Review
Disparities in Treatment for Substance Use Disorders and Co-Occurring Disorders for Ethnic/Racial Minority Youth

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Objective

To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents.

Method

A literature review was conducted of behavioral health services for minority youth. Articles were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized according to a sociocultural framework.

Results

Compared with non-Latino Whites with SUD, Black adolescents with SUD reported receiving less specialty and informal care, and Latinos with SUD reported less informal services. Potential mechanisms of racial and ethnic disparities were identified in federal and economic health care policies and regulations, the operation of the health care system and provider organization, provider level factors, the environmental context, the operation of the community system, and patient level factors. Significant disparity decreases could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Because treatments appear to work well independent of race/ethnicity, translational research to bring evidence-based care in diverse communities can bolster their effectiveness.

Conclusions

This review suggests promising venues to decrease ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.

Section snippets

Search Strategy

We performed PubMed searches using the Medical Subject Heading terms for substance use disorders, health services, adolescence, and health disparities. We repeated this search three times, substituting the terms ethnicity and then poverty for service disparities. This search was repeated using the PsycINFO database. Only studies that explicitly addressed racial/ethnic differences in behavioral health service use were included. Studies that did not include children or adolescents were excluded.

Behavioral Health Services for Racial/Ethnic Minority Youth

Recent results from the NSDUH serve as context for understanding unmet needs for behavioral health services. The NSDUH estimates the prevalence of SUDs and use of behavioral health services for the U.S. civilian, noninstitutionalized population 12 years and older. Table 1 presents 2005 to 2008 data on previous-year SUDs, specialty treatment, and informal treatment. Compared with non-Latino Whites with SUDs, Black adolescents with SUDs reported receiving less specialty and informal care, and

Discussion

Nationally representative studies that test the proposed mechanisms of behavioral health service disparities for minority youth with SUD are needed. Identifying such mechanisms is of particular concern so that outreach, treatment completion, and effective referral interventions can be designed. Parental perceptions and beliefs surrounding need for care are central to engaging minority youth, although further research is needed to quantify their impact. Schools are crucial referral sources, and

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    The statistical expert was Chih-Nan Chen, Ph.D., of the Center for Multicultural Mental Health Research, Cambridge Health Alliance. We are grateful to Ms. Sheri Lapatin, of the Center for Multicultural Mental Health Research, Cambridge Health Alliance, for her helpful editing of the article.

    This work was supported by grant 1P50 MHO 73469 funded by the National Institute of Mental Health/National Institutes of Health and by grant P60 MD0 02261 funded by the National Center for Minority Health and Health Disparities.

    Disclosure: Drs. Alegria, Carson, and Goncalves and Ms. Keefe report no biomedical financial interests or potential conflicts of interest.

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