Use of Complementary and Alternative Medicines for Mental and Substance Use Disorders: Comparing African Americans, Caribbean Blacks, and Non-Hispanic Whites

Background and Purpose: Complementary and alternative medicine (CAM) has been used in the United States for decades. Recently interest has grown in understanding who uses CAM, in what circumstances, and the relationship between alternative and conventional therapies. CAM use is important for social workers because it is a critical but under examined aspect of the mental health delivery system. Only a handful of studies on CAM have focused on CAM use among those with a mental disorder and even fewer have examined racial and ethnic differences in CAM use among this vulnerable group. The objective of this study is to examine the prevalence of CAM use among adults who meet diagnostic criteria for a mood, anxiety, or substance disorder and the racial/ethnic differences in CAM use among this group. This study expands understanding of help-seeking among vulnerable populations who are a significant proportion of social work caseloads and often underutilize conventional mental health and substance use services. Methods: This study uses data from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R) both of which include household residents aged 18 or older in the coterminous United States. The analytic sample for this study includes African Americans and Caribbean Blacks from the NSAL and non-Hispanic Whites from the NCS-R who met DSM-IV criteria for a mood, anxiety, or substance use disorder in the past 12 months (n=2,269). Respondents identified alternative therapies they had used in the past 12 months for problems with emotions or nerves or use of alcohol or drugs. Logistic regression was used to test the association between race/ethnicity and use of any CAM as well as CAM use with and without conventional professional services. Results: Thirty-five percent of adults with a 12-month mood, anxiety, or substance use disorder reported using CAM in the 12 months before the interview and over half of those who used CAM also used conventional services. Although a higher proportion of Whites reported using CAM overall, more African Americans and Caribbean Blacks used “prayer and other spiritual practices” or “spiritual healing by others” than Whites. In multivariate analyses, Whites were more likely to report any CAM use and were more likely to use CAM without conventional services compared to African Americans. No differences were observed between Caribbean Blacks and African Americans and race/ethnicity was not associated with CAM use with conventional services. Conclusions and Implications: Prevalence of CAM use for a mental or substance use disorder is consistent with previous estimates of CAM use for health problems more broadly. This suggests that CAM use is important for social workers to understand because it is an significant aspect of the mental health system. Despite overall disparities in mental health service use, African Americans and Caribbean Blacks do not rely on CAM as a substitute for more conventional services. Given the potential for interactions between treatments understanding CAM use is important. Social workers are uniquely positioned to gather this information and coordinate conventional and alternative sources of care for these at-risk populations.