Use of Concurrent Mental Health and Substance Use Treatment Among Individuals with Co-Occurring Mental Illness and Substance Use Disorders Differs By Race/Ethnicity

Background and Purpose: Racial/ethnic minority groups are widely documented in the literature to experience difficulties in accessing health care. However, little is known about racial/ethnic differences in use of mental health and substance use treatment among individuals with co-occurring mental illness and substance use disorders (CODs). While racial/ethnic disparities in the use of mental health treatment are consistently reported, research exploring disparities in the use of substance abuse treatment has shown mixed findings. 

Given that best practice for individuals with CODs is to provide both mental health treatment and substance use treatment, the purpose of this study was to examine whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals with CODs, particularly in regards to the use of concurrent mental health and substance use treatment. 

Methods: Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8,748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Guided by the Andersen’s behavioral model of health service use, multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of concurrent treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. In addition, to examine racial/ethnic differences in service use (i.e., the moderating effect of race), interaction terms between race/ethnicity and significant factors of service use were also examined.

Results: Results indicated that Black (OR=.53, 95% CI=.36-.79) and Latino respondents (OR=.41, 95% CI=.25-.66) were less likely to receive concurrent mental health and substance abuse treatment than White respondents. This racial difference was also observed in the use of mental health treatment but not in the use of substance abuse treatment.

Further analyses found moderating effects among race/ethnicity and predisposing, need and enabling factors on each type of treatment utilization. Specifically, the effect of being female on the concurrent use of mental health and substance abuse treatment was smaller among Blacks than their White counterparts (OR=0.36, 95% CI=0.14-0.91, p<0.05). The effect of substance dependence on the use of mental health treatment alone was smaller among Blacks than their White counterparts (OR=0.53, 95% CI=0.32-0.88, p<0.05), and the effect of insurance on the use of mental health treatment alone was greater among Latinos than their White counterparts (OR=1.66, 95% CI=1.07-2.57, p<0.05).  

Conclusions and Implications: The findings suggest that an underlying mechanism of racial/ethnic differences in treatment utilization among individuals with co-occurring mental illness and substance use disorders differ by the specific types of treatment and between adults who are Black, Latino or White. Therefore, efforts to reduce these disparities should consider specialty within treatment setting and heterogeneity within racial/ethnic groups.