July 2, 2009

Treatment for Substance Use and Depression among Adults, by Race/Ethnicity

Racial and ethnic diversity is perhaps one of the greatest strengths of the United States; however, addressing the health care needs of an increasingly racially and ethnically diverse population presents many challenges. One area of concern for policymakers is identifying and reducing racial and ethnic disparities in substance abuse and mental health treatment. The prevalence of the need for substance abuse and mental health treatment and the actual receipt of treatment have been shown to vary across racial and ethnic groups. Gaining a better understanding of these differences may help to increase the availability and access to treatment and ultimately may help substance abuse and mental health professionals to improve service to a diverse population.

The National Survey on Drug Use and Health (NSDUH) collects information that can be used to assess the need for and receipt of treatment for substance use and mental health problems. NSDUH classifies persons as needing treatment for a substance use (i.e., alcohol or illicit drugs) problem if they met the criteria for dependence or abuse or if they received specialty substance use treatment in the past year.¹ Specialty substance use treatment is defined as treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient services only), and mental health centers. Specialty substance use treatment excludes treatment in an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient.

NSDUH also includes questions about major depressive episode (MDE) and treatment for depression. MDE is defined using the diagnostic criteria set forth in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer in which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. Treatment for depression is defined as having seen or talked to a medical doctor or other professional about depression or having used prescription medication for depression in the past year.

This issue of The NSDUH Report focuses on the need for and receipt of treatment for a substance use problem and MDE among adults aged 18 or older by race/ethnicity. All findings are annual averages based on combined 2004 to 2007 NSDUH data.

Approximately one tenth of adults (9.7 percent; an estimated 21.2 million persons) needed treatment for a substance use problem in the past year. American Indian or Alaska Native adults had the highest rate of substance use treatment need (19.4 percent), followed by persons of two or more races (12.4 percent), Native Hawaiians or Other Pacific Islanders (12.0 percent), Hispanics (10.1 percent), blacks (10.0 percent), whites (9.7 percent), and Asians (5.0 percent) (Figure 1).

Figure 1. Need for Treatment for a Substance Use Problem in the Past Year among Adults, by Race/Ethnicity: 2004 to 2007

About 1 in 10 (10.5 percent) of the adults in need of substance use treatment in the past year received treatment at a specialty facility in the past year. Among those in need of treatment, blacks had a higher rate of receipt of treatment in a specialty facility than persons of two or more races, Hispanics, whites, and Asians (17.8 vs. 11.9, 11.3, 9.2, and 5.5 percent, respectively); the rate among Hispanics was higher than that among Asians (11.3 vs. 5.5 percent) (Figure 2).

Figure 2. Receipt of Treatment for a Substance Use Problem in a Specialty Facility in the Past Year among Adults with Past Year Need of Treatment, by Race/Ethnicity*: 2004 to 2007

About 1 in 12 adults (7.5 percent; an estimated 16.3 million persons) experienced MDE in the past year. Persons of two or more races had the highest rate of MDE (13.3 percent), followed by Native Hawaiians or Other Pacific Islanders (11.6 percent), American Indians or Alaska Natives (9.7 percent), whites (8.0 percent), blacks (6.5 percent), Hispanics (6.3 percent), and Asians (3.6 percent) (Figure 3).

Figure 3. Major Depressive Episode (MDE) in the Past Year among Adults, by Race/Ethnicity: 2004 to 2007

Approximately two thirds (66.1 percent) of adults with past year MDE received treatment for depression in the past year. Among adults with past year MDE, whites were more likely to have received treatment than blacks, Hispanics, and Asians (69.6 vs. 57.4, 53.4, and 48.0 percent, respectively), and persons of two or more races were more likely to have received treatment than Hispanics and Asians (65.2 vs. 53.4 and 48.0 percent, respectively) (Figure 4).

Figure 4. Receipt of Treatment for Depression in the Past Year among Adults with Past Year Major Depressive Episode (MDE), by Race/Ethnicity*: 2004 to 2007

Although the rates of past year need for treatment for a substance use problem and depression (i.e., past year MDE) were similar, there were large differences in receipt of treatment for these problems. Only about 1 in 10 adults in need of substance use treatment in the past year actually received it, whereas over 6 in 10 adults in need of treatment for depression in the past year received it.

The need for and actual receipt of treatment for both substance use and depression varied by race/ethnicity; however, the racial/ethnic patterns were different for each. Among those in need of substance use treatment, blacks had higher rates of receipt of treatment in a specialty facility than persons of two or more races, Hispanics, whites, and Asians. Among adults with past year MDE, whites were more likely to have received treatment than blacks, Hispanics, and Asians; persons of two or more races were more likely to have received treatment than Hispanics and Asians.

Differences in rates of receipt of substance use and mental health treatment may be linked to differential access to treatment, differences in rates of utilization of available services, and perceived need for treatment by race/ethnicity, as well as availability of culturally appropriate services. These findings highlight the need for continuing efforts to improve access to treatment, for educational services that help individuals recognize the need for and potential benefits of treatment, and for continued research on how and why treatment utilization varies across racial and ethnic groups.