Health disparities and substance abuse
Health disparities refer to significant differences in health outcomes and access to healthcare that affect specific groups based on ethnicity, race, gender, socioeconomic status, and other factors. These disparities are particularly pronounced in the context of substance abuse, where individuals from marginalized communities often face greater challenges. For instance, although substance use rates are similar across racial and ethnic groups, treatment access is markedly lower for minorities, with only about 10% of Black Americans and even fewer Native Americans receiving necessary treatment for substance use disorders. Compounding these issues, marginalized groups experience disproportionate health consequences related to substance use, including higher rates of drug-related deaths and comorbid health conditions like HIV and hepatitis.
Additionally, factors such as socioeconomic status and geographic location heavily influence access to treatment services, with individuals in rural areas facing significant barriers. The LGBTQIA+ community also exhibits higher rates of substance use compared to heterosexual individuals, highlighting the intersectionality of health disparities. Addressing these disparities requires targeted efforts, such as those initiated by various health organizations, which focus on improving healthcare quality, accessibility, and outcomes for affected populations. Understanding the multifaceted nature of health disparities in substance abuse is crucial for developing effective interventions and promoting health equity.
Health disparities and substance abuse
DEFINITION: Health disparities are those differences in health-related treatment or outcomes that disproportionately affect specific groups of individuals based on their ethnicity, race, gender, sexual orientation, socioeconomic class, or level of education.
Background
Social service agencies, the government, and researchers define a health disparity differently; however, it typically involves significant differences in treatment or outcomes. The National Institute of Allergy and Infectious Diseases states:
Health disparities are gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level. These disparities may stem from many factors, including accessibility of health care, increased risk of disease from occupational exposure, and increased risk of disease from underlying genetic, ethnic, or familial factors.
Health disparity is a problem in the primary and behavioral health care system and an increasing problem among individuals with substance use disorder. Individuals from traditionally marginalized groups continue to experience barriers to adequate health care and substance use treatment options.
Differences in Health and Health Care
The disparities found for many of these groups differ depending on the indicator or outcome examined; however, some underlying trends exist. Minorities tend to have poorer outcomes when compared to White individuals; women have poorer outcomes when compared with men; and gay and lesbian individuals have poorer outcomes when compared with heterosexual individuals. These disparities are noted even when other variables, such as socioeconomic status and availability of health care, are controlled for.
Health disparities are especially disconcerting when it comes to substance use. Of the entire population of individuals with substance use disorders, less than 20 percent receive treatment, but for individuals from marginalized groups, these rates are much lower—10 percent of Black Americans, 9 percent of Latinx Americans, and 3.5 percent of American Indians and Alaska Natives. Although racial and ethnic minorities use drugs and alcohol at roughly the same rate as White individuals, racial and ethnic minorities suffer more ill effects from substance abuse. Health disparities related to substance abuse are noted in several areas, including human immunodeficiency virus (HIV) infection rates, transmission of sexually transmitted diseases (STDs), cardiovascular health as it relates to substance use, hepatitis and tuberculosis infection, and drug-related deaths. These diseases are more prominent in individuals with addictions due to needle sharing, risky behaviors, unprotected sex, and lowered immune systems from poor overall health.
• Hispanic and Black American populations have higher rates of complete abstinence from alcohol, but they also have a higher risk for developing alcohol-related liver disease than White individuals if they do drink.
• Black Americans, Native Americans, and Alaska Native people had dramatic increases in drug-related deaths between 2019 and 2020.
• The diagnosis rate for HIV in the United States in 2019 was 12.6 per 100,000 persons and 42.1 among Black Americans. One out of every ten individuals who use intravenous drugs have HIV.
• Black and Native American men experience more overdose death rates than any other groups. The overdose death rates among Black men tripled between 2018 and 2023 with the fentanyl epidemic.
• The prevalence of smoking among White and Black Americans is almost identical, but Black Americans who are heavy smokers have an increased risk of diabetes. Native Americans are twice as likely to smoke as Hispanic individuals and almost three times as likely to smoke as Asian Americans.
When examining the disparities for individuals in the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, non-binary, pansexual, agender, and gender fluid (LGBTQIA+) community, similar results are noted. LGBTQIA+ persons have higher rates of alcohol and substance abuse when compared with the rates noted among heterosexuals, are less likely to abstain from alcohol and drug use, and are more likely to continue with heavy drinking into later life. All of these behaviors increase an individual's risk of contracting HIV or STDs.
Differences in Treatment
In addition to the disparities noted in health care among minority populations, disparities also are noted in access to and participation in treatment. For example, those of lower socioeconomic status typically access substance abuse treatment at levels significantly lower than persons in higher socioeconomic brackets. Furthermore, people in rural communities have fewer treatment options.
Asian Americans access substance abuse treatment at lower levels than other racial and ethnic groups, even when controlling for the prevalence of substance use disorders. Lesbians are less likely to access treatment services for substance use disorders. Black American men are less likely to access residential treatment when compared with men of other racial and ethnic groups, and Black Americans overall are less likely to complete substance abuse treatment compared to White Americans.
Health disparities also affect persons who have both a mental illness and a substance use disorder (co-occurring or comorbid disorders, or COD). Persons with COD have a more difficult time accessing treatment, perhaps because of a lack of adequate training for the professionals who treat substance use and those who treat psychiatric disorders. This is particularly true of persons whose psychiatric illness (such as schizophrenia or bipolar disorder) is more complex and requires medication management.
Conclusion
The effect of health disparities is far-reaching and has negative implications for all Americans. Disparities significantly impact the individual and community and lead to increased morbidity and mortality.
To address the wide-ranging scope of the problem, the National Institutes of Health, the American Psychological Association, the Office of Minority Health, and other state and federal organizations began increasingly addressing health disparities in the late twentieth century. Healthy People is an ongoing program sponsored by the Office of Disease Prevention and Health Promotion that began its first iteration in 1980. The program focuses on improving all Americans' health and well-being and reducing health disparities. Some of the actions taken include developing special task forces, funding research to examine and address disparities, and encouraging minority and other scholars to engage in research in this area by offering grants and opportunities for training. The program's fifth iteration, Health People 2030, includes 358 measurable objectives that aim to better understand, track, and apply health disparity research findings.
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