Alcohol and other drug (AOD) disorders have disproportionate impact on the health of minority groups, including more severe alcohol problems and higher rates of drug overdose mortality. Yet, members of racial/ethnic minority groups who need treatment are less likely to access treatment, and once entering treatment are less likely to become engaged in or complete treatment, and to have worse employment and criminal justice treatment outcomes than their white counterparts. Individual factors (e.g., socioeconomic status) have been shown to contribute, but not completely explain racial/ethnic disparities in treatment. One promising direction is to add a focus on community characteristics which have been shown to influence disparities broadly in health and general health care services. The proposed research examines the influence of community characteristics on racial/ethnic disparities in the treatment of AOD disorders. This study will be a secondary analysis using data from Washington's publicly funded specialty AOD treatment system linked to data from state employment and criminal justice agencies, as well as community level data from the U.S. Census, to understand drivers of disparities. The proposed analysis will test to what degree race/ethnicity and community characteristics influence receiving AOD care that conforms to a well-established quality indicator, engagement in outpatient treatment, as well as employment and arrest outcomes. The current study aims to: 1. Determine whether community characteristics mediate racial/ethnic disparities in treatment engagement. 2. Test whether racial/ethnic disparities in post-treatment employment, DUI arrests, and drug-related arrests exist and whether community characteristics mediate any disparities. 3. Explore whether community characteristics'moderate the relationship between race/ethnicity and treatment engagement, employment, and criminal justice outcomes this study has the potential to explain the pathways of how racial/ethnic disparities in AOD treatment occur. Findings from this study will inform the development of appropriate interventions, at the client or community- level, needed to eliminate disparities in AOD treatment, and ultimately in health outcomes.

Public Health Relevance

The 2010 Patient Protection and Affordable Care Act is expected to substantially increase access to treatment for alcohol and other drug (AOD) disorders. In view of the known disproportionate negative impact of these disorders experienced by racial/ethnic minorities, it is imperative to make high quality AOD treatment available to all groups. The findings of this study will inform development of targeted interventions which can be implemented at the individual and/or community levels to eliminate disparities in AOD treatment.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Small Research Grants (R03)
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Biomedical Research Review Subcommittee (AA)
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Roach, Deidra
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Brandeis University
Schools of Social Welfare/Work
United States
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Acevedo, Andrea; Miles, Jennifer; Garnick, Deborah W et al. (2018) Employment after beginning treatment for substance use disorders: The impact of race/ethnicity and client community of residence. J Subst Abuse Treat 87:31-41
Acevedo, Andrea; Panas, Lee; Garnick, Deborah et al. (2018) Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter? J Behav Health Serv Res 45:533-549