Racial and ethnic discrimination and DSM-5 substance use disorders among U.S. adults

Objective: Racial and ethnic discrimination is a risk factor for substance use among United States adults. However, whether discrimination is associated with substance use disorders (SUDs) overall and by race and ethnicity is less understood.

Methods: We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n=35,355) and defined past-year discrimination as a summary scale (range: 0-4). Past-year SUDs included alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and illicit drug use disorder (IDUD) based on DSM-5 criteria, and number of SUDs included one, two, or three or more SUDs. We estimated associations between discrimination and each SUD outcome using logistic and multinomial logistic regression and examined effect modification by race and ethnicity.

Results: Discrimination was associated with each substance-specific SUD (OR range: 1.36-1.78) and with one, two, and three or more number of SUDs (OR range: 1.34-2.19). Models stratified by race and ethnicity revealed that discrimination was associated with AUD among all groups (OR range: 1.42-1.52), with TUD only among adults who were non-Hispanic White, non-Hispanic Black and another non-Hispanic race, with CUD only among non-Hispanic White and non-Hispanic Black adults, and with only IDUD among Hispanic, non-Hispanic White, and non-Hispanic Black adults. In addition, discrimination was associated with three or more number of SUDs among all groups.

Conclusions: Discrimination was associated with all SUD outcomes, with variation in these relationships by race and ethnicity. Understanding this heterogeneity can inform efforts to prevent problematic substance use and promote health equity.