Blog: Substance use disorder stigma must end for Black, African American communities

The opioid epidemic impacts all racial and ethnic groups, but attention paid to this epidemic has often neglected to include Black/African American communities. While the opioid epidemic over time has been more appropriately framed as an urgent public health issue, there are still barriers to substance use disorder treatment for people of color.

Some of these barriers are due to the disparities of incarceration and drug dependency in communities of color. Beginning in the 1970s, the “War on Drugs” intended to manage the devastating effects of substance use on Black communities. Unfortunately, it had the opposite impact, resulting in mass incarceration of people of color. Many families were left financially unstable, homeless, food insecure and without access to addiction treatment and other health care services, a trend that continues today. When the impact of addiction hits parents, children often go to bed hungry, have poorer academic outcomes and display social and emotional problems.   

The trauma of daily life can be a barrier to care for people of color, particularly when that trauma is embedded in the community as a result of racial, ethnic and systemic biases, community violence, and poor environmental living conditions. African Americans are less likely to report or categorize traumatic experiences as trauma or seek treatment when symptoms occur; therapy and the use of medications to treat mental illness and substance use disorders are often unmentionable in the Black community. Consequently, these communities may be at higher risk of using substances as a maladaptive method to cope with stressors and to suppress thoughts and feelings associated with trauma.

It’s time to systemically reduce the stigma surrounding treatment for substance use disorders for all, but given the unique barriers described above, particularly for people of color, it’s essential that we provide education focused on the reality that substance use disorders are complex brain diseases, with context for how these ailments are driven by genetic and environmental factors.

Our hope is that access to and availability of resources will allow for proper diagnosis and treatment of these devastating brain illnesses. Here are some to initiate the path to healing: 

• Psychology Today (find a provider)
• Innopsych (locate therapist of color)
• SAMHSA (National Healthline)
• SAMHSA (treatment locator)
• Learning to Cope (family support)

While we can’t erase decades of misunderstanding of this epidemic, we do have the ability to change the devastating effects on the Black community moving forward.

Sejal B. Shah, M.D., is chief of the Division of Medical Psychiatry, and Carla B. Monteiro is a licensed clinical social worker at Brigham and Women’s Hospital.