Substance use and health disparities

Substance use—specifically drugs, alcohol, and tobacco—continues to be a major trend in the United States.

According to a 2023 survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), around 167 million people at or over the age of 12 reported having used tobacco products, alcohol, or illicit drugs and/or vaped nicotine in the past year. Of those who said they used alcohol recently, around 45% considered it binge drinking.

SAMHSA also found that marijuana was the most commonly used illicit drug—even though it’s legalized in some states, it’s still prohibited federally—with 36% of young adults, 21% of adults, and 11% of adolescents taking it in some form.

That said, opioid and other illicit drug use is also significant—the survey found that around nine million people misused heroin or prescription pain relievers in the past year, and 828,000 misused fentanyl, a potent synthetic opioid.

While any amount of individuals misusing drugs or alcohol is concerning, what’s often overlooked is the disparities in who is impacted by substance use and can access the proper treatments for it. When you dive into these health inequities, it becomes clear that providers, employers, and individuals alike must step up to meet the needs of everyone.

Below, we’ll explain what these disparities are in the context of substance use and why they might exist.

What are health disparities? 

Before we dive in, here’s a quick reminder about what we mean when we talk about health disparities.

Health equity refers to every patient, no matter their background, race, ethnicity, gender, or other similar factors, getting a fair shot at personalized, high-quality care. Health disparities, under this umbrella, are preventable gaps in care—or, to put it another way, ways in which some patients are treated poorly, given access to fewer resources and support, and experience unjust outcomes—all of which could be solved with the right investments and structural changes. When left unaddressed, these differences can result in certain populations suffering more physically and/or mentally than others andexperiencing higher rates of illness or even death.

Some of the most commonly cited health disparities in the U.S. are socioeconomic—such as those with a lower income having more difficulty receiving diagnoses or treatment—and geographic, in that some states or regions have better access or more support available to residents than other states or regions. These types of health disparities are easy to spot because we all know how expensive healthcare can be—so, naturally, if you’re not as well off, or your community is not as well off, you’re going to have a harder time generally receiving the right care.

But disparities also exist, sometimes starkly, between racial and ethnic groups, age groups, and individuals of different sexual orientations, socioeconomic and geographical factors excluded. This is the case for substance use disorders and substance use treatment options.

Substance use disparities

Almost 50 million people aged 12 or older, or around 17% of the population, reported a substance use disorder in 2023, SAMHSA found. Out of that amount, one in five people labeled it a severe disorder.

Tobacco and nicotine use, SAMHSA reported, was highest among American Indian or Alaska Native (AIAN) individuals at 34%, compared to 25% for white individuals, 24% for Black individuals, 18% for Hispanic individuals, and 10% for Asian individuals.

Illicit drug use was also highest among AIAN populations—37%, versus 26% among white populations and 21% among Hispanic populations. Meanwhile, alcohol use was highest among white communities (52%), followed by Black communities (42%) and Hispanic communities (41%).

It’s no surprise, then, that rates of substance use disorders were also highest among AIAN populations, with a quarter of those individuals reporting a substance use disorder disorder in the past year.

Other substance use disorder disparities worth noting:

• Rates of substance use disorders were highest among young adults (age 18-25) when compared to other age groups, such as adolescents, adults, and the elderly, with 27% of this population reporting battling a substance use disorderin the past year.
• Slightly more men than women—about 27 million men versus 20 million women aged 12 and older—had a past-year substance use disorder.
• 26% of lesbians had a past-year substance use disorder, while 32% of bisexual women, 32% of gay men, and 32% of bisexual men had a past-year substance use disorder. For comparison, straight women had a past-year substance use disorder rate of 13.8%, and straight men had a past-year substance use disorder rate of 20.7%.
• Even employment correlates to substance use disorders: SAMHSA found that 28% of unemployed American adults reported a substance use disorder in the past year, while only 19% of American adults with full-time employment and 19% with part-time employment reported a substance use disorder in the same timeframe.

The reasons for why these disparities exist vary and are in many ways still unclear to experts. Some research suggests that acceptance of Medicaid, or lack thereof, can contribute to rates of substance use disorder diagnoses and prevention. Stigmas and biases, too, among groups can prevent people from seeking out care or self-reporting.

Health disparities that exist in substance use treatment

Just as problematic as disparities in rates of substance use disorders are the differences in how certain populations receive or access treatment for substance use disorders.

For example, a 2019 regional study found that Black and American Indian clients in Washington State were less likely to receive timely services than white clients at the beginning of a treatment episode.

“Almost 30% of American Indians in our sample lived in rural areas, whereas the proportion of clients living in rural areas for other racial/ethnic groups in our sample ranged from 2%–17%. Rural areas in general tend to have lower access to treatment, and lower access and higher distances to treatment may impact whether American Indian clients can return for services easily,” the study writes.

Another study using Medicare claims data from 2015 to 2019 found that racial and ethnic minorities received buprenorphine (a treatment for opioid use disorder) at lower rates than white patients. And a more recent study found that Black and Hispanic individuals were less likely to receive medication for alcohol use disorder than non-Hispanic white individuals.

Substance use treatment mills—places where profit is prioritized over outcomes and thus leads to low-quality care—are one problem contributing to these disparities. When these centers are the only option available (or recommended by a doctor) based on where you live or your financial situation, you might struggle to overcome addiction or mental health issues, and potentially face money or other troubles that affect your health outcomes long-term.

Substance use isn’t something employees should have to tackle alone, and there are plenty of resources at your disposal as a company, consultant, or HR team—including centers of excellence like Carrum Health that focus on high-quality, holistic, and inclusive care. Learn more today and be a part of the solution!

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.