RESEARCH STARTER

Health disparities and substance use disorders

Health disparities refer to significant differences in health outcomes and access to healthcare that affect specific groups based on ethnicity, race, gender, socioeconomic status, and other factors. These disparities are particularly pronounced in the context of substance abuse, where individuals from marginalized communities often face greater challenges. For instance, although substance use rates are similar across racial and ethnic groups, treatment access is markedly lower for minorities, with only about 10% of Black Americans and even fewer Native Americans receiving necessary treatment for substance use disorders. Compounding these issues, marginalized groups experience disproportionate health consequences related to substance use, including higher rates of drug-related deaths and comorbid health conditions like HIV and hepatitis.

Additionally, factors such as socioeconomic status and geographic location heavily influence access to treatment services, with individuals in rural areas facing significant barriers. The LGBTQIA+ community also exhibits higher rates of substance use compared to heterosexual individuals, highlighting the intersectionality of health disparities. Addressing these disparities requires targeted efforts, such as those initiated by various health organizations, which focus on improving healthcare quality, accessibility, and outcomes for affected populations. Understanding the multifaceted nature of health disparities in substance abuse is crucial for developing effective interventions and promoting health equity.

Full Article

DEFINITION: Health disparities are those differences in health-related treatment or outcomes that disproportionately affect specific groups of individuals based on their ethnicity, race, gender, sexual orientation, socioeconomic class, or level of education.

Background

Social service agencies, the government, and researchers define a health disparity differently; however, it typically involves significant differences in treatment or outcomes. The National Institute of Allergy and Infectious Diseases states:

Health disparities are gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level. These disparities may stem from many factors, including accessibility of health care, increased risk of disease from occupational exposure, and increased risk of disease from underlying genetic, ethnic, or familial factors.


Health disparity is a problem in the primary and behavioral health care system and an increasing problem among individuals with substance use disorder (SUD). Individuals from traditionally marginalized groups continue to experience barriers to adequate health care and substance use treatment options.

Differences in Health and Health Care

The disparities found for many of these groups differ depending on the indicator or outcome examined; however, some underlying trends exist. People of color tend to have poorer outcomes when compared to White individuals; women have poorer outcomes when compared with men; and gay and lesbian individuals have poorer outcomes when compared with heterosexual individuals. These disparities persist even when other variables, such as socioeconomic status and access to health care, are controlled for.

Health disparities are especially disconcerting in the context of substance use. Although fewer than 20 percent of people with SUDs receive any form of treatment, studies show that access is even more limited for many marginalized groups, including Black, Hispanic, and American Indian/Alaska Native (AI/AN) communities. Research consistently finds that racial and ethnic minorities use alcohol and drugs at roughly the same rates as White individuals, yet they experience disproportionately worse outcomes due to reduced access to treatment, lower rates of treatment completion, and structural barriers within the healthcare system. These disparities are reflected in higher rates of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), increased risk of hepatitis and tuberculosis, elevated cardiovascular complications associated with substance use, and higher rates of drug-related deaths. Such conditions arise from a combination of factors, including inadequate access to evidence-based care, social and economic inequities, and compounded health risks linked to untreated or undertreated substance use.

  • Hispanic and Black American populations have higher rates of complete abstinence from alcohol than White individuals; however, among those who do drink, they face a higher risk of developing alcohol-related liver disease.
  • Black Americans and AI/AN communities experienced some of the largest increases in drug-related deaths between 2019 and 2020.
  • Accordigng to 2022 Centers for Disease Control and Prevention (CDC) surveillance, HIV diagnosis rates remain disproportionately high among Black Americans, who accounted for roughly 40 percent of all new HIV diagnoses despite representing only about 13 percent of the US population. People who inject drugs continue to have elevated HIV prevalence, with recent national estimates placing it at approximately 7 to 10 percent, although rates vary by region and access to harm-reduction services.
  • Black and AI/AN men have had some of the highest overdose death rates in recent years, with deaths among Black men increasing sharply during the fentanyl epidemic.
  • Smoking prevalence among White and Black adults is similar, but Black adults who smoke heavily face a heightened risk of diabetes. American Indian and Alaska Native adults have the highest smoking rates in the United States—roughly twice that of Hispanic adults and nearly three times that of Asian adults.

When examining the disparities for individuals in the LGBTQ community, similar patterns emerge. LGBTQ persons have higher rates of alcohol use and SUDs than heterosexual individuals, are less likely to abstain from alcohol and drugs, and are more likely to continue heavy drinking into later life. These behaviors substantially increase the risk of HIV and other STDs.

Differences in Treatment

In addition to the disparities noted in health care among minority populations, disparities are also noted in access to and participation in treatment. For example, those of lower socioeconomic status typically access substance abuse treatment at levels significantly lower than individuals in higher socioeconomic brackets. Furthermore, people in rural communities have fewer treatment options.

Asian Americans access substance abuse treatment at lower levels than other racial and ethnic groups, even when controlling for the prevalence of substance use disorders. Lesbians are less likely to access treatment services for substance use disorders. Black American men are less likely to access residential treatment when compared with men of other racial and ethnic groups, and Black Americans overall are less likely to complete substance abuse treatment compared to White Americans.

Health disparities also affect individuals who have both a mental illness and a substance use disorder—referred to as co-occurring or comorbid disorders (COD). Individuals with COD often face greater barriers to accessing treatment, in part because of a inadequate cross-training among professionals who specialize in substance use treatment and those who treat psychiatric disorders. This is particularly true for individuals whose psychiatric conditions, such as schizophrenia or bipolar disorder, are more complex and require ongoing medication management.

Conclusion

The effects of health disparities are far-reaching and negative for all Americans. Disparities significantly impact the individual and community and lead to increased morbidity and mortality.

To address the wide-ranging scope of the problem, the National Institutes of Health, the American Psychological Association, the Office of Minority Health, and other state and federal organizations began increasingly addressing health disparities in the late twentieth century. Healthy People is an ongoing program sponsored by the Office of Disease Prevention and Health Promotion that began its first iteration in 1980. The program focuses on improving all Americans' health and well-being and reducing health disparities. Some of the actions taken include developing special task forces, funding research to examine and address disparities, and encouraging minority and other scholars to engage in research in this area by offering grants and opportunities for training. The program's fifth iteration, Healthy People 2030, includes 358 measurable objectives that aim to better understand, track, and apply health disparity research findings.


Bibliography

“About the Objectives.” Office of Disease Prevention and Health Promotion, odphp.health.gov/healthypeople/objectives-and-data/about-objectives. Accessed 7 Dec. 2025.

Acevedo, Andrea, et al. “Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?” Journal of Behavioral Health Services & Research, vol. 45, no. 4, 2018, pp. 533–49, doi:10.1007/s11414-018-9586-y. Accessed 7 Dec. 2025.

Alsebaa, Fatimah, and Hashem Akbar. “Health Disparities in the Diagnosis and Treatment of Substance Use Among Racial and Ethnic Minority Older Adults.” The American Journal of Geriatric Psychiatry, vol. 31, no. 3, 2023, pp. S41–S42, doi:10.1016/j.jagp.2022.12.198. Accessed 7 Dec. 2025.

Burlew, Ann K., et al. "Measurement and Data Analysis in Research Addressing Health Disparities in Substance Abuse." Journal of Substance Abuse Treatment, vol. 36, no. 1, 2008, pp. 25–43, doi:10.1016/j.jsat.2008.04.003. Accessed 8 Dec. 2025.

Cruz, Fabiola Arbelo. “Racial Inequities in Treatments of Addictive Disorders.” TRU Addiction Health, 4 May 2022, truaddictionhealth.com/racial-inequities-in-treatments-of-addictive-disorders/. Accessed 7 Dec. 2025.

Grooms, Jevay, and Alberto Ortega. "Racial Disparities in Accessing Treatment for Substance Use Highlights Work to Be Done." USC Leonard D. Schaeffer Center for Health Policy & Economics, 29 Apr. 2022, healthpolicy.usc.edu/evidence-base/racial-disparities-in-accessing-treatment-for-substance-use-highlights-work-to-be-done. Accessed 7 Dec. 2025.

Higgins, Stephen T. "Behavior Change, Health, and Health Disparities 2021: Rural Addiction and Health." Preventive Medicine, vol. 152, pt. 2, Nov. 2021, doi:10.1016/j.ypmed.2021.106834. Accessed 7 Dec. 2025.

“HIV Diagnoses, Deaths, and Prevalence.” Centers for Disease Control and Prevention, 7 Feb. 2025, www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-prevalence.html. Accessed 7 Dec. 2025.

Jacobson, Jerry O. et al. “A Multilevel Decomposition Approach to Estimate the Role of Program Location and Neighborhood Disadvantage in Racial Disparities in Alcohol Treatment Completion.” Social Science & Medicine, vol. 64 no. 2, 2007, pp. 462–76, doi:10.1016/j.socscimed.2006.08.032. Accessed 7 Dec. 2025.

Kritz, Steven, et al. "Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs." Journal of Addiction Medicine, vol. 3, no. 2, 2009, pp. 95–102, doi:10.1097/ADM.0b013e318190f0e7. Accessed 8 Dec. 2025.

Morefield, Hans. "There Remain Startling Health Inequities in the Treatment of Substance Use Disorder." Pharmacy Times, 22 Feb. 2023, www.pharmacytimes.com/view/there-remain-startling-health-inequities-in-the-treatment-of-substance-use-disorder. Accessed 7 Dec. 2025.

"Racial Inequities in Treatments of Addictive Disorders." Yale School of Medicine, 1 Oct. 2021, medicine.yale.edu/news-article/racial-inequities-in-treatments-of-addictive-disorders. Accessed 20 Sept. 2024.



Full Article

DEFINITION: Health disparities are those differences in health-related treatment or outcomes that disproportionately affect specific groups of individuals based on their ethnicity, race, gender, sexual orientation, socioeconomic class, or level of education.

Background

Social service agencies, the government, and researchers define a health disparity differently; however, it typically involves significant differences in treatment or outcomes. The National Institute of Allergy and Infectious Diseases states:

Health disparities are gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level. These disparities may stem from many factors, including accessibility of health care, increased risk of disease from occupational exposure, and increased risk of disease from underlying genetic, ethnic, or familial factors.


Health disparity is a problem in the primary and behavioral health care system and an increasing problem among individuals with substance use disorder (SUD). Individuals from traditionally marginalized groups continue to experience barriers to adequate health care and substance use treatment options.

Differences in Health and Health Care

The disparities found for many of these groups differ depending on the indicator or outcome examined; however, some underlying trends exist. People of color tend to have poorer outcomes when compared to White individuals; women have poorer outcomes when compared with men; and gay and lesbian individuals have poorer outcomes when compared with heterosexual individuals. These disparities persist even when other variables, such as socioeconomic status and access to health care, are controlled for.

Health disparities are especially disconcerting in the context of substance use. Although fewer than 20 percent of people with SUDs receive any form of treatment, studies show that access is even more limited for many marginalized groups, including Black, Hispanic, and American Indian/Alaska Native (AI/AN) communities. Research consistently finds that racial and ethnic minorities use alcohol and drugs at roughly the same rates as White individuals, yet they experience disproportionately worse outcomes due to reduced access to treatment, lower rates of treatment completion, and structural barriers within the healthcare system. These disparities are reflected in higher rates of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), increased risk of hepatitis and tuberculosis, elevated cardiovascular complications associated with substance use, and higher rates of drug-related deaths. Such conditions arise from a combination of factors, including inadequate access to evidence-based care, social and economic inequities, and compounded health risks linked to untreated or undertreated substance use.

  • Hispanic and Black American populations have higher rates of complete abstinence from alcohol than White individuals; however, among those who do drink, they face a higher risk of developing alcohol-related liver disease.
  • Black Americans and AI/AN communities experienced some of the largest increases in drug-related deaths between 2019 and 2020.
  • Accordigng to 2022 Centers for Disease Control and Prevention (CDC) surveillance, HIV diagnosis rates remain disproportionately high among Black Americans, who accounted for roughly 40 percent of all new HIV diagnoses despite representing only about 13 percent of the US population. People who inject drugs continue to have elevated HIV prevalence, with recent national estimates placing it at approximately 7 to 10 percent, although rates vary by region and access to harm-reduction services.
  • Black and AI/AN men have had some of the highest overdose death rates in recent years, with deaths among Black men increasing sharply during the fentanyl epidemic.
  • Smoking prevalence among White and Black adults is similar, but Black adults who smoke heavily face a heightened risk of diabetes. American Indian and Alaska Native adults have the highest smoking rates in the United States—roughly twice that of Hispanic adults and nearly three times that of Asian adults.

When examining the disparities for individuals in the LGBTQ community, similar patterns emerge. LGBTQ persons have higher rates of alcohol use and SUDs than heterosexual individuals, are less likely to abstain from alcohol and drugs, and are more likely to continue heavy drinking into later life. These behaviors substantially increase the risk of HIV and other STDs.

Differences in Treatment

In addition to the disparities noted in health care among minority populations, disparities are also noted in access to and participation in treatment. For example, those of lower socioeconomic status typically access substance abuse treatment at levels significantly lower than individuals in higher socioeconomic brackets. Furthermore, people in rural communities have fewer treatment options.

Asian Americans access substance abuse treatment at lower levels than other racial and ethnic groups, even when controlling for the prevalence of substance use disorders. Lesbians are less likely to access treatment services for substance use disorders. Black American men are less likely to access residential treatment when compared with men of other racial and ethnic groups, and Black Americans overall are less likely to complete substance abuse treatment compared to White Americans.

Health disparities also affect individuals who have both a mental illness and a substance use disorder—referred to as co-occurring or comorbid disorders (COD). Individuals with COD often face greater barriers to accessing treatment, in part because of a inadequate cross-training among professionals who specialize in substance use treatment and those who treat psychiatric disorders. This is particularly true for individuals whose psychiatric conditions, such as schizophrenia or bipolar disorder, are more complex and require ongoing medication management.

Conclusion

The effects of health disparities are far-reaching and negative for all Americans. Disparities significantly impact the individual and community and lead to increased morbidity and mortality.

To address the wide-ranging scope of the problem, the National Institutes of Health, the American Psychological Association, the Office of Minority Health, and other state and federal organizations began increasingly addressing health disparities in the late twentieth century. Healthy People is an ongoing program sponsored by the Office of Disease Prevention and Health Promotion that began its first iteration in 1980. The program focuses on improving all Americans' health and well-being and reducing health disparities. Some of the actions taken include developing special task forces, funding research to examine and address disparities, and encouraging minority and other scholars to engage in research in this area by offering grants and opportunities for training. The program's fifth iteration, Healthy People 2030, includes 358 measurable objectives that aim to better understand, track, and apply health disparity research findings.


Bibliography

“About the Objectives.” Office of Disease Prevention and Health Promotion, odphp.health.gov/healthypeople/objectives-and-data/about-objectives. Accessed 7 Dec. 2025.

Acevedo, Andrea, et al. “Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?” Journal of Behavioral Health Services & Research, vol. 45, no. 4, 2018, pp. 533–49, doi:10.1007/s11414-018-9586-y. Accessed 7 Dec. 2025.

Alsebaa, Fatimah, and Hashem Akbar. “Health Disparities in the Diagnosis and Treatment of Substance Use Among Racial and Ethnic Minority Older Adults.” The American Journal of Geriatric Psychiatry, vol. 31, no. 3, 2023, pp. S41–S42, doi:10.1016/j.jagp.2022.12.198. Accessed 7 Dec. 2025.

Burlew, Ann K., et al. "Measurement and Data Analysis in Research Addressing Health Disparities in Substance Abuse." Journal of Substance Abuse Treatment, vol. 36, no. 1, 2008, pp. 25–43, doi:10.1016/j.jsat.2008.04.003. Accessed 8 Dec. 2025.

Cruz, Fabiola Arbelo. “Racial Inequities in Treatments of Addictive Disorders.” TRU Addiction Health, 4 May 2022, truaddictionhealth.com/racial-inequities-in-treatments-of-addictive-disorders/. Accessed 7 Dec. 2025.

Grooms, Jevay, and Alberto Ortega. "Racial Disparities in Accessing Treatment for Substance Use Highlights Work to Be Done." USC Leonard D. Schaeffer Center for Health Policy & Economics, 29 Apr. 2022, healthpolicy.usc.edu/evidence-base/racial-disparities-in-accessing-treatment-for-substance-use-highlights-work-to-be-done. Accessed 7 Dec. 2025.

Higgins, Stephen T. "Behavior Change, Health, and Health Disparities 2021: Rural Addiction and Health." Preventive Medicine, vol. 152, pt. 2, Nov. 2021, doi:10.1016/j.ypmed.2021.106834. Accessed 7 Dec. 2025.

“HIV Diagnoses, Deaths, and Prevalence.” Centers for Disease Control and Prevention, 7 Feb. 2025, www.cdc.gov/hiv-data/nhss/hiv-diagnoses-deaths-prevalence.html. Accessed 7 Dec. 2025.

Jacobson, Jerry O. et al. “A Multilevel Decomposition Approach to Estimate the Role of Program Location and Neighborhood Disadvantage in Racial Disparities in Alcohol Treatment Completion.” Social Science & Medicine, vol. 64 no. 2, 2007, pp. 462–76, doi:10.1016/j.socscimed.2006.08.032. Accessed 7 Dec. 2025.

Kritz, Steven, et al. "Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs." Journal of Addiction Medicine, vol. 3, no. 2, 2009, pp. 95–102, doi:10.1097/ADM.0b013e318190f0e7. Accessed 8 Dec. 2025.

Morefield, Hans. "There Remain Startling Health Inequities in the Treatment of Substance Use Disorder." Pharmacy Times, 22 Feb. 2023, www.pharmacytimes.com/view/there-remain-startling-health-inequities-in-the-treatment-of-substance-use-disorder. Accessed 7 Dec. 2025.

"Racial Inequities in Treatments of Addictive Disorders." Yale School of Medicine, 1 Oct. 2021, medicine.yale.edu/news-article/racial-inequities-in-treatments-of-addictive-disorders. Accessed 20 Sept. 2024.



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