Black women in the US suffer more negative health consequences of illicit drug use than their White counterparts, despite using drugs to a lesser degree. The present study examined individual factors associated with need for substance use treatment and attendance in professional treatments and community-based services like AA.
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Black Americans are less likely to engage in illicit drug use than other Americans but suffer more negative consequences when they use drugs. Black Americans make up ~25% of all drug-related arrests in the US despite Black people comprising less than 14% of people who use illicit drugs. Black Americans also progress from substance use to substance use disorders more quickly than White Americans and experience more negative substance use related consequences over the life course than White Americans.
Substance use disorder recovery may be especially challenging for Black women due to discrimination within healthcare and the criminal legal system. Mutual-help groups (e.g., Narcotics Anonymous [NA]) could be an affordable and accessible strategy to mitigate the burden that illicit drugs have on the Black community. However, Black women with alcohol use disorder may be less inclined to utilize mutual-help groups than their male and White counterparts (i.e., black men, white men, and white women), though researchers caution this conclusion is “tentative” given studies were not designed specifically to test health disparities by race/ethnicity. Evidence also suggests that co-occurring mental health issues impact substance use disorder utilization in the general population. How mental health challenges typically present among Black women who use drugs, and their impact on treatment and mutual-help utilization can help inform best practice recommendations for this unique, often at-risk group. To this end, the present research was designed to determine substance related needs among Black women, including those involved, and not involved, with the criminal-legal system.
Data for the present analysis were derived from a longitudinal cohort study- the Black Women in Study of Epigenetics (B-WISE). The goal of the primary study was to examine health disparities among Black women who were involved in the criminal-legal system (e.g., in prison) and used drugs. Participants were 565 self-identified Black women recruited from a single southern state. Participants were recruited proportionally from prison (35.6%), probation offices (31.5%) and the community (32.9%). Participants engaged in the study completed a baseline survey and then a follow-up survey 18 months later. Data collection ended in 2015.
To recruit women from prison, the authors invited women who were meeting with their parole board or were being released within 60 days to an information session on the study where they were invited to participate. For those on probation, the authors reached out to 6 probation offices to identify potential participants who were invited to participate. For those in the community (not involved with the criminal-legal system) the authors posted flyers in predominantly Black neighborhoods. Eligibility criteria included: 1) self-identification as a Black woman, (2) ≥18 years of age, (3) English language fluency, and (4) willingness to participate. In addition, participants recruited from the community could not currently be involved or have pending criminal legal system contact at baseline.
The primary outcomes of this study were participation in either substance use treatment or mutual-help groups. These outcomes were assessed at follow-up via the item “Have you participated in an alcohol or drug treatment program?” (1=yes, 0=no). Women were also asked at 18 months how frequently they participated in Alcoholics Anonymous, Cocaine Anonymous, or Narcotics Anonymous (0=never, 1= monthly/less than monthly, 2=at least weekly). In addition, the authors measured culturally relevant factors at baseline. These measures included religiosity via the 12-item Spiritual Well-Being scale, active coping via the 12-item John Henryism Active Coping Scale. Mental health was assessed via measures of trauma and psychiatric symptoms. Lifetime trauma was measured using an adapted version of the Traumatic Life Events Questionnaire. Lifetime psychiatric symptoms were measured via the Addiction Severity Index psychiatric subscale.
The goal of this study was to determine potential profiles of substance use needs among Black women. To do this the authors a sophisticated statistical method to categorize participants based on a series of shared characteristics. In the present study, Black women were categorized into 4 groups based on their substance use and mental health: “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”. “Low need” women (44.1%) reported never using alcohol, marijuana, or crack ever or in the past year and had very low prevalence of mental health issues. “Daily marijuana use” (19.6%) reported some marijuana use in the past year with the majority reporting daily use and had low prevalence of mental health issues. “High mental health needs” women (14.0%) reported little to no alcohol, marijuana, or crack use, but had high rates of trauma and psychiatric symptoms. Finally, the “high comorbidity needs” group was characterized by high crack use and high prevalence of trauma and psychiatric symptoms. After deriving these 4 profiles, analyses examined differences in treatment and mutual-help attendance, as well as other factors relevant to understanding help-seeking behavior, including religiosity, use of active coping, and trust in physicians.
The average age of women in the study was 36 years. Most participants were single (not married; 63.5%). Nearly half (44.6%) had health insurance during the year prior to baseline. Most participants reported earning less than $10,000 annually (65.9%). About half of the women (52.3%) had a history of substance use disorder treatment.
Differences in treatment varied by criminal-legal system involvement
Black women in the High Comorbidity Need group had the highest likelihood of attending treatment – greater than the High Mental Health and Daily Marijuana groups – but this was not significantly different from the Low Need Group. That said, women recruited from the community were less likely to attend treatment compared to those recruited from prison.
Women involved in the criminal-legal system were more likely to attend treatment and mutual-help
Women recruited from prison were more likely to attend treatment than both women from the community as well as those recruited from probation. Women recruited from prison were also more likely to attend mutual-help than those in the community, but no more likely to attend mutual-help than those on probation.
Women with comorbid mental health and substance use challenges were more likely to attend mutual-help
Women in the High Comorbidity Needs group (with both substance use and mental health challenges) were more likely to attend mutual-help than those with Low Need. But the Daily Marijuana and High Mental Health groups were no more likely to attend than the Low Need Group, suggesting that only the High Comorbidity Need group had an increased likelihood of attending mutual-help by the follow-up. More religiosity was also uniquely associated with greater odds of attending mutual-help (but not treatment).
The results of this study suggest that Black women who use drugs most in need of substance use treatment – with daily marijuana use and/or additional mental health challenges – are no more likely to receive treatment than those with low need. The authors did find, however, that women recruited from prison or probation were more likely to receive treatment and attend mutual-help. These elevated rates of service utilization, while not examined specifically in this study, are almost certainly related to contingencies regarding their criminal-legal status (e.g., treatment or mutual-help attendance required in order to avoid jail time). Mandated or involuntary treatment is both associated with positive outcomes and also carries increased risks for individuals with opioid use disorder in context of reduced tolerance during an abstinence-based involuntary treatment episode with no access to FDA-approved medications increasing risk for overdose.
It is interesting that the High Comorbidity Need Group – who were more likely to have been recruited from prison, had more trauma symptoms, and higher rates of injection drug use – were more likely to attend mutual-help, but not treatment, compared to the Low Needs group. It may be that mutual-help groups are more accessible than treatment for this at-risk group of Black women that use drugs. It could also be that the conditions of their criminal-legal status required either treatment or mutual-help, and they were more likely to choose the comparatively more flexible options, with meetings at various times and locations whereas treatment may be more constraining. Future qualitative research might help better understand perceptions of treatment, mutual-help, and other services for Black women who use drugs.
Finally, the relationship between religiosity and mutual-help is consistent with other studies showing that more religious individuals have higher rates of 12-step mutual-help attendance. Also of note, there was a bivariate association between religiosity and treatment attendance that did not remain in the full model. Religion/spirituality may be a salient part of recovery for Black individuals, in particular, where they are much more likely to report that they make “all the difference” than White individuals in resolving their substance use problem. Religiously-affiliated approaches may help to attract and engage Black individuals generally, and Black women in particular, to treatment and recovery supports.
This study of Black women who use drugs found no differences between four identified profiles — “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”— on substance use disorder treatment attendance, suggesting that other factors may play a role in treatment utilization. However, the those with high comorbidity needs were more likely to attend mutual-help groups. The current findings highlight the complex patterns of substance use and mental health needs among Black women, particularly those involved with the criminal-legal system, and underscore the importance of interventions that address their unique needs.
Oser, C. B., Moody, M. D., Hansen, A. C., Stevens-Watkins, D., Staton, M., & Bunting, A. M. (2024). Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: a latent class approach. Drug and Alcohol Dependence, 260. doi: 10.1016/j.drugalcdep.2024.111326.
l
Black Americans are less likely to engage in illicit drug use than other Americans but suffer more negative consequences when they use drugs. Black Americans make up ~25% of all drug-related arrests in the US despite Black people comprising less than 14% of people who use illicit drugs. Black Americans also progress from substance use to substance use disorders more quickly than White Americans and experience more negative substance use related consequences over the life course than White Americans.
Substance use disorder recovery may be especially challenging for Black women due to discrimination within healthcare and the criminal legal system. Mutual-help groups (e.g., Narcotics Anonymous [NA]) could be an affordable and accessible strategy to mitigate the burden that illicit drugs have on the Black community. However, Black women with alcohol use disorder may be less inclined to utilize mutual-help groups than their male and White counterparts (i.e., black men, white men, and white women), though researchers caution this conclusion is “tentative” given studies were not designed specifically to test health disparities by race/ethnicity. Evidence also suggests that co-occurring mental health issues impact substance use disorder utilization in the general population. How mental health challenges typically present among Black women who use drugs, and their impact on treatment and mutual-help utilization can help inform best practice recommendations for this unique, often at-risk group. To this end, the present research was designed to determine substance related needs among Black women, including those involved, and not involved, with the criminal-legal system.
Data for the present analysis were derived from a longitudinal cohort study- the Black Women in Study of Epigenetics (B-WISE). The goal of the primary study was to examine health disparities among Black women who were involved in the criminal-legal system (e.g., in prison) and used drugs. Participants were 565 self-identified Black women recruited from a single southern state. Participants were recruited proportionally from prison (35.6%), probation offices (31.5%) and the community (32.9%). Participants engaged in the study completed a baseline survey and then a follow-up survey 18 months later. Data collection ended in 2015.
To recruit women from prison, the authors invited women who were meeting with their parole board or were being released within 60 days to an information session on the study where they were invited to participate. For those on probation, the authors reached out to 6 probation offices to identify potential participants who were invited to participate. For those in the community (not involved with the criminal-legal system) the authors posted flyers in predominantly Black neighborhoods. Eligibility criteria included: 1) self-identification as a Black woman, (2) ≥18 years of age, (3) English language fluency, and (4) willingness to participate. In addition, participants recruited from the community could not currently be involved or have pending criminal legal system contact at baseline.
The primary outcomes of this study were participation in either substance use treatment or mutual-help groups. These outcomes were assessed at follow-up via the item “Have you participated in an alcohol or drug treatment program?” (1=yes, 0=no). Women were also asked at 18 months how frequently they participated in Alcoholics Anonymous, Cocaine Anonymous, or Narcotics Anonymous (0=never, 1= monthly/less than monthly, 2=at least weekly). In addition, the authors measured culturally relevant factors at baseline. These measures included religiosity via the 12-item Spiritual Well-Being scale, active coping via the 12-item John Henryism Active Coping Scale. Mental health was assessed via measures of trauma and psychiatric symptoms. Lifetime trauma was measured using an adapted version of the Traumatic Life Events Questionnaire. Lifetime psychiatric symptoms were measured via the Addiction Severity Index psychiatric subscale.
The goal of this study was to determine potential profiles of substance use needs among Black women. To do this the authors a sophisticated statistical method to categorize participants based on a series of shared characteristics. In the present study, Black women were categorized into 4 groups based on their substance use and mental health: “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”. “Low need” women (44.1%) reported never using alcohol, marijuana, or crack ever or in the past year and had very low prevalence of mental health issues. “Daily marijuana use” (19.6%) reported some marijuana use in the past year with the majority reporting daily use and had low prevalence of mental health issues. “High mental health needs” women (14.0%) reported little to no alcohol, marijuana, or crack use, but had high rates of trauma and psychiatric symptoms. Finally, the “high comorbidity needs” group was characterized by high crack use and high prevalence of trauma and psychiatric symptoms. After deriving these 4 profiles, analyses examined differences in treatment and mutual-help attendance, as well as other factors relevant to understanding help-seeking behavior, including religiosity, use of active coping, and trust in physicians.
The average age of women in the study was 36 years. Most participants were single (not married; 63.5%). Nearly half (44.6%) had health insurance during the year prior to baseline. Most participants reported earning less than $10,000 annually (65.9%). About half of the women (52.3%) had a history of substance use disorder treatment.
Differences in treatment varied by criminal-legal system involvement
Black women in the High Comorbidity Need group had the highest likelihood of attending treatment – greater than the High Mental Health and Daily Marijuana groups – but this was not significantly different from the Low Need Group. That said, women recruited from the community were less likely to attend treatment compared to those recruited from prison.
Women involved in the criminal-legal system were more likely to attend treatment and mutual-help
Women recruited from prison were more likely to attend treatment than both women from the community as well as those recruited from probation. Women recruited from prison were also more likely to attend mutual-help than those in the community, but no more likely to attend mutual-help than those on probation.
Women with comorbid mental health and substance use challenges were more likely to attend mutual-help
Women in the High Comorbidity Needs group (with both substance use and mental health challenges) were more likely to attend mutual-help than those with Low Need. But the Daily Marijuana and High Mental Health groups were no more likely to attend than the Low Need Group, suggesting that only the High Comorbidity Need group had an increased likelihood of attending mutual-help by the follow-up. More religiosity was also uniquely associated with greater odds of attending mutual-help (but not treatment).
The results of this study suggest that Black women who use drugs most in need of substance use treatment – with daily marijuana use and/or additional mental health challenges – are no more likely to receive treatment than those with low need. The authors did find, however, that women recruited from prison or probation were more likely to receive treatment and attend mutual-help. These elevated rates of service utilization, while not examined specifically in this study, are almost certainly related to contingencies regarding their criminal-legal status (e.g., treatment or mutual-help attendance required in order to avoid jail time). Mandated or involuntary treatment is both associated with positive outcomes and also carries increased risks for individuals with opioid use disorder in context of reduced tolerance during an abstinence-based involuntary treatment episode with no access to FDA-approved medications increasing risk for overdose.
It is interesting that the High Comorbidity Need Group – who were more likely to have been recruited from prison, had more trauma symptoms, and higher rates of injection drug use – were more likely to attend mutual-help, but not treatment, compared to the Low Needs group. It may be that mutual-help groups are more accessible than treatment for this at-risk group of Black women that use drugs. It could also be that the conditions of their criminal-legal status required either treatment or mutual-help, and they were more likely to choose the comparatively more flexible options, with meetings at various times and locations whereas treatment may be more constraining. Future qualitative research might help better understand perceptions of treatment, mutual-help, and other services for Black women who use drugs.
Finally, the relationship between religiosity and mutual-help is consistent with other studies showing that more religious individuals have higher rates of 12-step mutual-help attendance. Also of note, there was a bivariate association between religiosity and treatment attendance that did not remain in the full model. Religion/spirituality may be a salient part of recovery for Black individuals, in particular, where they are much more likely to report that they make “all the difference” than White individuals in resolving their substance use problem. Religiously-affiliated approaches may help to attract and engage Black individuals generally, and Black women in particular, to treatment and recovery supports.
This study of Black women who use drugs found no differences between four identified profiles — “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”— on substance use disorder treatment attendance, suggesting that other factors may play a role in treatment utilization. However, the those with high comorbidity needs were more likely to attend mutual-help groups. The current findings highlight the complex patterns of substance use and mental health needs among Black women, particularly those involved with the criminal-legal system, and underscore the importance of interventions that address their unique needs.
Oser, C. B., Moody, M. D., Hansen, A. C., Stevens-Watkins, D., Staton, M., & Bunting, A. M. (2024). Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: a latent class approach. Drug and Alcohol Dependence, 260. doi: 10.1016/j.drugalcdep.2024.111326.
l
Black Americans are less likely to engage in illicit drug use than other Americans but suffer more negative consequences when they use drugs. Black Americans make up ~25% of all drug-related arrests in the US despite Black people comprising less than 14% of people who use illicit drugs. Black Americans also progress from substance use to substance use disorders more quickly than White Americans and experience more negative substance use related consequences over the life course than White Americans.
Substance use disorder recovery may be especially challenging for Black women due to discrimination within healthcare and the criminal legal system. Mutual-help groups (e.g., Narcotics Anonymous [NA]) could be an affordable and accessible strategy to mitigate the burden that illicit drugs have on the Black community. However, Black women with alcohol use disorder may be less inclined to utilize mutual-help groups than their male and White counterparts (i.e., black men, white men, and white women), though researchers caution this conclusion is “tentative” given studies were not designed specifically to test health disparities by race/ethnicity. Evidence also suggests that co-occurring mental health issues impact substance use disorder utilization in the general population. How mental health challenges typically present among Black women who use drugs, and their impact on treatment and mutual-help utilization can help inform best practice recommendations for this unique, often at-risk group. To this end, the present research was designed to determine substance related needs among Black women, including those involved, and not involved, with the criminal-legal system.
Data for the present analysis were derived from a longitudinal cohort study- the Black Women in Study of Epigenetics (B-WISE). The goal of the primary study was to examine health disparities among Black women who were involved in the criminal-legal system (e.g., in prison) and used drugs. Participants were 565 self-identified Black women recruited from a single southern state. Participants were recruited proportionally from prison (35.6%), probation offices (31.5%) and the community (32.9%). Participants engaged in the study completed a baseline survey and then a follow-up survey 18 months later. Data collection ended in 2015.
To recruit women from prison, the authors invited women who were meeting with their parole board or were being released within 60 days to an information session on the study where they were invited to participate. For those on probation, the authors reached out to 6 probation offices to identify potential participants who were invited to participate. For those in the community (not involved with the criminal-legal system) the authors posted flyers in predominantly Black neighborhoods. Eligibility criteria included: 1) self-identification as a Black woman, (2) ≥18 years of age, (3) English language fluency, and (4) willingness to participate. In addition, participants recruited from the community could not currently be involved or have pending criminal legal system contact at baseline.
The primary outcomes of this study were participation in either substance use treatment or mutual-help groups. These outcomes were assessed at follow-up via the item “Have you participated in an alcohol or drug treatment program?” (1=yes, 0=no). Women were also asked at 18 months how frequently they participated in Alcoholics Anonymous, Cocaine Anonymous, or Narcotics Anonymous (0=never, 1= monthly/less than monthly, 2=at least weekly). In addition, the authors measured culturally relevant factors at baseline. These measures included religiosity via the 12-item Spiritual Well-Being scale, active coping via the 12-item John Henryism Active Coping Scale. Mental health was assessed via measures of trauma and psychiatric symptoms. Lifetime trauma was measured using an adapted version of the Traumatic Life Events Questionnaire. Lifetime psychiatric symptoms were measured via the Addiction Severity Index psychiatric subscale.
The goal of this study was to determine potential profiles of substance use needs among Black women. To do this the authors a sophisticated statistical method to categorize participants based on a series of shared characteristics. In the present study, Black women were categorized into 4 groups based on their substance use and mental health: “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”. “Low need” women (44.1%) reported never using alcohol, marijuana, or crack ever or in the past year and had very low prevalence of mental health issues. “Daily marijuana use” (19.6%) reported some marijuana use in the past year with the majority reporting daily use and had low prevalence of mental health issues. “High mental health needs” women (14.0%) reported little to no alcohol, marijuana, or crack use, but had high rates of trauma and psychiatric symptoms. Finally, the “high comorbidity needs” group was characterized by high crack use and high prevalence of trauma and psychiatric symptoms. After deriving these 4 profiles, analyses examined differences in treatment and mutual-help attendance, as well as other factors relevant to understanding help-seeking behavior, including religiosity, use of active coping, and trust in physicians.
The average age of women in the study was 36 years. Most participants were single (not married; 63.5%). Nearly half (44.6%) had health insurance during the year prior to baseline. Most participants reported earning less than $10,000 annually (65.9%). About half of the women (52.3%) had a history of substance use disorder treatment.
Differences in treatment varied by criminal-legal system involvement
Black women in the High Comorbidity Need group had the highest likelihood of attending treatment – greater than the High Mental Health and Daily Marijuana groups – but this was not significantly different from the Low Need Group. That said, women recruited from the community were less likely to attend treatment compared to those recruited from prison.
Women involved in the criminal-legal system were more likely to attend treatment and mutual-help
Women recruited from prison were more likely to attend treatment than both women from the community as well as those recruited from probation. Women recruited from prison were also more likely to attend mutual-help than those in the community, but no more likely to attend mutual-help than those on probation.
Women with comorbid mental health and substance use challenges were more likely to attend mutual-help
Women in the High Comorbidity Needs group (with both substance use and mental health challenges) were more likely to attend mutual-help than those with Low Need. But the Daily Marijuana and High Mental Health groups were no more likely to attend than the Low Need Group, suggesting that only the High Comorbidity Need group had an increased likelihood of attending mutual-help by the follow-up. More religiosity was also uniquely associated with greater odds of attending mutual-help (but not treatment).
The results of this study suggest that Black women who use drugs most in need of substance use treatment – with daily marijuana use and/or additional mental health challenges – are no more likely to receive treatment than those with low need. The authors did find, however, that women recruited from prison or probation were more likely to receive treatment and attend mutual-help. These elevated rates of service utilization, while not examined specifically in this study, are almost certainly related to contingencies regarding their criminal-legal status (e.g., treatment or mutual-help attendance required in order to avoid jail time). Mandated or involuntary treatment is both associated with positive outcomes and also carries increased risks for individuals with opioid use disorder in context of reduced tolerance during an abstinence-based involuntary treatment episode with no access to FDA-approved medications increasing risk for overdose.
It is interesting that the High Comorbidity Need Group – who were more likely to have been recruited from prison, had more trauma symptoms, and higher rates of injection drug use – were more likely to attend mutual-help, but not treatment, compared to the Low Needs group. It may be that mutual-help groups are more accessible than treatment for this at-risk group of Black women that use drugs. It could also be that the conditions of their criminal-legal status required either treatment or mutual-help, and they were more likely to choose the comparatively more flexible options, with meetings at various times and locations whereas treatment may be more constraining. Future qualitative research might help better understand perceptions of treatment, mutual-help, and other services for Black women who use drugs.
Finally, the relationship between religiosity and mutual-help is consistent with other studies showing that more religious individuals have higher rates of 12-step mutual-help attendance. Also of note, there was a bivariate association between religiosity and treatment attendance that did not remain in the full model. Religion/spirituality may be a salient part of recovery for Black individuals, in particular, where they are much more likely to report that they make “all the difference” than White individuals in resolving their substance use problem. Religiously-affiliated approaches may help to attract and engage Black individuals generally, and Black women in particular, to treatment and recovery supports.
This study of Black women who use drugs found no differences between four identified profiles — “low need”, “daily marijuana use”, “high mental health needs” and “high comorbidity needs”— on substance use disorder treatment attendance, suggesting that other factors may play a role in treatment utilization. However, the those with high comorbidity needs were more likely to attend mutual-help groups. The current findings highlight the complex patterns of substance use and mental health needs among Black women, particularly those involved with the criminal-legal system, and underscore the importance of interventions that address their unique needs.
Oser, C. B., Moody, M. D., Hansen, A. C., Stevens-Watkins, D., Staton, M., & Bunting, A. M. (2024). Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: a latent class approach. Drug and Alcohol Dependence, 260. doi: 10.1016/j.drugalcdep.2024.111326.
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