, 7: 188-199. 10.1080/15332640802055640.CrossRefPubMed

38.

Perron BE, Bright CL: The influence of legal coercion on dropout from substance abuse treatment: results from a national survey. Drug Alcohol Depend. 2008, 92: 123-131. 10.1016/j.drugalcdep.2007.07.011.PubMedCentralCrossRefPubMed

Title: Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders
Authors: Brian E Perron
Orion P Mowbray
Joseph E Glass
Jorge Delva
Michael G Vaughn
Mathew Owen Howard
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Substance Abuse Treatment, Prevention, and Policy / Issue 1/2009
Electronic ISSN: 1747-597X
DOI: https://doi.org/10.1186/1747-597X-4-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders

Abstract

Background

Methods

Results and discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results and discussion

Conclusion

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