The Evidence Base

Informing Policy in Health, Economics & Well-Being
A collaboration with
USC Dornsife Center for economic and social research

Racial Disparities in Accessing Treatment for Substance Use Highlights Work to Be Done

Earlier this month, the Biden Administration released its National Drug Control Strategy, which included a call for addressing untreated addiction. To succeed in this, we need to do more to address the unmet need for culturally, racially and ethnically appropriate care for individuals seeking substance use treatment.

Key Points:

  • Lack of cultural competency in the healthcare work force is an issue that has been documented in the literature.
  • This issue extends to substance use and mental health treatment.
  • Older Americans are increasingly seeking treatment for substance use disorders.
  • Black Americans are less likely to finish substance use disorder treatment and are more likely to be asked to leave before treatment is complete compared to their white counterparts.

In Context: It is estimated that in 2020, over 41 million Americans had a substance use disorder (SUD). Yet only 2.7 million received treatment. According to SAMHSA, of individuals who need treatment for illicit substance use disorders, whites receive treatment 23.5% of the time, while Black and Hispanic individuals receive treatment 18.6% of 17.6% of the time, respectively.[1] While one may expect that this divide would dissipate when looking at older populations, our research suggests this may not be the case. Access to adequate and culturally appropriate substance use treatment is imperative to meet the health needs of all patients.

A critical component of the issue is adequate health insurance. While there have been significant efforts to expand access to mental healthcare, many individuals still do not have adequate coverage. Medicaid is the largest payer of mental health services in the United States, and yet 12 states have not adopted the ACA’s Medicaid expansion. Seven of the 12 states are in the southeast, where a majority of the U.S. Black population resides.  The Black population in these states ranges from 15% (FL) to 37% (MS), compared to the U.S. population of 12.4%.

Our prior research and other researchers have shown that states that expanded Medicaid were associated with significant increases in substance use treatment admissions relative to states that did not expand Medicaid.

Our current research highlights two important aspects in the trends of substance use disorder treatment that are often overlooked:

  • Older Americans are increasingly seeking treatment for substance use disorders and
  • Older Black Americans who start treatment are much more likely to have their treatment terminated and not finish the treatment compared to white adults.

While most admissions for SUD treatment are for individuals who are under 50 years old, a significant and growing share of patients are over 50. We analyzed data from 2006 through 2017 and find that throughout that time, Black and Hispanic older patients were significantly less likely to successfully complete the course of treatment.

Given data limitations we cannot conclusively identify the root of this disparity— we are confident it is multifaceted—but asking patients to leave does not fix the root health reason that they were there.

Ensuring that care is culturally, racially and ethnically appropriate is a critical component of this problem. There is a significant body of literature about how cultural competency of a healthcare provider affects the relationship and outcomes of a patient. This includes making sure the sociodemographic characteristics of providers match the patients they are serving.  For patients seeking out care for mental health and substance use issues, this may be especially important.

Building a culturally competent healthcare workforce will also help with issues of implicit bias, which can affect the care that individuals receive. We don’t know if that is why we saw this disparity in older Black Americans being asked to leave treatment facilities at higher rates than whites, but it may be part of the story.

Part of the reason that this is so important is the U.S.’s recent past. Black older adults who are entering treatment facilities in their 50s are still struggling with the effects of the crack cocaine epidemic, which had devastating effects on families and communities of color throughout the U.S. Providers need to understand the role and importance of this history in their patients’ lives. 

Learn More:

[1] Center for Behavioral Health Statistics and Quality. (2021). Racial/ethnic differences in substance use, substance use disorders, and substance use treatment utilization among people aged 12 or older (2015-2019) (Publication No. PEP21-07-01-001). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://