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. Author manuscript; available in PMC: 2026 Jul 7.
Published in final edited form as: J Subst Use Addict Treat. 2025 Jul 7;177:209754. doi: 10.1016/j.josat.2025.209754

Formal and Informal Substance Use Treatment Utilization Amongst Asian Americans

Christopher Villongco 1, Benjamin G Druss 1
PMCID: PMC12503370  NIHMSID: NIHMS2097987  PMID: 40633909

Abstract

Introduction:

Asian Americans (AA) with alcohol or substance use, alcohol use disorder (AUD), and substance use disorder (SUD) utilize substance use treatment at lower rates than all other races/ethnicities. This study tested if the lack of utilization is offset by greater informal substance use treatment utilization.

Methods:

Analysis utilized pooled data from 2015–2019 National Survey of Drug Use and Health (NSDUH) in individuals aged ≥ 18. Unadjusted proportions, confidence intervals, and adjusted multivariate logistical regression examined the relationship of race/ethnicity (Asian, White, Black, and Hispanic) and substance use treatment in individuals with 12-month substance/alcohol use or AUD/SUD. Classifications of treatment were formal (doctor’s office, mental health center, hospital, rehabilitation facility) or informal (self-help group, home/family/friends, school/college, or Church/religious/spiritual influence).

Results:

AA with AUD/SUD were significantly less likely to utilize formal substance use than individuals who were White (aOR = 0.28, p < 0.05). There was no significant difference in informal treatment utilization between AA with alcohol use, substance use or AUD/SUD and individuals of any other race/ethnicity. AA with AUD/SUD utilized combined (both informal and formal) services significantly less than individuals who were White (aOR = 0.31, p < 0.05).

Discussion:

Informal services did not offset the limited substance use treatment engagement in AA. More work is needed to better and understand low rates of substance use treatment in this population.

Keywords: Asians, Alcohol and Drug misuse, Drug treatment

1.1. Introduction:

Asian Americans (AA) are the fastest growing population in the United States (Pew Research, 2021). Traditionally, AA have lower substance use disorder (SUD) rates than the general population (SAMHSA, 2021). However, AA are understudied in substance use research (Choi et al., 2023) and many studies aggregate AA in with Native Hawaiians and Other Pacific Islanders (Wu & Blazer, 2015). Despite low SUD rates overall, AA and Pacific Islanders have similar problem severity compared to non-AA and Pacific Islanders at lower alcohol and drug use severity (Niv et al., 2007). Additionally, AA and Pacific Islanders with SUD were more likely to have persistent disorders compared to White individuals (Xu et al., 2011). AA also saw a significant increase in the incidence of alcohol, cocaine, and tranquilizers misuse compared to White Americans during the COVID-19 pandemic (Yan et al., 2023) and this is linked to racial discrimination and attacks on the AA community (Lozano et al., 2022; Wang et al., 2023).

AA have the lowest formal substance use treatment utilization of all racial and ethnic groups in the US (SAMHSA, 2021). Of those who need alcohol or drug treatment, AA were less likely to receive treatment in a specialty facility and more likely to feel that they do not need treatment compared to all racial or ethnic groups (Lipari & Hager, 2013). Known barriers to treatment amongst AA and Pacific Islanders include: stigma (Fong & Tsuang, 2007), language barriers (Yu et al., 2009), gender issues (Han et al., 2016), peer pressure, family pressure, loss of face (Masson et al., 2013). However, the overall lack of attention to AAs with substance use issues indicates that further work to understand service disparity is needed.

One explanation for the lack of formal substance use treatment utilization could be preference amongst AA for informal or alternative substance use treatments. AA adolescents valued family-based programming for substance treatment and family bonding was seen as a protective factor (Fang et al., 2011). AA in substance use treatment facilities were twice as likely to express preference for help from a minister, priest, or rabbi and were more inclined to utilize a change in environment, relaxation, and self-control training for substance use when compared to White individuals (Goebert & Nishimura, 2011). Amongst AA and Pacific Islanders more broadly, self-help groups were utilized at higher rates than outpatient rehabilitation facilities for substance use treatment (Substance & Mental Health Services, 2020). The traditional AA response is an attempt to handle substance use issues within the family itself, serving as a buffer with an emphasis on maintaining “normal functioning” (Fong & Tsuang, 2007). An explanation for the preference for informal substance use treatment is that many AA have strong cultural traditions of eastern alternative medicine systems (Felicilda-Reynaldo et al., 2020). In contrast, the combination of behavioral and pharmacological interventions in formal substance use treatment is developed from a Westernized approach to disease (Arria & McLellan, 2012) most familiar to individuals who are non-Hispanic White.

The purpose of this study is to understand whether greater utilization of informal services offsets the lower rates of formal substance use services within the AA community. We hypothesize that AA with alcohol or substance use (alcohol/substance) or alcohol use disorder (AUD) or substance use disorder (SUD) will have lower rates of formal substance use treatment rates, but equivalent or higher informal substance use treatment utilization compared to individuals who are White and that this would offset the limited formal utilization.

2.1. Material and Methods:

2.2. Data source:

We utilized SAMHSA’s National Survey on Drug Use and Health (NSDUH) which provides nationally representative data on substance use, mental health, and treatment in civilian and non-institutionalized people ages ≥ 12 years old and up (Substance & Mental Health Services). Systematic stratified sampling was completed, and interviews were conducted face-to-face (2019 NSDUH Methods Summary and Definitions). NSDUH surveys from 2015–2019 were selected. Due to the COVID-19 pandemic, the NSDUH 2020 survey estimates should not be compared to years prior (“2020 National Survey on Drug Use and Health (NSDUH) Releases,”). NSDUH 2021 and 2022 surveys changed from a face-to-face interview to include web-based interviews (2021 National Survey on Drug Use and Health (NSDUH) Releases) and removed questions about other substance use treatments (Center for Behavioral Health & Quality, 2023). Therefore, the study did not include these years. Data was restricted to age >=18 because of the difference in substance use and treatment engagement between adolescents and adults (Lind Bk et al., 2019). This study utilized publicly available, de-identified data and thus was IRB exempt.

2.3. Study Variables:

Demographics variables were all categorical. Demographic variables included biological sex (male and female only), age (only recorded on NSDUH as categorial), household income, highest level of education, coverage by any health insurance, and race/ethnicity. Only those who identified as non-Hispanic white (White), non-Hispanic Black/African American (Black), non-Hispanic Asian (Asian American or AA), and Hispanic (Hispanic) were selected for race/ethnicity. Racial and ethnic groups were selected to contextualize the impact of Asian culture on informal and combined substance use utilization patterns compared to the broader US population. Individuals who were White, Black, and Hispanic were selected as they represent the four largest populations along with AA in the US (“Population of the U.S. by Ethnicity Since 2000,” 2025) as well as had the largest sample in NSDUH for statistical analysis. Due to high comorbidity of substance use and mental health issues (Regier et al., 1990), analysis also included past year history of any mental illness.

Individuals met criteria of past year substance use disorder (SUD) or alcohol use disorder (AUD) if they met criteria of alcohol or substance (excluding tobacco) abuse or dependence based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric, 2000). Because informal treatments are beneficial in broad skill development to prevent substance use (Baird et al., 2023) and are also utilized by individuals not only with SUD (Zemore et al., 2017), this study also examined treatment rates of individuals with not only SUD but merely substance use. Respondents had 12-month alcohol or substance use if they reported using an illicit drug (excluding tobacco) or alcohol within the past year.

Three mutually exclusive treatment outcome variables included: Formal substance use treatment only – determined if a respondent reported that in the past 12 months, they only received illicit drug or alcohol treatment at an outpatient rehabilitation facility, inpatient rehabilitation facility, doctor’s office, mental health center, or hospital and no other substance use treatment services of any kind. Informal substance use treatment only – determined if in the past 12 months, they only received illicit drug or alcohol treatment at a self-help group (Alcoholic/Narcotics Anonymous), home/family/friends, school/college, or Church/religious/spiritual influence and no other substance use treatment services of any kind or Both formal and informal substance use treatment – coded for participants who used both formal and informal treatment modalities. No participant was counted twice.

2.4. Statistical Analysis:

Design-based analysis generated nationally representative and weighted estimates to control for the clustered and stratified sampling of NSDUH (Center for Behavioral Health & Quality, 2020). Descriptive summary statistics were generated for all study variables. This included unweighted frequencies as well as weighted frequencies, percentages, confidence intervals. Percentages and confidences intervals were calculated using weighted frequencies. Differences in demographic data by race/ethnicity were tested using a chi-square test. Estimates with unweighted samples sizes of n < 100 or % < 0.00005 were suppressed due to unstable sample size or percentage in accordance with NSDUH guidelines (Statistics & Quality, 2024).

Bivariate associations of race/ethnicity with formal, informal, and both substance treatment use in those with past year alcohol or substance use or AUD or SUD was completed by calculating the percentage use rate and 95% confidence intervals within each racial/ethnic group respectively. Due to the limited evidence for effectiveness of self-help groups and perceived lack of cultural fit amongst some racial/ethnic groups (Zemore et al., 2021), informal substance use percentage and confidence interval was further split into “Self-help groups only” and an “Other informal treatment only.” To better characterize heterogeneity within the AA diaspora, a separate analysis compared treatment utilization by education level and income.

Multivariate logistical regression modeled the different substance use treatment outcomes by race/ethnicity with AA being the reference group. These models additionally accounted for sex, gender, age, family income, highest level of education, any mental illness, and health insurance. Since odds ratios are symmetrical (Cummings, 2009), the reciprocal aOR is reported within the text to keep the focus on AA. Given differences in the persistence of AUD and SUD based on racial background (Evans et al., 2017), a separate sensitivity analysis investigated AUD and SUD respectively. Statistical analysis was conducted using SAS version 9.4 (SAS Institute Inc., 2023).

3.1. Results:

Descriptive statistics and unweighted percentages and numbers are shown in Table 1. 53.77% of AAs reported a household income of $75,000 or more compared to 43.97% in participants who were White, 21.65% in participants who were Black, and 24.65% of participants who were Hispanic. The percentage of AA who attained a college degree was (62.75%) compared to participants who were White (35.53%), Black (19.54%), and Hispanic (16.14%). AAs had Alcohol and substance use rates of (56.50 %) compared to participants who were White (76.27%), Black (64.44%), and Hispanic (66.11%). AA rates were (4.25%) for SUD compared to participants who were White (8.16%), Black (7.60%), and Hispanic (7.45%).

Table 1:

Weighted unadjusted demographic frequencies, percentages, and confidence intervals from the United States National Surveys on Drug Use and Health, 2015–2019.

Asian (Unweighted N = 10,275) White (Unweighted N = 128,924) Black (Unweighted N = 27,081) Hispanic (Unweighted N= 37,015) X2 p
% 95% CI % 95% CI % 95% CI % 95% CI
Gender 53.03 > 0.05
Male 47.14 45.60–48.67 48.60 48.12–49.08 45.32 44.51–46.13 49.72 48.89–50.54
Female 52.86 51.33–54.40 51.40 50.92–51.88 54.68 53.44–54.87 50.28 49.46–51.11
 
Age 1569.76 > 0.05
18–25 Years Old 15.41 14.49–16.33 11.79 7.53–7.83 16.47 15.99–16.95 19.10 18.58–19.62
26–34 Years Old 20.63 19.49–21.77 14.02 10.67–11.10 17.69 17.08–18.30 20.48 19.73–21.23
35 or Older 63.96 62.39–65.52 74.19 81.15–81.73 65.84 65.06–66.62 60.42 59.40–61.44
 
Income 4595.68 > 0.05
Less than $20,000 11.92 10.96–12.88 12.44 12.12–12.78 29.29 28.27–30.32 22.02 1.28–22.75
$20,000 – $49,999 20.03 18.75–21.31 26.81 26.40–27.23 35.11 34.20–36.03 38.44 37.42–39.47
$50,000 – $74,999 14.28 13.29–15.27 16.77 16.48–17.06 13.94 13.36–14.52 15.15 14.55–15.74
$75,000 or More 53.77 52.00–55.54 43.97 43.35–44.58 21.65 20.71–22.60 24.40 23.39–25.40
 
Insurance 4107.80 > 0.05
Yes 93.98 93.21–94.74 93.32 93.14–93.50 87.63 87.09–88.17 77.48 76.85–78.11
No 6.0245 5.26–6.79 6.68 6.49–6.86 12.37 11.83–12.91 22.52 21.89–23.15
 
Highest level of Education 8193.14 > 0.05
Less than HS 5.97 5.13–6.81 8.17 7.93–8.40 16.64 15.96–17.32 30.06 29.23–30.89
HS Diploma 10.79 9.63–11.95 24.33 23.98–24.69 31.45 30.63–32.27 26.09 25.37–26.81
Some college/Associates 20.49 19.34–21.64 31.96 31.56–32.36 32.36 31.50–33.22 27.72 27.04–28.40
College 62.75 60.69–64.80 35.53 34.97–36.09 19.54 18.80–20.29 16.14 15.47–16.81
 
Any Mental Illness 357.52 > 0.05
  86.60 85.71–87.48 79.50 79.16–79.83 84.00 83.31–84.68 83.84 83.25–84.43
  13.40 12.52–14.29 20.50 20.17–20.84 16.01 15.32–16.69 16.16 15.57–16.75
 
Substance or EtOH use in past 12 months 56.50 54.83–58.18 76.27 75.88–76.67 64.44 63.52–65.35 66.11 65.36–66.86 1529.86 > 0.05
SUD or AUD in past 12 months 4.25 3.78–4.71 8.16 7.92–8.40 7.60 7.17–8.03 7.45 7.10–7.80 151.25 > 0.05
AUD in past 12 months 3.52 3.02–4.01 6.16 5.97–6.35 5.24 4.93–5.55 5.79 5.43–6.14 97.94 > 0.05
SUD in the past 12 months 1.23 0.99–1.47 2.84 2.71–2.96 3.45 3.11–3.79 2.69 2.42–2.97 81.12 > 0.05
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For unadjusted rates of individuals who used alcohol or substances within the past 12 months, AA had formal only substance use treatment utilization of (0.12%, 95% CI = 0.05–0.19) compared to participants who were White (0.58%, 95% CI = 0.52–0.65), Black (0.77%, 95% CI = 0.54–0.99), and Hispanic (0.52%, 95% CI = 0.37–0.67). AA also utilized only informal substance use treatment with rates of (0.06%, 95% CI = 0.00–0.13) compared to participants who were White (0.19 %, 95% CI = 0.16–0.22), Black (0.22%, 95% CI = 0.12–0.32), and Hispanic (0.27%, 95% CI = 0.17–0.37). Combed formal and informal treatments utilization rates of AA was (0.17%, 95% CI = 0.04–0.31) in contrast to participants who were White (0.74%, 95% CI = 0.66 −0.81), Black (0.69%, 95% CI = 0.58–0.80), and Hispanic (0.51%, 95% CI =0.33–0.69).

Unadjusted rates of individuals with AUD or SUD within the past 12 months found AA had formal only treatment utilization rates of (0.71 %, 95% CI =0.00–1.43) compared to individuals who were White (3.34, 95% CI = 2.94–3.79), Black (3.00, 95% CI =2.08–3.91), and Hispanic (3.14 %, 95% CI = 2.13–4.15). AA with AUD or SUD also utilized informal only treatments at rates of (0.37 %, 95% CI =0.00–0.95), compared to individuals who were White (1.01 %, 95% CI =0.74–1.28%), Black (1.24 %, 95% CI =0.60–1.89%), and Hispanic (1.66%, 95% CI=0.90–2.43). Both formal and informal substance treatment utilization was (1.35%, 95% CI = 0.06–2.64) in participants who were AA, compared to (5.34%, 95% CI =4.84–5.85) for participants who were White, (4.35 %, 95% CI = 3.60–5.12) for participants who were Black and (3.61%, 95% CI = 2.29–4.94) for participants who were Hispanic.

Table 3 summarizes between-group difference within AA with SUD specifically looking at highest level of education and income. Treatment (formal, informal, or both treatments) rates were suppressed for AA with less than a High School Diploma and AA in the “$50,000–74,999” family income range due to unstable estimates per NSDUH guidelines. Only AA with a family income of $20,000 - $49,999 had utilization rates for informal substance use treatment which could be estimated.

Table 3:

Receipt of Treatment Amongst Subgroups of Asian Americans with SUD/AUD amongst highest education level, and income

Highest Level of Education Less than High School (Unweighted N = --) High School Diploma (Unweighted N = 110) Some College/Associates (Unweighted N = 217) College (Unweighted N = 251)
% 95% CI % 95% CI % 95% CI % 95% CI
Formal Only -- -- 2.08 0.00–4.70 0.68 0.00– 2.04 0.40 0.00–1.23
Informal Only -- -- 0.60 0.00–1.80 0.91 0.00– 2.74 -- --
Both formal and informal -- -- 2.39 0.00–6.05 1.24 0.00– 2.83 1.24 0.00–2.72
 
Income Less than $20,000 (unweighted N = 157) $20,000 - $49,999
(unweighted N = 131)		 $50,000 - $74,999
(unweighted N = --)		 $75,000 or More (unweighted N = 238)
Formal Only 1.53 0.00–3.44 0.96 0.00–2.91 -- -- 0.43 0.00–1.34
Informal Only -- -- 1.70 0.00–4.46 -- -- -- --
Both formal and informal 0.73 0.00–1.17 1.32 0.00–4.10 -- -- 2.02 0.19–3.84
 
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--

Estimate suppressed due to unstable sample size or percentage in accordance with NSDUH guidelines

Table 4 presents the aOR from multivariate logistic regression of formal only, informal only, and combined substance use treatment based on substance use pattern and race/ethnicity, while adjusting for age, highest level of education, insurance, household family income, and the presence of any mental illness. The adjusted odds of receiving formal only substance use treatment in AA with 12-month substance or alcohol use was 0.28 times (p < 0.05, 95% CI = 0.16–0.50 as high as individuals who were White, 0.31 times (p < 0.05, 95% CI = 0.16–0.58) as high for AA as compared with individuals who were Black, and 0.43 (p < 0.05, 95% CI = 0.22–0.83) times as high as Hispanic individuals. This pattern of significant difference continued in individuals with AUD/SUD with the odds of receiving only formal substance use treatment in AA being 0.24 times (p < 0.05, 95% CI 0.08–0.68) as high as compared with White individuals, 0.35 times (p < 0.05, 95% CI = 0.14–0.91) as high than for Black individuals, and 0.28 (p > 0.05, 95% CI = 0.09–0.82) times as high as compared with Hispanic individuals. Differences in informal-only substance use treatment were not statistically significant (Table 4).

Table 4:

multivariate logistical regression analyses: association among race and treatment controlled by gender, age, household family income, education level, and any mental illness

Model 1 (Formal substance use treatment only) Model 2 (informal substance use treatment only) Model 3 (Both formal and informal substance use treatment)
aOR 95% CI aOR 95% CI aOR 95% CI
12-month alcohol or Substance use
Asian (reference group) (Unweighted N = 6,295)
White (Unweighted N = 102,807) 3.55* 1.98–6.37 2.54 0.87–7.41 3.19* 1.36–7.36
Black (Unweighted N = 18,527) 3.27* 1.71–6.27 2.37 0.72–7.85 2.36* 1.03–5.37
Hispanic (Unweighted N = 25,467) 2.32* 1.20–4.50 2.72 0.94–7.87 1.792 0.72–4.48
 
Substance Use Disorder or Alcohol Use Disorder (SUD/AUD)
Asian (reference group) (Unweighted N = 610)
White (Unweighted N = 13,853) 4.16* 1.46–11.84 2.47 0.48–12.75 3.23* 1.19–8.77
Black (Unweighted N = 2,503) 2.85* 1.10–7.39 2.49 0.39–16.15 2.28 0.83–6.32
Hispanic (Unweighted N = 3,537) 3.62* 1.22–10.72 3.47 0.63–18.98 2.15 0.74–6.20
 
Alcohol Use Disorder (AUD)
Asian (reference group) (Unweighted N = 485)
White (Unweighted N = 10,236) 3.70 0.97–14.18 2.139 0.41–11.19 2.062 0.77–5.53
Black (Unweighted N = 1,637) 3.84* 1.03–14.3 2.144 0.377–12.21 1.81 0.69–4.76
Hispanic (Unweighted N = 2,643) 4.78* 1.15–19.82 2.670 0.49–14.68 1.50 0.54–4.21
 
Substance Use Disorder (SUD)
Asian (reference group) (Unweighted N = 199)
White (Unweighted N = 5,333) 6.78* 1.54–29.82 -- -- 7.06* 1.44–34.67
Black (Unweighted N = 1,210) 3.56 0.78–16.18 -- -- 4.16 0.83–20.87
Hispanic (Unweighted N = 1,437) 4.48* 1.11–18.15 -- -- 4.44 0.86–22.94
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*

p < 0.05

--

Estimate suppressed due to unstable sample size or percentage in accordance with NSDUH guidelines

AA with 12-month alcohol/substance use, utilized both formal and informal substance treatments combined significantly less than participants who were White (aOR = 0.32, p < 0.05, 95% CI = 0.14–0.73). AA with AUD/SUD were also significantly less likely to utilize both services compared to individuals who were White (aOR = 0.31, p < 0.05, 95% CI = 0.11–0.84). For both alcohol or substance use and AUD/SUD, differences comparing AA and participants who were Black and Hispanic were not statistically significant.

A sensitivity analysis gives insight into how the specific substance utilized may impact treatment utilization patterns (table 4). While AA with AUD utilized less formal, and combined substance use treatments when compared to participants who were White, Black, and Hispanic. Adjusted odds ratios reached a level of significance based on effect size when comparing AA to participants who were Black (aOR = 0.26, p < 0.05, 95% CI = 0.07–1.0) and Latino (aOR = 0.21, p < 0.05, 95% CI = 0.05–0.87) but no significant difference was found compared with participants who were White. Conversely, the largest discrepancies in adjusted odds ratios were found amongst AA and other races with SUD. AA were 0.15 times as likely (p < 0.05, 95% CI = 0.03–0.65) as White participants and 0.22 times as likely (p < 0.05, 95% CI = 0.06–0.93) as Hispanic participants to utilize only formal treatment. Informal only substance use treatment was not able to be calculated as the regression model was found to be unstable due to the rarity of this treatment outcome causing quasi complete separation (Institute for Digital & Education). Looking at the combined group, AA were 0.15 times as likely (p < 0.05, 95% CI = 0.03–0.79) to utilize the both formal and informal substance use treatment compared to participants who were White.

4.1. Discussion:

Our study found that AA with past 12-month alcohol or substance use, or AUD/SUD utilize only formal substance use treatment at lower levels than all other racial/ethnic groups. This is consistent with previous findings that AA have lower substance use treatment utilization of all racial and ethnic groups (SAMHSA, 2021). Possible explanations for the lack of formal substance use treatment are due to cultural and language barriers (Clough et al., 2013; Yu et al., 2009). Another factor is the “model minority myth” (Pew Research, 2023) which has led to providers identifying AUD in AA at lower levels (Cheng et al., 2018) and decreased treatment utilization within the AA community (Chow, 2002). Barriers may not only be external factors, as one study amongst individuals in need of formal substance use treatment who did not receive it, AA were less likely than any other racial group to even recognize their need for treatment (Lipari & Hager, 2013). Stigma is another barrier for AA seeking substance use treatment and a major factor preventing help seeking behavior (Choi et al., 2024; Fong & Tsuang, 2007; Wu & Blazer, 2015) and this combined with lesser awareness of issues could impact engagement with formal treatments.

Once controlling for family income, insurance, gender, highest education level, and any mental illness, we found AA with AUD/SUD used informal substance use rates lower than all other racial or ethnic groups, but even including participants who were White, this difference was not significant. The lack of statistical significance may be due to the overall small informal treatment utilization across all racial/ethnic groups in addition to the smaller sample of AAs within the survey. Regardless, this finding is consistent with previous findings on informal preference for substance use issues amongst AA (Fang et al., 2011; Goebert & Nishimura, 2011; Substance & Mental Health Services, 2020) but our study expands this finding to those with AA with SUD specifically. AA specifically, given their unique background and heritage, are likely to engage with a network that shares the same cultural values and support system (Weng, 2016). AA youth with substance issues prefer to utilize personal and informal resources rather than professional help and may even see formal treatment as a last resort (Lee et al., 2002). Due to fear of shame, AA family members discourage disclosure of substance issues to those outside of the family (Masson et al., 2013) and this may explain the significant findings in AA with SUD alone. A cultural preference for familiarity combined with the limited recognition of substance use severity may explain the similar informal substance use engagement amongst AA.

Increasing capacity in the informal setting has been suggested as a promising culturally tailored solution to substance use disparity (Choi et al., 2024). Informal family interventions in the AA community have been successful in decreasing substance and alcohol use (Fang & Schinke, 2013). Many similar barriers to substance help seeking are found in Asia, and utilization of community health workers to provide substance use treatment through task shifting has been successful at improving substance use outcomes (Baloloy et al., 2023; Li et al., 2014; Rashid et al., 2014). This task shifting strategy has been proposed as a method to engage the AA in the US population as well (Choi et al., 2024; Kormendi & Brown, 2021). Overall, the findings of this study strengthen the evidence that AA with substance use issues seek informal services and this is a missed opportunity for service delivery as well as a promising way to engage a difficult to reach population.

Overall, even after combining formal and informal substance use, AA with alcohol and substance use or AUD/SUD were still significantly less likely to utilize substance use treatment compared to individuals who were White. This expands on previous findings that AA with SUD utilize formal substance use treatment at lower levels than other races (Gunten & Wu, 2021; Lipari & Hager, 2013; Sahker et al., 2024), despite recent increasing substance treatment admissions (Sahker et al., 2024). Informal services may present a way to improve access to services for AA with SUD but alone will not make up for the limited engagement of services. As previously discussed, strategies that incorporate family into substance use counseling is important (Naegle et al., 2002). Additionally, aligning with the goals and interests of AA who use substances, such as improved social adjustment and interaction with significant others can be an effective strategy for delivering treatment (Chin et al., 1991). These interventions may focus on AA entering substance use treatment as AA and Pacific Islanders in general have high satisfaction with substance use treatment once engaged in treatment (Han et al., 2016).

Lastly, despite being small in sample size and descriptive in nature, AA substance use treatment engagement does not seem to vary by education levels. This contrasts with previous findings that lower education levels were associated with increased substance use treatment utilization (Wu et al., 2003). This is finding is commonly explained by the association of increased substance use in populations with lower academic achievement (Martin et al., 2015; Thompson et al., 2015), however, this may not be true for AA. AA with limited English proficiency have been found to utilize medical and mental health treatment at much lower rates than those proficient in English (Jang & Kim, 2019; Kuerban & Seo, 2024). These findings taken together may suggest that AA at lower education levels may have more difficulty navigating the healthcare field due to language compared to their counterparts who are White.

There are several key limitations in this study. This data is only limited to 4 years (2015–2019) and data was collected before the COVID-19 pandemic. It may not fully reflect the increased substance use rates of AA during the pandemic (Yan et al., 2023). The cross-sectional data due not make it possible to draw causal conclusions. The sample size of AA, while not small, were noticeably less than other racial/ethnic groups, and individuals with substance use or SUD within the AA sample were even smaller. These small samples may impact the logistical regression model when looking at formal and informal treatment outcomes. Lastly, due to small sample sizes, AA and Native Hawaiians and Other Pacific Islanders are often pooled into a single category or even “other” (Wu & Blazer, 2015). AA are a large heterogeneous group and disaggregated data finds discrepancies in use amongst the different ethnicities of AA (Bersamira et al., 2017). While this study only looked at AA, we had to utilize research findings in the AA and Pacific Islanders community to explain the results and this other community may be impacting these groups studies. Even more so, the AA community is extremely heterogeneous and grouping these races into a single race and ethnicity group has limitations. For example, Filipino Americans compared to other AA were less likely to refer themselves to treatment, less likely to know where to get services, and more likely to report that family and friends were against substance use treatment (Masson et al., 2013).We could also not account for treatment due to criminal justice involvement. Other factors such as nativity and language spoken at home were not included in the NSDUH strategy and this limits the ability to understand further cultural and linguistic needs amongst AA. More research into dis-aggregated data within the AA community is needed to further characterize and address unique barriers to substance use treatment.

5.1. Conclusion:

Despite these limitations, our study has several implications. First, greater use of informal substance treatment does not make up for lack of engagement with formal substance use treatment. More research and resources are needed to address the systemic issues of language and cultural barriers, discrimination, stigma, and psychoeducation to address disparities in treatment amongst AA communities. Second, AA engagement with informal substance use treatment presents unique opportunities for engaging these populations in substance use treatment. However, it may also speak to the importance of providing treatment that aligns with cultural values and topics that AA and using those elements to motivate engagement with formal treatments in this population.

Table 2:

Receipt of treatment amongst those who use drugs or alcohol use or SUD/AUD amongst race

Asian (Unweighted N = 6,295) White (Unweighted N = 102,807) Black (Unweighted N = 18,527) Hispanic (Unweighted N = 25,467)
Substance or EtOH use in past 12 months % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Formal Only 0.12 0.05–0.19 0.58 0.52–0.65 0.77 0.54–0.99 0.52 0.37– 0.67
Informal Only 0.06 0.00–0.13 0.19 0.16–0.22 0.22 0.12–0.32 0.27 0.17– 0.37
Self-help groups only 0.05 0.00–0.12 0.17 0.14–0.21 0.20 0.11–0.30 0.22 0.13– 0.31
Other informal treatment only 0.01 0.00–0.02 0.02 0.01–0.04 0.02 0.00–0.04 0.05 0.00– 0.11
Combined Formal and Informal 0.17 0.04–0.31 0.74 0.66–0.81 0.69 0.58–0.80 0.51 0.33– 0.69
  Asian (Unweighted N = 610) White (Unweighted N = 13,853) Black (Unweighted N = 2,503) Hispanic (Unweighted N = 3,537)
SUD or AUD in past 12 months % 95% CI % 95% CI % 95% CI % 95% CI
Formal Only 0.71 0.00–1.43 3.36 2.94–3.79 3.00 2.08–3.91 3.14 2.13– 4.15
Informal Only 0.37 0.00–0.95 1.01 0.74–1.28 1.24 0.60–1.88 1.66 0.90– 2.43
Self-help groups only 0.28 0.00–0.83 0.91 0.63–1.19 1.07 0.46–1.69 1.28 0.70– 1.85
Other informal treatment only 0.09 0.00–0.27 0.10 0.01
0.19		 0.16 0.01
0.32		 0.39 0.00– 0.94
Combined Formal and Informal 1.35 0.06–2.64 5.34 4.84–5.85 4.35 3.60–5.11 3.61 2.29– 4.94
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Highlights.

  • Asian Americans (AA) with alcohol use, substance use, AUD, or SUD utilize less formal substance use treatment than individuals who are White, Black, and Latino

  • AA with SUD utilize informal substance use treatment similar to individuals who are White, Black, and Latino

  • Compared to individuals who are White, AA with AUD/SUD utilized less combined (informal and formal) services.

6.1. Acknowledgements:

The authors have no acknowledgements

Footnotes

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