Substance Use Treatment Needs Among Adults in Detroit

Background: Medicaid expansion efforts have resulted in positive changes in healthcare utilization for physical health needs; unfortunately evidence suggests treatment for behavioral health needs have not seen similar improvements.¹ Detroit’s community behavioral health service system is often challenging to navigate and many people find accessing treatment to be difficult. Aside from this challenge, Detroit’s Black and Indigenous People of Color (BIPOC) population often face systemic oppression across multiple structures. Previous research has identified the importance of social support in marginalized communities. The purpose of this study is to analyze substance use treatment needs among Detroit residents and examine the relationship to mental health treatment needs, social support, and demographic variables. Identifying variables associated with behavioral health needs in marginalized communities may help improve services to these areas.

Methods: Secondary analysis of the Detroit Metro Area Community Study (DMACS) was conducted to examine substance use treatment needs among adults residing in Detroit. DMACS is a longitudinal study that includes a representative sample of Detroit residents. Surveys were completed via face-to-face, online, and phone interviews. The current analysis used the third wave of data collection because it included measures of self-identified substance use and mental health needs. The sample (N = 973) included adults between 18 to 98 years old (Mean= 47 years; SD = 17.3) and was predominantly Black (73%) and female (63%). Descriptive statistics were calculated and binary logistic regression was used to examine association with mental health treatment need, social support, and demographics (age, race, gender, education).

Results: About 7.2% of adults self-identified a substance use treatment need and a larger proportion (23.5%) identified a need for mental health treatment. Results of the logistic regression indicate female gender (OR = .396, p = .016), older age (OR=.971, p=.010), and higher levels of social support (OR = .917, p = .037) were associated with lower odds of having a substance use treatment need. Individuals who reported a mental health treatment need had greater odds of having a substance use treatment need (OR = 17.24, p < .001). Race and education were not significantly associated with having a substance use treatment need.

Conclusion & Implications: Findings suggest Detroit residents who are younger, male, and have lower social support levels may be more vulnerable to substance use-related problems. Consistent with previous research reporting co-occurring substance use disorders and mental health disorders are common, mental health needs were significantly associated with having a substance use need. These findings highlight the need for understanding and addressing substance use treatment needs in Detroit and other marginalized communities. Future research on social support would benefit community organizations and healthcare policy advocacy groups who regularly work with this target population.

1.Patel, M. R., Tipirneni, Kieffer, E. C., Kullgren, J. T., Ayanian, J. Z., Change, T., Solway, E., Beathard, E., Kirch, M., Lee, S., Clark, S., Skillicorn, J., Rowe, Z., & Gool, S.D. Examination of changes in health status among Michigan Medicaid expansion enrollees from 2016 to 2017. (2020). Journal of American Medical Association Network Open, 3(7), e208776.