As AmeriCorps members conducting social determinants of health (SDOH) screeners, we’ve witnessed firsthand how structural barriers and health disparities interconnect and compound. From transportation barriers resulting in difficulties accessing primary care to financial barriers preventing medication follow-up, our conversations with patients have illuminated health as a complex environmental web.
January is Substance Use Disorder Treatment Month. Organized by the Substance Abuse and Mental Health Services Administration (SAMHSA), this month serves to support people with substance use disorders (SUDs) and raise awareness. In the spirit of the month, this blog post will aim to reduce stigma and provide education on current barriers to care and connections to health equity. We will begin with a look at the facts and end with recommendations.
Introduction and Background
Nationally, SUDs represent a public health crisis that is worsening, highlighting the urgency of understanding and addressing relevant trends:
- Alcohol use disorders (AUDs) are the most prevalent kind of SUD among all racial and ethnic groups in America.
- In 2024, 16.8% of all Americans 12 years old or older had a SUD.
- Unhoused youth are at drastically higher risk of developing SUDs, often citing substances as useful for numbing despair and coping with circumstances of isolation and victimization.
- Overdose death rates have risen in the past three decades. Importantly, this rise has been most drastic in Black communities, who also experience limited access to certain types of opioid use disorder (OUD) treatments compared to white communities.
Health Equity Applications: A Look at Chicago
In Chicago, structural inequities and resulting health disparities in the city’s South and West Sides are well-documented. Disparities related to SUDs are, unfortunately, no exception.
- While some Chicago communities experienced three overdose incidents in the first six months of 2020, others, primarily West Side neighborhoods, experienced nearly a thousand.
- Chicago communities with the highest levels of economic hardship have the highest opioid-related overdose fatalities.
- Naloxone (narcan) access after an emergency room visit represents a compounded burden: while this medication can be essential for preventing overdose deaths, prescription fill rates are as low as 18.2% in Chicago EDs due to insurance, financial, and motivational barriers. Studies on Chicago EDs analyze take-home naloxone programs as a budding and effective alternative.
Current Challenges
In a healthcare and cultural climate where only about a fifth of the people that needed substance use treatment in 2024 received it, a few key challenges stand out:
- Historical legacies: In the United States, legacies of racialization (such as the War on Drugs) cast a long shadow over cultural understandings of SUDs. Social conceptions of SUDs as moral failings or issues of weakness wrongly essentialize what we know to be influenced by socioecological factors. There is evidence that racial trauma and forced assimilation in boarding schools has contributed to higher rates of AUDs in Indigenous communities.
- Policies: Criminalization of drug use and possession penalizes people at their most vulnerable, creating even greater barriers to accessing social resources. Regulations that prevent methadone (a drug used in substance use treatment) access outside of specialized clinics also hinder care. While there has been legal progress on this front in the past few years, adoption is slow-moving.
- Self-stigma and shame: In 2020 interviews of Chicagoans with SUDs, internalized shame and feelings of being looked down upon by society and healthcare providers were prevailing themes.
- Abstinence-or-nothing recovery: While traditional approaches to substance use treatment define abstinence as a singular marker of success and a precondition to accessing resources such as supportive housing, research has shown that harm reduction and other dynamic views of recovery can be beneficial. SUD recovery is a complex topic, and effective treatments can vary across patients. Black-and-white approaches may discount this variance.
Looking Forward: Destigmatization, Access, and Empathy
Effective treatment of SUDs on individual and macro levels requires a critical lens on structural barriers and policies that can be adopted moving forward. Some recommendations include:
- Make substance use treatment easy for patients: The threshold for seeking care should be lowered and made more accessible. To circumvent barriers to entry like transportation and ID requirements, expedited substance use treatment referrals and protocols for same-day methadone access can help tackle barriers.
- Make substance use treatment easy for providers: Health protocols and programs for substance use treatment must become more widespread. Administrative priorities should include training that enables ED physicians to feel confident around prescribing buprenorphine (an important medication that helps with the management of opioid use disorder) and offering patients at risk of overdose take-home naloxone.
- Whole-person integration: SUDs represent a coalescence of social and health factors. To rise to this challenge, health systems should become similarly integrated, with a comprehensive approach that combines medical care, social care, and trauma-informed mental health care.
- Harm reduction practices: Harm reduction strategies like syringe services and fentanyl test strip programs are proven public health interventions that empower people who use drugs (PWUD) to move towards recovery, reducing shame and enabling avenues of care.
As people working within health systems, we have a moral and professional obligation to promote evidence-based substance use treatments rooted in equity. Dispelling myths and stigmas around substance use begins with education. Together, we can prioritize a path towards recovery that comprehensively addresses structural barriers.
Aya Hilal is an AmeriCorps member in the 2025-2026 C4P Rush cohort. She is interested in clinical science, cultural conceptions of disease, medical anthropology, and understanding health disparities.