Racial-Ethnic Differences in Lack of Treatment Among Care-Seeking People With Substance Use Disorders

Introduction

Substance misuse is a significant public health concern in the United States, yet most affected individuals, particularly within certain ethnoracial groups, face barriers in receiving treatment (1). This study investigates the reasons behind the lack of substance use treatment receipt among individuals who perceived a need for treatment by different ethnoraical groups. The findings are intended to highlight potential disparities in perceived access and value of treatment, identifying critical areas for intervention and policy development to address barriers to care.

Methods and Data Set

We utilized data from the 2022 National Survey on Drug Use and Health, a nationally representative survey of the non-institutionalized population (aged 12+). 7% (N_weighted= 7162802/N_unweighted=3807) of respondents received treatment past-year; 93% (N_weighted= 262411269, N_unweighted=54751) of respondents did not receive treatment past-year because they did not seek or perceive the need for treatment; 1% (N_weighted= 2433371/N_unweighted =511) of respondents did not receive treatment past-year even though they sought or perceived the need for treatment. We focused on the 511 respondents who experienced unmet treatment need past-year and assessed 18 items on reasons for not receiving treatment by race and ethnicity.

Results

The results are summarized in Table 1. The two most common reasons were: “You thought you should have been able to handle your alcohol or drug use on your own” and “You were not ready to start treatment”. Substantial differences exist in some of the reported reasons for not receiving treatment across ethnoracial groups (e.g., 76.6% of Hispanic not knowing how to get treatment vs. 38.5% of Non-Hispanic white) suggesting differential experiences and barriers for treatment utilization among diverse ethnoracial groups. Remarkably higher rates of Black individuals endorsed “thought you should have been able to handle your alcohol or drug use on your own” and “not ready to start treatment” compared to other groups. In addition, “could not find a treatment group or health care professional you wanted to go to” and “did not know how or where to get treatment” were endorsed by Hispanic at a considerably higher rate than any other groups.

Table 1.

Reasons for not receiving substance use disorder (SUD) treatment among individuals who perceived a need by race and ethnicity⁺ (N=511, weighted %, 2022)

There may be many reasons you did not get treatments during the past 12 months. For each statement, please mark whether or not it was one of the reasons why you did not get professional counseling, medication, or other treatment for your alcohol or drug use.	Total	Non-Hispanic white	Non-Hispanic Black	Hispanic a	Others b
You thought you should have been able to handle your alcohol or drug use on your own.	77.8%	79.2%*	91.1%*	70.6%	68.4%
You were not ready to start treatment.	57.8%	60.6%*	66.2%*	56.3%	29.3%
You did not know how or where to get treatment.	50.5%	38.5%	58.2%*	76.6%*	44.0%
You thought it would cost too much.	50.1%	51.1%*	49.9%	49.6%	44.7%
You were not ready to stop or cut back using alcohol or drugs.	48.6%	53.8%*	34.5%	52.4%*	24.5%
You were worried about what people would think or say if you got treatment.	44.8%	54.9%*	26.3%	40.3%	17.3%
You did not have health insurance coverage for alcohol or drug use treatment.	43.5%	42.7%	47.9%*	49.0%*	25.2%
You didn’t have enough time for treatment.	43.4%	40.7%	49.8%*	48.6%*	36.0%
You thought that if people knew you were in treatment bad things would happen, like losing your job, home, or children.	39.9%	37.7%	44.0%*	49.5%*	20.6%
Your health insurance would not pay enough of the costs for treatment.	37.8%	33.8%	49.0%*	43.8%*	25.2%
You could not find a treatment program or health care professional you wanted to go to.	37.0%	28.1%	41.6%*	53.8%*	41.0%*
You were worried that your information would not be kept private.	36.3%	39.6%*	29.9%	34.5%	29.0%
You didn’t think treatment would help you.	28.8%	26.7%	34.3%*	25.6%	43.5%*
You thought you would be forced to stay in rehab or treatment against your will.	26.7%	23.5%	38.5%*	29.3%*	22.2%
You had problems with things like transportation, childcare, or getting appointments at times that worked for you.	24.8%	21.8%	34.3%*	28.4%*	19.9%
You thought no one would care if you got better.	19.9%	19.6%	7.3%	30.5%*	10.5%
You thought your family, friends, or religious group wouldn’t like it if you got treatment.	19.0%	19.6%*	15.0%	21.0%*	14.8%
There were no openings in the treatment program or with the health care professional you wanted to go to.	13.5%	12.4%	16.5%*	16.3%*	7.4%

⁺Race/ethnicity was used to refer to the respondent’s self-classification of racial and ethnic origin and identification, in accordance with federal standards for reporting race and ethnicity data developed by the U.S. Census Bureau. For Hispanic origin, respondents were asked, “Are you of Hispanic, Latino, or Spanish origin or descent?” For race, respondents were asked, “Which of these groups describes you?” Response options for race were (1) American Indian or Alaska Native, (2) Asian, (3) Black or African American, (4) Native Hawaiian or Other Pacific Islander, and (5) White. American Indian or Alaska Native includes North American, Central American, or South American Indians. Asian includes Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or Other Asian. Native Hawaiian or Other Pacific Islander includes Native Hawaiian, Guamanian, Chamorro, Samoan, or Other Pacific Islander. Respondents were allowed to choose more than one of these groups. For full description about how NSDUH collects information on race and ethnicity, please see Appendix A in the 2022 National Survey on Drug Use and Health (NSDUH): Methodological Summary and Definitions report (2).

^a.Regardless of race

^b.Included Non-Hispanic Native American and Alaska Native, Non-Hispanic Native Hawaiian and other Pacific Islander, Non-Hispanic Asian, and Non-Hispanic more than one race individuals.

^*Indicates higher than average endorsement (i.e., values noted in Total column of the table) for particular ethnoracial group.

Implications

These results point to the potential benefits of de-stigmatizing treatment and communicating the efficacy of treatment, and that these may be particularly valuable for individuals who identify as Black. Also, our results support the need for inclusive, culturally appropriate approaches to treatment as well as educational efforts tailored to the unique perceptions of affected ethnoracial groups.