This post seeks to examine the ways race factors into drug and alcohol dependence and the chances for recovery within minority communities. To break down this controversial topic, we will review current data on substance abuse within five American communities: Black, White, Hispanic, Native American, and Asian. In interpreting this data, we will emphasize two things: abuse patterns across the age spectrum of each racial group and why various communities prefer different substances.
Alcohol, methamphetamines, opiates, cocaine, and heroin all follow different rates of abuse across these people groups. We will look at how and why these patterns emerge and what bearing these factors have on the ways each group seeks treatment and rehabilitation. Here, we will look at the rates of treatment for each population and discuss potential challenges that affect each group’s prognosis.
In an attempt to answer why some groups are more apt to seek or complete available treatment options, we must highlight a few issues that can directly affect treatment access and outcomes. Therefore, we will begin with an overview of racism.
What is Racism?
A complete definition of racism requires more detail than we can go into in this blog post. However, it is important to clarify a working definition to ensure that we are all addressing the intersection of addiction and racism based on the same framework.
Racism is fundamentally prejudice, discrimination, or active hostility towards an individual or a group, particularly a minority or a marginalized population. Racism is rooted in the belief that different races have distinct characteristics (like skin color), qualities, or abilities, which can be considered better or worse than other groups.
Skin color and physical features, while subject to wide variation within a given racial group, are observable. However, terms like “qualities” and “abilities” are amorphous and subject to abuse by members of a hostile population.
In America, a large majority of citizens believe that current political, bureaucratic, and economic systems create and reinforce power disparities according to the color of a person’s skin. And because of that, there are significant differences in the range of opportunities, like education, employment, access to healthcare, housing situations, and mundane challenges of existence that perpetuate racism on many different levels. This type of system-wide discrimination is known as systemic racism.
Unfortunately, this too, is a controversial term, which has been politicized in recent months. For instance, according to a Pew Research Center survey in 2019, 85% of African American respondents believed that “the legacy of slavery affects the position of black people in American society today a great deal / fair amount” with most pointing to unfair policing behavior as Exhibit 1. However, data compiled by the Washington Post, says that only 10 unarmed Black Americans were killed at the hand of the police in 2019.
So, is this just media hype, data manipulation, or something else? And, more importantly, does this belief perpetuate addictive behavior in minority communities? We’ll aim to provide guidance on the latter through peer-reviewed research and let you to come to your own conclusion on the former.
What is Addiction?
Since we are examining addiction and racism, we must also make sure to accurately define addiction. The National Institute on Drug Abuse (NIDA) defines addiction as compulsive drug-seeking despite negative consequences. It is often a chronic, relapsing disorder and may create long-lasting changes in the brain. Other terms for addiction used interchangeably in this article are “substance abuse” and “drug and alcohol dependence.”
Data on Drug Abuse in Different Communities
A distinct range of circumstances translates into different rates of substance abuse for members of the five racial groups examined in this article. While reviewing the current data, we must consider the numbers themselves rather than the perception of abuse within a community. The numbers do not lie, and they paint a picture that is at odds with common stereotypes.
Much of this information comes from self-reported data. Population information, for example, comes from the U.S. Census, which relies on how individuals report themselves. Statistics for substance abuse are based on answers obtained from individuals 12 years old and up that was collected in the National Household Survey on Drug Abuse (NHSDA). This information is only collected from ‘non-institutionalized’ people, meaning that it excludes prison populations. The results from this landmark 2003 survey, which was conducted by the Substance Abuse and Mental Health Administration (SAMHSA), may be somewhat inaccurate due to the self-reporting.
Still, the sample size is significant, especially for the young adult age group. The information is valuable to use as a snapshot of substance abuse in American communities. It challenges firmly held perceptions of drug use.
Please note, overlap of race and Hispanic ethnicity is one of the main comparability issues in these surveys. And because of that, the term Black is used to encompass non-Hispanic individuals with African, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. ancestries.
Illicit Drug Use
According to the NHSDA, 6.1% of White, non-Hispanic individuals reported that they used any illicit drug within the past month. 8.2% of Blacks, 9.3% of American Indians (Native Americans), 2.8% of Asians, and 6.1% of Hispanics surveyed indicated that they tried illicit substances within the past month. Rates for Black and White populations are similar until age 26 when they begin to diverge. From that point on, Blacks report increased illicit drug use. Reports of illegal drug use in Asian communities taper off significantly as the population ages, with only 0.7% of individuals over the age of 35 using illicit drugs. Similarly, Hispanic reports of illicit drug use decline steadily between 26-34 years old and older.
Marijuana use within the past month was reported by 5% of Whites, 6.6% of Blacks, 8% of American Indians, 2.6% of Asians, and 4.5% of Hispanics who responded to the survey. The highest reports of marijuana use were from the 18-25 age group, including American Indian (23.3%), Black (15.2%), and White (14.9%). It should be noted, however, that this data does not take the state-by-state legalization of marijuana into account.
Reported use of alcohol within the previous month is highest among Whites (55.3%), Hispanics (45.4%), American Indians (43.3%), and Blacks (39.8%), followed by Asians (34.5%). Heavy alcohol use, defined by the survey as five drinks or more at the same time on at least five or more days, was reported by 13.7% of American Indians, 6.5% of Hispanics, 6% of Whites, 4.9% of Blacks and 2.9% of Asians.
The National Survey on Drug Use and Health (NSDUH) in 2013 found that the average addiction rates in the general population of Americans over 12 years of age were 5.6%. In the American Indian community, 14.9% of those surveyed reported substance addiction. 8.6% of Hispanics, 8.4% of Whites, 7.4% of Blacks, and 4.6% of Asians also suffered from substance addiction.
Analysis of the Data:
According to Johns Hopkins researchers who analyzed the data from the most recent NHSDA in a publication for the NIDA referenced above, “the common perception is that minority groups, particularly Blacks and Hispanics, use drugs more than Whites even though epidemiological data show little difference in overall use by race/ethnicity. In fact, in some instances, minority groups are less likely to use licit or illicit drugs”. The summary goes further to say that “there are, however, great differences in the consequences of drug use for racial/ethnic minorities, creating a great need to better understand the unique prevention, treatment, and health services of these communities.”
Several systemic issues may contribute to the popularity or prevalence of a particular drug within a community. Those tendencies do change over time, but data consistently show that drug use similarly affects most communities. Further, the data dispels the common perception that regular substance abuse in minority communities, especially by Black and Hispanic people, exceeds those of White communities.
Substance abuse data is subject to interpretation thanks to a variety of factors noted for each group below.
Black: The Black population accounts for 13% of the total population, yet makes up approximately 40% of the prison population. Many attribute these incarcerations to the so-called “War on Drugs” that are the result of disparate policing of drug abuse in African American communities. However, the vast majority of those in jail for drug crimes are incarcerated for distribution, not merely drug use, which suggests there might be more underlying issues driving these stats.
Regardless of your opinions on mass incarceration, it is a prevalent issue within the African American community and does influence how that community is helped or treated.
Consequently, the stereotype of pervasive drug abuse within African American communities exists and often colors the perception of this community. As the data show, however, these perceptions are not rooted in reality. African-Americans tend to use and abuse drugs at similar (or lower) rates than their White counterparts in many cases.
The Black American community self-reports widespread marijuana use across all age groups. It is routinely penalized for possession at a higher rate than other groups. Crack cocaine use, though significantly lower than most substances abused within the community, is also a uniquely African American dilemma. Though opioid abuse is curtailed by a lack of access to quality healthcare, numbers of opioid-addicted members of the community are on the rise.
In the Black community, synthetic opioids such as illegally manufactured fentanyl (IMF) cause almost 60% of opioid-related deaths. These synthetic opioids can be mixed into heroin, cocaine, methamphetamines, and counterfeit prescription pills. This has caused opioid rates in the Black community to climb rapidly between 2015-2017, more than doubling among Black adults between 45-54 years old.
It is important to note that there are a couple of important distinctions within the Black American community. The most notable one is the distinction between African Americans and Blacks of Caribbean descent. Immigration status, education, marital status, and income mark significant departures between the two groups that are usually lumped together. However, Caribbean Blacks suffer from lower rates of substance abuse than African Americans. This is especially true of first-generation immigrants, individuals with higher education and income, and in the widowed/divorced population of Caribbean Blacks.
White: White communities in America consistently report the highest levels of alcohol abuse, including high numbers of heavy drinkers, and teenagers consuming alcohol more frequently than their peers in other communities. Additionally, opiate and methamphetamine abuse are attributed mainly to white users. In fact, economists report that since the introduction of OxyContin in the mid-1990s, life expectancy of White Americans has steadily decreased. This reduced life expectancy is due to widespread opioid use, abuse, and frequent death due to overdose.
Opioids are highly addictive substances. Thanks to targeted drug promotion strategies and healthcare disparities that limit minority access to healthcare, they are disproportionately used and abused by White communities. Poorer communities, notably throughout Appalachia and in other predominantly “White” regions, suffer from high overdose rates. However, recent reform and lawsuits have put opioid abuse at the forefront of addiction treatment efforts, which may help curtail this deadly trend.
Hispanic: The Hispanic population reports substance abuse and addiction rates that are similar–and often slightly lower–than those of the general population. The two exceptions are 30-day crack cocaine use and heavy drinking, which are somewhat above that of Blacks
Hispanic people in America tend to engage in heavy drinking closer to the higher rates of White Americans.
The Hispanic community in America includes people of Mexican and Latin American descent. One of the contributing factors to substance abuse in this community is assimilation, often measured by an individual’s ability to communicate in English. Latinos/Latinas who assimilate and learn the language tend to abuse substances at a higher rate. This degree of assimilation may factor into how those surveyed view the system and their place in it. Assimilation also directly affects their willingness to report.
Native American: Native Americans, identified as American Indians by SAMHSA, comprise slightly over 2.0% of the population. The 6.9 million Native Americans suffer from relatively high rates of substance abuse, especially alcohol and marijuana. They also have the highest death rate of alcohol poisoning.
The high rates of substance abuse in this population can be attributed to several socioeconomic factors. In general, American Indians experience poor overall health, ready access to alcohol, and historical trauma, and low socioeconomic standing.
Asian: Asian Americans (sometimes including Pacific Islanders) generally show lower rates of substance abuse disorders than the rest of the population, supporting the stereotype of the model minority. Though the occurrences of substance abuse in the Asian community may be fewer, lack of reporting, especially in self-reported studies, is an issue. Many users may hide their addictions for fear of reprisal from family members. Similarly, Asians often hide their addictions until they have become increasingly severe and harder to treat.
U.S.-born Asian Americans were three times more likely to use drugs than Asian Americans who immigrated to America. Additionally, Asian Americans attending college used drugs at rates similar to that of their peers. The most common substances abused by this community include alcohol, nicotine, and methamphetamines in recent years.
Access to Treatment
Access to recovery and rehabilitation for the treatment of various substance abuse disorders varies widely across different race groups in America. Apart from access to facilities, there are issues with the quality and appropriateness of treatment that significantly impact the effectiveness of treatment programs within each community.
Common Barriers to Treatment
Americans and Hispanics are more likely to recognize the need for treatment than other populations. Among the racial groups discussed, members of the Asian community tend to have the best rates of completion and recovery.
Unfortunately, African Americans generally have lower addiction recovery rates and are less apt to complete treatment programs.
Studies found that African American participants completed fewer days of treatment for cocaine addiction than their white peers. Though multiple factors contribute to this disparity, several African Americans self-reported employment problems and housing instability that may have interfered with their ability to continue treatment.
Other socioeconomic barriers tend to come into play as well. For many more impoverished communities, access to treatment options may be limited by factors like transportation. Elements like criminal history, Medicaid enrollment, and lower income have a more significant impact on minorities who seek treatment for substance abuse disorders. For example, the criminal justice system often serves as an entry point to treatment for minorities, ultimately affecting the outcome. Interestingly, this may also promote greater access to substance abuse treatment for these minority communities.
Though the Asian community generally experiences positive results from treatment, several significant barriers result in lower rates of Asians who seek treatment. These include cultural barriers, like shame and stigma, that lead to high rates of suppression. Familial insulation found in immigrant families without language and cultural assimilation is also common, and this translates to difficulty finding affordable, accessible treatment.
Factors that Affect Treatment Outcomes
While treatment rates vary widely based on the type of substance, overall completion rates for drug and alcohol treatment were low for all groups, but especially for Blacks and Hispanics. For instance, Blacks and Hispanics were 3.5% to 8.1% less likely than Whites to complete treatment for drugs and alcohol.
But, don’t jump to conclusions based on the disparity as disparity doesn’t necessarily indicate racial prejudice as this issue is extremely complex.
Regardless, addressing the barriers to treatment is essential, especially since minority communities report lower rates of recovery from substance abuse disorders even when they are overcome. Some argue that minority communities are disenfranchised throughout the treatment process that has been tailored for Whites.
Whereas others state that social acceptance of drug usage in said communities is suppressing these numbers.
Additionally, one study reported that programs attended by Black and Hispanic populations were “less intense,” and therefore, yielded worse outcomes for minorities. Other studies have disagreed with this hypothesis though.
When discussing engagement in programs like Alcoholics Anonymous, for example, Blacks report attending fewer meetings than Whites of Hispanics. This may be attributed to feeling unwelcome at meetings largely attended by non-POC. It’s also possible that the idea of powerlessness, which is central to the 12-steps that are central to A.A., holds no allure for this community. Some disagree seeing as the only requirement for A.A. membership is “a desire to stop drinking.” So, that wouldn’t exclude these populations.
This is an interesting paradox though as according to one study, African Americans reported higher levels of spirituality than Caucasians and African American participants in A.A. reported more perceived benefits of 12-Step programs. However, Caucasians were more likely to endorse 12-Step involvement.
And in another interesting twist, among those who didn’t attend A.A., African Americans reported higher abstinence levels than Whites. The hard part to answer is why. Some point to a 2005 study by Arthur Durant that suggests African Americans had difficulty accepting the belief that alcoholism is a disease – a concept that is central to the 12-Step philosophy.
Whatever the case, there is a disparity of participation in 12-Step programs between racial groups. That we know for sure. But, there’s not enough evidence to suggest that racism is driving this. Regardless, it’s important that public health officials acknowledge this discrepancy in order to help minority communities in their access to healthcare.
All of this information leads to an obvious conclusion: addiction is not racist, but it does have the potential to affect treatment outcomes in each of these communities. According to most recent studies that surveyed adults across the US, the data indicate that White, Black, Hispanic, Native American, and Asian communities all suffer from similar substance abuse rates. In a couple of categories, White communities experience the highest addiction rates, but they do not point to heightened disparities that would make one race more prone to addiction than another
Still, Blacks report using more illicit drugs, but the majority of opioid, methamphetamine, and cocaine (powder) users are Whites. Unfortunately, the recent rise in the number of deaths of Black adults due to opioid overdose is on the rise, showing that even these data points are fluid. Substance abuse pervades American communities, minority and majority, without regard to race.
Although employment, housing, and transportation concerns hinder African American access to treatment, this group still readily acknowledges the need for and seeks out treatment. Other minorities, like Asians and Hispanics must contend with other barriers to treatment like the stigma of addiction, cultural/familial relationship dynamics, and language limitations.
While proportionately higher numbers of Black people check in to rehab, many fail to complete treatment programs for a variety of reasons. For those who manage to complete treatment, recovery rates are still relatively low. This may be due to inorganic impetus (after all, many minorities are referred to state-funded treatment facilities by way of the criminal justice system) which may indicate a less genuine pursuit of treatment from the outset. Treatment only can work if the individual is ready for and committed to the process.
Other factors that diminish the success of treatment across each of these populations are aftercare considerations. Without adequate family involvement and support, individuals who are addicted to substances face a longer, steeper road to recovery. If environmental concerns are not addressed, people who abuse substances are likely to resort back to those same coping mechanisms, perpetuating the cycle of abuse. In this instance, it is likely that poverty, rather than race, is responsible for negative treatment outcomes.
Taking a holistic approach to the treatment of substance abuse is vital for long-term success. It is challenging to provide this level of complete rehabilitation when an individual will return to the same environment that fostered the addiction in the first place. While more research is needed to fully understand the dynamics of substance abuse in the Black, White, Hispanic, Native American and Asian communities in America, addiction is not inherently racist. Addressing the barriers to treatment and encouraging inclusive aftercare will go a long way towards facilitating recovery for members all of these communities.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.