Differences in Service Utilization and Barriers Among African Americans, Hispanics, and Whites with Drug Use Disorders

Background and Purpose: Drug use disorders are among the most common and debilitating mental disorders. They are associated with poor physical health, accidental injury, homelessness, unemployment, and criminal activity. Treatment for these disorders can be effective, but only a small proportion of people with these disorders seeks or receives treatment. Prior research has shown that, while African Americans and Hispanics have similar rates of disorders compared to Whites, they are less likely to use treatment services. Understanding patterns of service utilization and barriers to treatment is important for social workers in order to improve access and utilization for these at risk groups. The purpose of this study is to critically examine racial/ethnic patterns of utilization and treatment barriers for drug use disorders using nationally representative data.

Methods: Data for this study are from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093). Survey respondents were asked whether they had ever gone to see someone for a reason related to the use of illicit drugs. Participants who endorsed this question were asked about the various services they received. Participants were also asked whether there was ever a time when they felt the need to see a doctor, counselor or health professional for drug use and did not go. Participants who endorsed this question were asked about the different reasons for not getting help. African Americans, Hispanics, and non-Hispanic Whites who met DSM-IV lifetime criteria for a drug use disorder (abuse or dependence) were included in this study.

Results: Approximately 16.3% of persons with a lifetime DSM-IV drug use disorder reported using some type of treatment service. The most commonly used services were self-help, rehabilitation, and professional health services. Personal beliefs about drug problems were the most commonly mentioned barriers. This included feeling embarrassed to discuss the problem and believing the problem would get better on its own. Multivariate logistic regression showed that Hispanics and Whites were almost six times more likely to use professional services compared to African Americans. No additional associations between race/ethnicity and types of service utilization or treatment barriers were observed after controlling for sociodemographic factors.

Conclusions and Implications: With the exception of use of professional health services for the treatment of drug use disorders, few racial/ethnic differences were observed after controlling for other sociodemographic factors. However, this difference represents a potentially significant treatment disparity, since professional health service providers such as social workers are key frontline providers in the delivery of empirically supported treatments. The lack of racial/ethnic differences in barriers to treatment suggests that other barriers not assessed may be particularly influential. For example, professional health services may not be culturally compatible and, therefore, under-utilized by the African American population. Pathways to care may also explain differential patterns of use of professional services. Future research is needed to understand how African Americans can be more effectively connected to professional health service providers, and the extent to which other sociodemographic factors and comorbid conditions influence patterns of access and utilization.