Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

  • Andrea Acevedo
  • Lee Panas
  • Deborah Garnick
  • Dolores Acevedo-Garcia
  • Jennifer Miles
  • Grant Ritter
  • Kevin Campbell


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.


Treatment 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.

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflict of interests to declare.


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Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Department of Community HealthTufts UniversityMedfordUSA
  2. 2.Institute for Behavioral Health, The Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA
  3. 3.Institute for Child Youth and Family Policy, The Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA
  4. 4.Behavioral Health AdministrationWashington State Department of Social and Health ServicesOlympiaUSA

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