Mining Social Determinants of Health to Decode the Substance Use Disorder Crisis

Where Substance Use Disorders and Social Determinants of Health Intertwine

Research confirms links between substance use and SDOH factors. Equally as fascinating and enlightening is the evidence suggesting that these factors can also influence the consequences of substance use. Here’s a rundown of how it all intersects:

• Economic Factors: Socioeconomic status influences both the development of and consequences stemming from substance use disorders. Individuals in the throes of poverty, unemployment, and financial instability are often vulnerable to engaging in substance misuse as a coping mechanism. Once usage has begun, there’s an increasing risk for spiraling usage and consequences due to a lack of access to quality healthcare and treatment resources. What’s more, fear of costly legal repercussions can stop low-income individuals from seeking help.
• Education: Lower educational attainment is linked with higher rates of substance use disorders. This elevated susceptibility can be linked to an individual’s limited understanding of the risks associated with substance use. Additionally, overall health literacy and decision-making abilities may be stagnant due to a lack of early education.
• Social Support and Relationships: We know that having a strong social support network has an insulating effect against substance use disorders. The reverse is true for people experiencing social isolation and a lack of positive social connections. Additionally, dysfunctional relationships can increase risks for substance use.
• Adverse Childhood Experiences (ACEs): Negative experiences in early childhood are believed to increase risk factors for substance abuse substantially. Physical abuse, emotional abuse, and neglect are linked with an increased likelihood of developing SUD later in life. While not every at-risk person experiences overt abuse, general household dysfunction can also reproduce the same risks. Finally, it’s known that having a parent with SUD puts a person at risk. The negative effects of ACEs are often compounded by negative socioeconomic factors.

While the factors listed above can make a person more vulnerable to SUD, it’s by no means a foregone conclusion that someone who experiences any or all negative SDOH factors will experience SUD. Similarly, a person who never experiences classic SDOH factors is not immune to SUD.

What Can Public Health Programs Do?

Public health and community programs can serve as first defenses against the factors that make people vulnerable to SUD. While there is no magic answer for ending the crisis, there are many ways to reduce vulnerability for at-risk people. Below are some focus areas where public entities are having meaningful and lasting impact on the SUD crisis.

Improving Access to Care

A gap in access to evidence-based care is one of the biggest barriers to creating a uniform approach to both preventing and treating SUDs within the healthcare system. One of the biggest challenges to date for care providers involved in mental health and substance use is finding ways to address opioid use disorder (OUD). A 2020 paper focused on improving access to evidence-based medical treatment for opioid users identified these core barriers to care within the current treatment system:

• Stigma.
• Scarcity of qualified addiction specialists.
• Inadequate clinical training.
• Lack of integration of medications for opioid use disorder (MOUD) provisions in practice.
• Regulatory restrictions.
• Statutory restrictions.
• Data-sharing restrictions.
• Financial barriers.
• Lack of integration of substance-use screening and treatment in primary care.
• Lack of guidelines and enforcement ensuring that evidence-based recovery approaches are used by providers.

One of the glaring problems within the current healthcare system is that even people who courageously step forward to receive care may not get the help they need. Regulations, crossed wires, a lack of tools that facilitate care coordination, and other factors keep the hands of many providers essentially tied. Cohesive measures simply aren’t as robust as they should be when it comes to identifying at-risk patients, referring patients to the appropriate care professionals, and following up.

Equitable Delivery

A conversation about SUDs can’t happen without discussing the need for greater behavioral health equity. This refers to the right to access high-quality healthcare services and support networks and tools for all populations. Marginalized communities often lack both physical access and messaging regarding available resources. People in these communities may also receive messages that care is not available to them based on everything from social stigma to a lack of educational resources. Geographically speaking, people of all backgrounds living in rural areas often lack access to qualified professionals compared to their urban counterparts.

Referral Networks

A holistic approach should include both referrals and a continuum of care. It’s important for service providers to have systems in place to make referrals to other providers or agencies. In addition to helping to address a patient’s urgent and unmet needs, this practice helps to ensure that an individual doesn’t simply retreat from care completely. Collaboration is crucial for preventing clients from “falling through the cracks.”

The Bottom Line

Addressing the correlation between Social Determinants of Health and substance use disorders is crucial for creating effective interventions for at-risk populations. While SDOH factors should never be used to “explain away” addiction, understanding them is crucial for improving access to care resources, providing equitable delivery of services, and expanding referral networks. SDOH factors are also crucial for both self-education and provider education when it comes to understanding the intricacies of how lived experiences contribute to substance use disorder.