Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?
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This study focused on (1) whether disparities in timely receipt of substance use services can be explained in part by the characteristics of the community in which the clients reside and (2) whether the effect of community characteristics on timely receipt of services was similar across racial/ethnic groups. The sample was composed of adults receiving publicly funded outpatient treatment in Washington State. Treatment data were linked to data from the US census. The outcome studied was “Initiation and Engagement” in treatment (IET), a measure noting timely receipt of services at the beginning of treatment. Community characteristics studied included community level economic disadvantage and concentration of American Indian, Latino, and Black residents in the community. Black and American Indian clients were less likely to initiate or engage in treatment compared to non-Latino white clients, and American Indian clients living in economically disadvantaged communities were at even greater risk of not initiating treatment. Community economic disadvantage and racial/ethnic makeup of the community were associated with treatment initiation, but not engagement, although they did not entirely explain the disparities found in IET.
KeywordsTreatment Disparities Community Quality
The authors would like to thank Can Du from the Behavioral Health Administration in the Washington State Department of Social and Health Services for her comments on an earlier version of the manuscript.
This research was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under award number R03AA023390. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or of the participating state.
Compliance with Ethical Standards
Conflict of Interest
The authors have no conflict of interests to declare.
- 1.SAMHSA. 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration;2016.Google Scholar
- 4.Snyder HN, Mulako-Wangota J, Bureau of Justice Statistics. Arrests by Race and Age in the U.S., 2012. In. Generated using the Arrest Data Analysis Tool at www.bjs.gov . (December 30, 2015).2015.
- 6.Mack K. Drug-induced deaths - United States, 1999-2010 Morbidity and Mortality Weekly Report. 2013;62 Suppl 3:161–163.Google Scholar
- 19.Andersen RM, Davidson PL, Kominski GF. Improving Access to Care in America: Individual and Contextual Indicators. In: Andersen RM, Rice TH, Kominski GF, eds. Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management. San Francisco: Jossey-Bass Inc.; 2007:3–32.Google Scholar
- 20.National Quality Forum. NQF Endorsed Standards. 2017; http://www.qualityforum.org/MeasureDetails.aspx?SubmissionID=1245. Accessed 05/01/17.
- 21.National Committee for Quality Assurance. NCQA HEDIS 2016. 2016; http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures/HEDIS2016.aspx. Accessed 05/06/17.
- 28.Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.Google Scholar
- 30.Norris T, Vines P, Hoeffel E. Census Briefs: The American Indian and Alaska Native Population: 2010. 2012; https://www.census.gov/content/dam/Census/library/publications/2012/dec/c2010br-10.pdf. Accessed May 5, 2017.
- 31.Cohn D. American Indian and white, but not ‘multiracial’. 2015; http://www.pewresearch.org/fact-tank/2015/06/11/american-indian-and-white-but-not-multiracial/. Accessed May 5, 2017.
- 33.U.S. Census Bureau. Geographic Terms and Concepts - Census Tract. 2012; https://www.census.gov/geo/reference/gtc/gtc_ct.html. Accessed March 3, 2017.
- 38.StataCorp. Heckman two-stage procedure. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.Google Scholar
- 58.Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: NSDUH Series H-44, HHS Publication No. (SMA) 2013;13–4795.Google Scholar
- 59.Substance Abuse and Mental Health Services Administration. Racial and Ethnic Minority Populations. Specific Populations 2016; https://www.samhsa.gov/specific-populations/racial-ethnic-minority. Accessed 9/14/17.