This was nearly 80 years after Dr. Solomon Carter Fuller became America's first Black psychiatrist in 1897 at the young age of 25. He was a researcher, neuropsychiatrist, teacher, and pioneer in Alzheimer's Disease. He worked closely with Dr. Alois Alzheimer to understand the illness and develop treatments. Dr. Fuller blazed the path for the numerous Black psychiatrists, psychologists, social workers, peers, and others who have similarly dedicated their professional lives to understanding the illness of addiction and changing the way we treat the people who experience it.

To truly honor those who came before us, and those who continue to champion the cause today, we have to address the healthcare and social inequities that exist for Black people with addiction. 

What does inequality look like?

The book Unaddiction: 6 Mind-Changing Conversations That Could Save a Life says that “Black people have lower rates of substance use disorders (SUD) overall, but once we have a substance use disorder, we’re more likely to lose our job as a result of it or go to prison because of it, more likely to acquire another disease like cirrhosis of the liver, and even more likely to die from it.” 

If the first question you asked yourself was “WHY??” You’re asking the right question.

These health disparities occur in substance use disorders for the same reasons health disparities occur with other chronic illnesses. While this certainly isn’t an exhaustive list, I would say the four big drivers are:

Stigma 

75% of people with addiction recover. And yet, as many as 51% of health professionals surveyed had negative attitudes and beliefs about a SUD. It’s not surprising then, that the same study showed a third of Americans don’t believe treatment for SUD works. This stigma is killing our loved ones – and it’s making it harder for us to start recovery.

Access to Care

Black communities are more likely to face barriers to treatment for an SUD including work responsibilities, financial barriers, family obligations, stigma, and others. Despite similar rates of opioid use disorder (OUD) occurring in Black and white populations, Black people are 77% less likely to be prescribed buprenorphine. This medication is considered to be the gold standard for treating an OUD.

Implicit Bias, Racism, & Discrimination

Highly educated professionals, like doctors, often think their educational level reduces implicit bias. However, this simply is not the case, and not recognizing this is dangerous. While we’ve seen decreases in explicit racism in medicine, we have not yet begun to see meaningful decreases in implicit bias. Studies repeatedly show that higher levels of implicit bias lead to lower quality of care.

Lack of Whole Person Care 

What do I even mean when I say whole person care?! I mean care that addresses the mental, physical, psychological, environmental, and cultural aspects of a person’s health. Simply stopping drug use is not enough.

Imagine you have a car with four flat tires. You fix one tire, but don’t touch the other three. Would you really be surprised when your car doesn’t run the way it should? We have to fix all the tires.  This means addressing adult and childhood trauma, depression, anxiety, and other mental health conditions. It also means accounting for physical health conditions and social drivers of health while empowering people to maximize positive cultural inputs (e.g. traditions and community connection). 

Where do we go from here?

The first step to being able to make a change is recognizing we have a problem. When it comes to health disparities for Black people with addiction – We. Have. A. Problem. I have been so encouraged these last 5 years to see the conversations around stigma reduction, whole person care, and health equity transform from conversations to expectations to regulations. This is the way we will create change. First, we talk the talk. Then, we walk the walk. And finally, we turn the walk into the new standard. 

Nzinga Harrison, MD, DFAPA  |  Founder & Chief Medical Officer, Eleanor Health
- Author, Un-Addiction: 6 Mind-Changing Conversations That Could Save a Life
- Host, Un-Addiction Podcast
- @NzingaMD on social