Disparties in substance abuse (SA treatment)
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The goal of this study is to supply service planners and policy makers with the best available data on the magnitude and sources of racial/ethnic disparities in substance abuse treatment services, and the economic and social consequences of substance disorders in minority populations in the US. In the first three aims, we apply the Institute of Medicine health disparity framework, which emphasizes that a disparity includes all differences in treatment between racial/ethnic groups that are mediated through factors other than health status and preferences. The first aim estimates and compares unmet need for substance abuse treatment services by racial/ethnic group (Asians, Latinos, African-Americans, and non-Latino whites). The second aim calculates disparities in substance abuse treatment utilization for each racial/ethnic minority group relative to non-Latino whites. The third aim identifies and assesses the relative contribution of various mechanisms of disparities such as insurance, SES, language, and geography. The fourth aim estimates the association between substance disorders and labor market and public assistance outcomes in minority populations in order to highlight the economic burden that potentially could be prevented by reducing disparities. Finally, the goal of the fifth aim is to disseminate policy-relevant findings generated from the prior four aims to key stakeholders in the health disparities and substance abuse field. Data come from four new, large, nationally representative data sets, the National Latino and Asian American Study (NLAAS), the National Comorbidity Survey Replication study (NCS-R), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the National Survey on Drug Use and Health (NSDUH). These surveys offer diagnostic information on substance and other mental disorders, treatment utilization information, and rich data on labor market outcomes, public assistance receipt and other sociodemographic factors. To estimate disparities, we apply non-linear models of service use recently introduced in the health services research literature. To study mechanisms, we apply regression-based decomposition methods to understand what proportion of disparities can be explained by different sources. We test the sensitivity of our findings to several alternate definitions of need and treatment. Our findings will offer some of the best and most recent data available on the magnitude and sources of national racial/ethnic disparities in the utilization of substance abuse treatment. The study also will generate some of the first information available about the potentially preventable labor market and public assistance consquences of substance disorders in minority populations. This information is critically needed to develop effective policies to remediate disparities, and, ultimately, to improve public health by reducing the burden of substance disorders in racial/ethnic minority populations.
