Racial and Ethnic Minorities, Issues in Treatment

Service Utilization

Health services research has examined the extent to which people seek treatment for mental health and substance-related problems. A number of observations can be made regarding the literature on service utilization: (a) It suggests a general underutilization of mental health and substance abuse services nationwide, (b) the problem of underutilization is more pronounced among ethnic minorities, and (c) the pattern of underutilization of mental health and substance abuse services is persistent because studies spanning approximately a third of [Page 755]a century show similar underutilization rates. Although one might assume that lack of insurance is a major barrier to utilization of services, some research shows that, at least among insured Hispanics working for the federal government, utilization of mental health and substance abuse services is lower than the utilization rates of non-Hispanic Whites.

In 2006, 1,800,717 persons entered treatment for substance abuse in publicly funded treatment. Approximately 35% of these individuals admitted to treatment were ethnic-racial minorities. The largest single ethnic group represented was African Americans (17.7%), followed by Hispanics (12.7%), American Indians-Alaska Natives (2.1%), and Asian-Pacific Islanders (0.7%). Whites comprised 65% of total treatment admissions to publicly funded substance abuse treatment in 2006. As the nation's demographics change in the coming years, it is likely that more and more individuals from traditionally minority ethnic and racial backgrounds will present for treatment in publicly funded substance abuse treatment settings.

Some data suggest, however, that among Hispanics and African American daily drug users, perceived need for treatment is lower than among non-Hispanic Whites. Such differences in perceived need for treatment may serve as a barrier to treatment entry among individuals of minority ethnicity-race. Interventions to change cultural attitudes toward the utility of substance abuse treatment among racial and ethnic minorities may help to reduce the differences in perceived need for treatment among those with substance-related problems. Further, increasing the awareness of and perceived utility of substance abuse treatment services may be part of what is necessary to reduce ethnic disparities in substance abuse treatment services.

Once admitted to treatment, findings in the literature suggest that minority clients may be more likely to leave treatment early, are less likely to complete a course of treatment, and may adhere less to treatment programs than nonminority clients. Early treatment exit is an important issue in that time in treatment is associated with increased gains from treatment (e.g., reductions in drug use and drug-related criminal activity). It is unclear what factors contribute to these differences in treatment outcome; however, it may be that traditional drug treatment interventions, designed primarily for non-Hispanic White males, likely need modifications for use with other ethnic-racial groups. In particular, the incorporation of culturally congruent constructs (e.g., familism for Hispanics, Afrocentrism for African Americans) may make treatment environments more conducive to retention of racial-ethnic minorities in treatment. With regard to the issue of treatment adherence, the cultural relevance of aspects of substance abuse treatment programs may be important. For example, for African Americans, there may be a preference for church-provided recovery groups over Alcoholics Anonymous (AA). If attendance at AA is part of a treatment program, the program may be less likely to be completed by African American clients.

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