Are Communities with High African-American Census Receiving Best Practices in Substance Use Disorder Services?

Background: Untreated substance use disorders (SUD) continue to be a major health issue in the US. Tens of thousands of Americans die prematurely each year and the financial cost to our economy extends beyond $200 billion annually.  In 2007, approximately 20 million Americans needed SUD treatment and the amount of people seeking treatment could double as a result of the Affordable Care Act.  Yet, most people who seek professional services are not provided with empirically supported treatments (ESTs).  While the chasm between research and practice has been connected with various factors and a combination of individual, organizational, and system-level conditions in general services, this project primarily focuses on whether this gap is more predominate in African-American (AA) communities. 

Methods: In order to understand utilization of ESTs in SUD treatment, we used the National Survey of Substance Abuse Treatment Services 2008 to 2010 data, which collects information on SUD treatment providers in the U.S.  A subset of 40,058 SUD treatment organizations which offered ESTs was included in the study. The frequency of utilizing EST practices were recorded using a scale from 1 (Never) to 4 (Always or Often), which included various practices/treatments.  The score for all EST items was summed to create a total EST score for each treatment organization that could range from 11(lowest) to 44 (highest). The percentage of AAs in a particular county was derived from census data and dichotomized with a cutoff at 50% to reflect demographic variation of counties.  Counties with ≥50% AAs will be referred to as AA+ counties while those with <50% AAs will be labelled AA- counties.

Results: Bivariate and multivariate models were employed. After controlling for demographics, quality standards, and organizational factors, we found that SUD treatment agencies that received government funding were not only more likely to administer ESTs but would also utilize them more comprehensively.  However, in AA+ counties, we found several significant differences compared to AA- counties.  First, a larger percentage of government funded SUD treatment agencies were in AA+ areas.  Further, EST practices were not as fully utilized among agencies located in AA+ counties.

Conclusion: ESTs are used in practice due to a considerable amount of scientific evidence indicating that client outcomes are improved when using ESTs. Failure to provide or receive empirical-based SUD treatment has negative implications both for the individual and the community, including financial difficulties, poor health, increased rates of HIV, and increased burden on loved ones.  Instead of fully embracing SUD treatments supported by evidence to produce the best health and wellness outcomes, AA+ communities do not have comprehensive access to the best treatments.  Furthermore, scientifically verified services have a higher level of legitimacy with the public as well as with funders.  Given the benefits of using ESTs, research exploring the impact of organizational characteristics and client populations on the use of ESTs remains crucial, especially in marginalized, underserved communities.