Addiction Among African Americans

The health concerns, including substance abuse and addiction treatment, of African Americans reflect the needs and issues of a diverse, heterogeneous group. Although the term African American is generally applied to individuals in the United States who can trace their ancestry to Africa, the term is often used to encompass a broad range of people of color, including individuals from Brazil or the Caribbean.

Today, the term Black American is also considered an acceptable definer of this demographic.

From the 1960s and ’70s “War on Drugs” to today’s opioid epidemic, addiction—whether real or exaggerated—has greatly affected the Black population of the United States.

Diversity in the Black American Demographic

Africa itself is an enormous continent, and its immigrants represent numerous nations. Yet the major government-sponsored studies of substance abuse and mental illness in African American communities do not differentiate between these recent immigrants from countries like Ethiopia or Somalia versus African Americans whose ancestors were brought to the U.S. as slaves many generations ago.

According to the U.S. Census Bureau as of July 2019, African Americans represent approximately 13.1% of the national population.¹

When looking at a portrait of substance abuse and mental illness among African Americans, it is important to remember that this group—like other racial groupings—also includes many ethnic subgroups, with varying traditions, religious beliefs, and cultural practices. For example, there is the ethnic subgroup of Afro-Hispanics and two dominant religious groups exist in African American culture: Christians and Muslims.

In addition, some individuals are multi-racial and do not identify with a single racial category, but rather two or more racial groups. A Black American might identify as White as well as African American, for instance.

Providing effective substance abuse treatment and mental healthcare requires that practitioners look at the complete picture of an individual, which includes so many factors beyond one’s race and requires that sensitivity to an individual’s unique history and origins.

This includes factors like:

• Nationality.
• Ethnicity.
• Geographic location (urban versus rural).
• Religious background.
• Family history.
• Cultural identification.

Patterns of Alcoholism in African Americans

National surveys on substance use in the U.S. consistently show that substance abuse rates are similar among African Americans, white Americans, and Hispanic Americans. In its 2018 National Survey on Drug Use and Health (NSDUH), the Substance Abuse and Mental Health Services Administration (SAMHSA) reports the following patterns of alcohol use:²

• 43% of African American respondents 12+ reported that they had used alcohol in the past 30 days, compared with 51.1% of population as a whole.
• 23% of African Americans age 12 and older reported binge drinking (consuming five or more drinks in one sitting)³, compared with a U.S. average of 24.5%.

While protective factors in black culture, such as a disapproval of drinking to intoxication, may reduce rates of binge drinking, African Americans tend to suffer more serious health and psychosocial problems from alcohol consumption, including:⁴

• Alcohol-related illnesses, such as liver disease, heart disease, esophageal cancer, and pancreatitis.
• Alcohol-related accidents and injuries.
• Exposure to violence.
• Legal repercussions.
• Exposure to communicable diseases, such as HIV/AIDS.

According to the 2018 NSDUH, the rate of alcohol use disorders among African Americans is lower (6.9%) than every other measured demographic except Asian Americans (4.9%).² However, African Americans are more likely than most other demographic groups to have ongoing problems with alcohol dependence once it occurs.⁵

The rate of recurrent alcoholism among Black Americans is 35.4%, versus 33% among Hispanic Americans and 22.8% among whites. The persistence of alcoholism among African Americans may be partly responsible for the higher rates of liver disease and other alcohol-related illnesses that affect those individuals.⁵

Substance Abuse in the African American Community

Although rates of past 30-day drinking and problem drinking among African Americans are lower than the national average, overall illicit drug use in the past 30 days is slightly higher. Illicit drug use includes use of marijuana (which is illegal in some states and at the federal level) and misuse of prescription psychotherapeutics (opioids, sedatives and stimulants). Interestingly, rates of illicit drug use other than marijuana in the past 30 days among African Americans are lower than the national average.

• Of Black Americans aged 12 and older, 13.7% reported using illicit drugs in the past 30 days, compared with 11.7% of the nation as a whole.²
• Of Black Americans aged 12 and older, 2.8% reported using illicit drugs other than marijuana in the past 30 days, compared with 3.2% of the nation as a whole.²

Black Americans have been historically plagued by problems with drugs, some real and some the result of racial profiling and cultural stereotypes. Yet national statistics from 2018 show that the rates of illicit drug abuse were roughly the same among African Americans, white Americans, and Native Hawaiians and Other Pacific Islanders.²

African Americans, especially in urban areas, have been associated with higher rates of cocaine use and trafficking, but these trends are changing. In 2015, 397,000 Black Americans aged 26 and up used cocaine in the past month (1.7%), whereas in 2018, 303,000 used the illicit substance (1.2%).⁶

In 2015, 54% of people admitted to treatment for cocaine abuse were African Americans, while 32% were white Americans, and 9% were Hispanic Americans. While cocaine-related admissions among Black Americans have gone down since the 1990s, Black Americans are still twice as likely as other racial groups to report having a cocaine problem on admission to treatment.⁷

Opioid abuse has been on the increase for many demographics, but there is concerning data around its use for this demographic in particular. In 2017, the opioid-related overdose death rate among African Americans was the third highest when compared to other race demographics, with 12.9 deaths per 100,000 people.⁸

Synthetic opioids in particular are causing a huge problem. Nearly 70% of opioid-related overdose deaths are caused by synthetic opioids in this demographic.⁸

Both the over-prescription of opioids in clinical settings and the use of illicit drugs like heroin and cocaine have been credited with this increase in opioid overdose deaths.⁸

African American Mental Health Issues

Finding culturally sensitive rehab programs and other mental health treatment programs can be a challenge for Americans who are members of minority groups.

Around 30% of African Americans with a mental health disorder seek out and use mental health services; about 49% of white Americans do.⁹

African Americans are 20% more likely than the rest of the U.S. population to experience severe forms of mental illness, such as major depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD), as well as higher rates of suicide among African American men.¹⁰

Lack of insurance is one of the greatest barriers to mental health treatment. Prior to the implementation of the Affordable Care Act, approximately 20% of African Americans were uninsured, though recent studies show an increase in coverage equality between non-Hispanic white and minority groups.¹¹

Although insurance would help offset some of the cost of treatment, many facilities will work with you to create payment plans or look into other approaches to help you reach your recovery goals. Sunrise House may be able to help in this regard. Call to find out your options.

When mental illness is combined with substance abuse, the search for treatment may become even more challenging. Serious mental health disorders, such as depressive episodes, suicidal thoughts, and co-occurring disorders, are increasing among African Americans.⁶

Substance abuse can worsen the symptoms of mental illness and may make it more difficult for clinicians to diagnose serious psychiatric conditions like depression, anxiety, bipolar disorder, or schizophrenia.¹² Mental illness combined with substance abuse, a condition known as having a co-occurring disorder, can be effectively addressed through an integrated treatment program that combines substance use recovery services with intensive mental health treatment.¹³

Addiction Treatment Needs among Black Americans

In order for Black Americans to receive the most effective substance abuse treatment and psychiatric care possible, addiction treatment professionals should address each patient as an individual, considering all of the variables that affect his or her mental health.^{14, 15}

No matter a person’s background, an individualized approach to treatment—and not a one-size-fits-all approach—can lead to better recovery outcomes. An individual approach, such as how Sunrise House and American Addiction Centers, takes into consideration race, culture, spirituality, and any other factors that could affect a patient’s approach to treatment.^{14, 15}

Providing a supportive, culturally sensitive environment is one of the keys to engaging Black Americans in treatment and helping them overcome the barriers to recovery.

References:

1. United States Census Bureau. (2019). QuickFacts United States.
2. Substance Abuse and Mental Health Services Administration. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
3. Centers for Disease Control and Prevention. (2019). Binge drinking.
4. Zapolski, T.C.B., Pedersen, S.L., McCarthy, D.M., & Smith, G.T. (2014). Less drinking, yet more problems: understanding African American drinking and related problems. Psychological Bulletin 140(1).
5. Chartier, K. & Caetano, R. (n.d.). Ethnicity and health disparities in alcohol research.
6. Substance Abuse and Mental Health Services Administration. (2018). 2018 National Survey on Drug Use and Health: African Americans.
7. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2017). Treatment Episode Data Set (TEDS): 2005-2015. Rockville, MD: Substance Abuse and Mental Health Services Administration.
8. Substance Abuse and Mental Health Services Administration. (2020). The opioid crisis and the Black/African American population: an urgent issue.
9. National Alliance on Mental Health. (2019). Mental health by the numbers.
10. National Alliance on Mental Health. (n.d.). Black/African American.
11. Sohn, H. (2017). Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course. Population Research and Policy Review 36(2), 181-201.
12. National Institute on Drug Abuse. (2020). Why is there comorbidity between substance use disorders and mental illnesses?
13. National Institute on Drug Abuse. (2020). What are the treatments for comorbid substance use disorder and mental health conditions?
14. National Institute on Drug Abuse. (2020). Principles of effective treatment.
15. Hilton, T. & Pilkonis, P.A. (2015). The key to individualized addiction treatment is comprehensive assessment and monitoring of symptoms and behavioral change. Behavioral Sciences 5(4), 477-495.