Intersection of Minority Health, Health Disparities, and Social Determinants of Health With Psychopharmacology and Substance Use

Although the United States (U.S.) is an increasingly multicultural society (Vespa et al., 2018), the incorporation of psychopharmacology and basic behavioral addiction science into research on minority health and health disparities is underleveraged. Similarly, psychopharmacology and substance use research has often overlooked the societal context in which drugs are consumed. The relative schism of psychopharmacology and basic behavioral addiction science with research on minority health and health disparities is an area of opportunity for improving public health in an ever more diverse society (Muennig et al., 2018). In efforts to stimulate research on these topics, this special issue focuses on research addressing the intersection of minority health, health disparities, and social determinants of health (MHDS) with psychopharmacology and substance use.

The articles in the special issue are transdisciplinary in nature, encompassing topics that range in focus from how sociocultural variables at the individual and societal level influence risk for substance use, to statistical and methodological issues in execution on minority health and health disparities research, to etiology focused studies and clinical applications. The special issue begins with Ozga et al. (2021) who contextualize tobacco use health disparities in rural communities via a cumulative disadvantage framework. By reviewing the development of tobacco use disparities among rural communities with the consideration of systemic and pharmacological factors that contribute to the disparities, the authors identify potential points of macrolevel interventions, as well as articulate how health outcomes can be shaped by societal forces. This is followed by Phillips et al. (2021) who delineate the various factors that impact the development of tobacco use among Asian and Pacific Islander (API) youth using the National Institute on Minority Health and Health Disparities (NIMIID) multidimensional research framework, which serves as a tool to “unpack” distinct levels of analysis in the development of health disparities from cell to society. Reviewing psychometric critiques of cross-cultural research, Lopez-Vergara et al. (2021) emphasize the need to statistically test for the cultural equivalence of measurement (within a falsifiable psychometric framework) when making inferences across cultural groups in addiction and clinical science.

These reviews are followed by five novel studies examining sociocultural, MHDS, and psychopharmacological factors that influence substance use risk across racial, ethnic, and sexual minority populations. First, in an empirical search for mechanisms of health disparities, Bacio (2021) uses structural equation modeling to investigate drinking motives as pathways to problematic drinking among Latinx college students. Bacio (2021 ) provides evidence that sociocultural variables may influence drinking among Latinx students via motivational pathways (drinking to cope), demonstrating how sociocultural variables can influence individual-level processes. This is followed by Clifton et al. (2021), who compared differences in racial identity among Black young adults based on both explicit and implicit measurement strategies. By leveraging basic behavioral science principles, the authors provide an indirect way of assessing aspects of racially based self-concept that may be difficult to measure directly due to social desirability, as well as how such assessments relate to substance use outcomes among Black young adults. Next, demonstrating how intersectionality of identities can overlap with distinct risk and protective factors, Albuja et al. (2021) disaggregate correlates of increased alcohol involvement among Monoracial and Multiracial Native American/American Indian college students.

Finally, in this section, we have two studies that utilize novel study designs to examine sociocultural factors, psychopharmacology, and substance use among minority populations. In an empirical study at the within-person level of analysis, Lewis et al. (2021) use a daily diary study to investigate the proximal effects of sexual minority stress on alcohol involvement among sexual minority women, providing insights into how experiences of marginalization can unfold in day-to-day drinking experiences and may intersect with negative reinforcement mechanisms underlying substance use. Leveraging experimentally induced nicotine withdrawal, Liautaud et al. (2021) show that symptoms of anhedonia may be a phenotypic feature of acute withdrawal among African—American smokers (which provides hypotheses for phenotypically personalized treatments) in a population subject to tobacco-related health disparities.

The special issue concludes with articles addressing interventions. Nalven et al. (2021) provide a systematic review of diversity inclusion in opioid pharmacological treatment trials, finding evidence that minoritized populations are frequently underrepresented in treatment trials; whereas Fogg et al. (2021) document that minoritized individuals are typically omitted from samples in the reemerging field of Psychedelic-Assisted Psychotherapies. Finally, in a remote adaptation to a contingency management intervention for problematic drinking, Koffarnus et al. (2021) show that a contingency management intervention for alcohol use disorder (with a participant-funded incentive) is effective but is less accessible to participants with lower income and greater alcohol use.

Overall, these articles provide a window into the breadth of issues at the intersection of MHDS with psychopharmacology and substance use. Integrating the fields of psychopharmacology and basic behavioral addictions science with research on MHDS is not only of public health importance, but can help further elucidate our understanding of human behavior in all of its complexity. As demonstrated here, a better understanding of the synergy between societal context(s) and individual-level processes can lead to interventions tailored to specific risk and resilience factors; interventions that are personalized and contextualized have the potential to improve the health of our society. We are very grateful to the authors for their contributions to this special issue. We hope that professionals from various disciplines who read this special issue become inspired to bridge psychopharmacological and social determinants perspectives in their own work, and, in turn, accelerate scientific progress within each field.