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.
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
- 7.Cook BL, Alegría M. Racial-ethnic disparities in substance abuse treatment: The role of criminal history and socioeconomic status. Psychiatric Services. 2011;62(11):1273–1281.Google Scholar
- 10.Saloner B, Cook BL. Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health Affairs. 2013;32(1):135–145.Google Scholar
- 15.Jacobson JO, Robinson P, Bluthenthal RN. A multilevel decomposition approach to estimate the role of program location and neighborhood disadvantage in racial disparities in alcohol treatment completion. Social Science & Medicine. 2007;64(2):462–476.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.
- 32.Krieger N, Chen JT, Waterman PD, et al. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--the public health disparities geocoding project. American Journal of Public Health. 2003;93(10):1655–1671.CrossRefPubMedPubMedCentralGoogle Scholar
- 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
- 50.Stahler GJ, Mazzella S, Mennis J, Chakravorty S, Rengert G, Spiga R. The effect of individual, program, and neighborhood variables on continuity of treatment among dually diagnosed individuals. Drug and Alcohol Dependence. 2007;87(1):54–62.Google Scholar
- 52.Guerrero EG, Kao D, Perron BE. Travel distance to outpatient substance use disorder treatment facilities for Spanish-speaking clients. International Journal of Drug Policy. 2013;24(1):38–45.Google Scholar
- 53.Rosenblum A, Cleland CM, Fong C, Kayman DJ, Tempalski B, Parrino M. Distance traveled and cross-state commuting to opioid treatment programs in the United States. Journal of Environmental and Public Health. 2011;2011:1–10.Google Scholar
- 54.Gaskin DJ, Dinwiddie GY, Chan KS, McCleary R. Residential segregation and disparities in health care services utilization. Medical Care Research Review. 2012;69(2):158–175.Google Scholar
- 55.Dinwiddie GY, Gaskin DJ, Chan KS, Norrington J, McCleary R. Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health. Social science & medicine. 2013;80:67–75.Google Scholar
- 56.Mark TL, Levit KR, Vandivort-Warren R, Buck JA, Coffey RM. Changes In US spending on Mental Health And Substance Abuse Treatment, 1986-2005, and implications for policy. Health affairs. 2011;30(2):284–292.Google Scholar
- 57.Mark TL, Levit KR, Yee T, Chow CM. Spending on mental and substance use disorders projected to grow more slowly than all health spending through 2020. Health affairs. 2014;33(8):1407–1415.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.
- 60.Archibald ME, Putnam Rankin C. A spatial analysis of community disadvantage and access to healthcare services in the U.S. Social science & medicine. 2013;90:11–23.Google Scholar