Identifying as someone wrestling with substance abuse and seeking adequate addiction treatment is often problematic for those who also identify as Black. Statistics show that only about 25% of African Americans seek mental health care, compared to 40% of Whites. Decoding why they get involved in substance abuse in the first place is critical to developing solutions.
Residing in communities whose enforcers exact disproportionately harsh consequences but also whose residents disparage and stigmatize mental health conversations situates many African Americans between a rock and a hard place. While African Americans make up only 12.5% of illicit drug users, 33% of people incarcerated for drug violations are black, according to the National Association for the Advancement of Colored People. Citizens of all ethnic groups commonly cope with any such situation – regardless of what the rock or hard place are – via substance abuse. This partly accounts for the significant opioid and marijuana addiction rates among Blacks.
The rate of deaths among Blacks from opioid overdose jumped 38% from 2018 to 2019, according to a study including the National Institute on Drug Abuse at the National Institutes of Health. Authors of that study called for an “antiracist public health approach” to curtail what it identified as a growing racial disparity in opioid overdoses. The study’s methodology involved the analysis of overdose data and death certificates across Kentucky, Massachusetts, New York and Ohio. It found no comparable spikes for any other ethnic groups. This has finally brought the Black opioid overdose rate above that of Whites despite it having been lower than the White opioid overdose rate during earlier waves of the current opioid crisis, as evinced by a study published in Addiction last year showing an unmoved, lower Black rate from 1999 through 2012.
That being said, far more Blacks ages 12 and up use marijuana than cocaine, heroin or methamphetamines. The Substance Abuse and Mental Health Services Administration (SAMHSA) found in a 2020 national survey that 19.3% of Blacks above the age of 11 were using marijuana, compared to just 1.6% on cocaine, 0.3% on heroin and 0.2% on meth. The figure accounts for an estimated 6.4 million Blacks on marijuana.
McLean Hospital, a Harvard Medical School affiliate, positioned a strong mental health stigma in the Black community as a major culprit in any investigation of barriers to substance abuse treatment. Dr. Christine M. Crawford, Boston University School of Medicine’s assistant director of psychiatric medical student education, framed the stigma of mental health in Afro Americana in a guest blog for McLean Hospital. Crawford states that stigma is a product of trans-Atlantic Slave Trade ideology, which saw slaves as subhuman, especially intellectually. While it’s human to occasionally succumb to irrational thought in emotional reactions, Slaves weren’t afforded the same luxury, so mental health problems among Blacks led Whites to label them defective. Countless anecdotal commentaries from 17th- and 18th-century Whites characterized the so-called Negro as too unsophisticated to develop depression, anxiety or other mental health disorders.
“From those historic misconceptions, we learned to ignore mental illness or call it other terms, like ‘stress’ and ‘being tired,’” Crawford said, describing antebellum culture as having conditioned Blacks to avoid acknowledging any such defects.
Crawford pointed out that a psychiatric disorder is viewed as a personal weakness in the Black community. This aligns with a study published in the National Library of Medicine that found 63% of African Americans believed that a mental health condition is a sign of personal weakness. The racial disparities in the War on Drugs campaign of the last 50 years have come to be viewed by some, including LZ Granderson (a Black op-ed columnist for the Los Angeles Times), as its own obstacle to progress for his community.
A History of Addiction and Black Conviction
The U.S. has endeavored to fight illicit drug use for several consecutive decades, but results thus far lend little credence to the efficacy of strategies engaged to fight either addiction or substance abuse. For one, Granderson castigates incarceration as the whole point to the War on Drugs, arguing that stats show the war succeeded in what it set out to accomplish. The U.S. has the largest prison population in the world, and the most common reason for imprisonment in state prisons is drug-related crimes. The Brennan Center for Justice at NYU Law buttresses that claim with the reminder that John Ehrlichman, Richard Nixon’s domestic policy advisor, confirmed in a 1994 interview that the War on Drugs campaign began as a discussion about criminalizing Blacks and liberals.
A more glaring challenge is the issue of systemic racism which has encouraged disparity in addiction treatment and crippled efforts made by marginalized Black and Hispanic demographics in accessing professional help. Reports indicate that Black people who engage in illicit drug use don’t do so any more than their White counterparts. However, more Black drug offenders have been arrested and incarcerated than Whites. In fact, Lafuente, a Southern California-based addiction treatment center, believes the rate of drug abuse among Blacks may be lower than among Whites. Regardless, the mere conversation demonstrates bias in dealing with substance abuse.
A typical example is racially-motivated policing, which is considered by sympathizers to lead some in the Black community to drugs as a coping mechanism. A May 2020 study on substance abuse pathology and intervention found a strong correlation between the rate at which individuals discount future rewards and their statistical propensity for substance abuse. This indicates a broad spectrum of personalities – regardless of race or ethnicity – that are easily influenced to undervalue long-term consequences weighed against short-term rewards. That influence can be anything that threatens long-term rewards. In other words, reinforcer pathology theory might suggest Blacks are deterred from investing in long-term rewards by prejudicial policing to risk incarceration, death and other negative outcomes for immediate relief to cope with dismal horizons of expectation.
The concept parallels an even more mainstream, ongoing investigation of the correlations between substance abuse disorders and depression or anxiety disorders as explored in countless studies. Moreover, the Black community is notorious for avoiding necessary mental health conversations. African Americans who abuse drugs are also more likely to end up in jail than European Americans. These factors are major contributors to the access barriers African Americans have to hurdle for addiction treatment services.
What Progress Looks Like
In all, the good news is that part of the Black community, though small in number, are actively seeking treatment for opioid addiction. The will to free themselves from the controlling elements of addiction has, for them, grown strong enough to take action, ideally in the form of drug and alcohol rehab via medical detox and psychotherapy. When they arrive at Landmark Recovery, for example, they ultimately end up exploring the mental health conversations that were either obfuscated or avoided earlier in life. Sociologists and addiction experts also believe that, with the right approach, more African Americans can embrace drug rehabilitation and be more willing to discuss their challenges.
According to a paper published in the Journal of Community Health, “Healthcare environments are not exempt from the impact of stigma against mental illness and addiction,” and to address the problem, healthcare organizations need to implement “mental illness and addiction anti-stigma anti-discrimination programming as part of their staff-wide professional development.”
A workable solution is to shore up the relationships between treatment centers or outpatient rehab facilities and other medical facilities, which already treat conditions that include those commonly comorbid with marijuana, alcohol, heroin, cocaine and other addictions. This also makes treatment options like those offered by Landmark the ideal approach to addiction treatment for its suboxone-based medical detox procedures and therapy for inpatients. Landmark provides a safe space to discuss mental health, introducing medical detox using suboxone for minimal discomfort when coming off drugs, addiction therapy and even residential treatment.