Racial-ethnic disparities in substance abuse treatment: the role of criminal history and socioeconomic status.
OBJECTIVE
Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities.


METHODS
Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005-2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt.


RESULTS
Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differences decreased and became significantly less than 1 after adjustment for criminal history and socioeconomic status factors. Higher rates of criminal history and enrollment in Medicaid among blacks and Latinos and lower income were specific mechanisms that influenced changes in estimates of disparities across models.


CONCLUSIONS
The greater likelihood of treatment receipt among persons with a criminal history and lower socioeconomic status is a pattern unlike those seen in most other areas of medical treatment and important to the understanding of substance abuse treatment disparities. Treatment programs that are mandated by the criminal justice system may provide access to individuals resistant to care, which raises concerns about perceived coercion.
Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, MA 02143, USA. bcook@charesearch.org
Benjamin Lê
BL
Cook
Margarita
M
Alegría
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D003415:Crime / Q000208:ethnology / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D037141:Mandatory Programs; D008484:Medicaid; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D012923:Social Class; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000534:rehabilitation; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult