Perceived barriers to access care, anticipated discrimination and structural vulnerability among African Americans with substance use disorders

Background: The application of the structural vulnerability construct in medicine addresses social structures as the source of health inequities. Evidence demonstrates structural vulnerability as the meta-problem that underlie health disparities faced by underrepresented minorities who are less likely to access care and face stigma for substance use disorders (SUDs).

Objective: The objective of this study is to assess perceived vulnerability at the structural and interpersonal levels depicted by barriers to care, treatment-related stigma and anticipated discrimination among African Americans with SUDs.

Methods: Participants were 58 consecutive African American patients receiving treatment at an acute inpatient substance use service of a teaching hospital from September to November 2019. Structural vulnerability, barriers to care and anticipated discrimination were assessed using the structural vulnerability assessment tool, Barriers to Access Care Evaluation (BACE) and the Questionnaire on Anticipated Discrimination (QUAD) surveys, respectively.

Results: The total mean scores for the BACE-3, BACE-3 stigma subscale and QUAD were 1.0, 1.15 and 1.51, respectively. No statistically significant differences are found in the stigma subscale based on gender and psychiatric diagnosis (p > .05). Furthermore, there were also no gender, age or differences based on psychiatric diagnosis across both the BACE and QUAD scales.

Conclusion: Structural and interpersonal factors remain sources of vulnerability, stigma and anticipated discrimination for African Americans with SUDs and comorbid mental illness.