Why Staying in Addiction Recovery Is Difficult

A mother of four makes plans to enter a residential addiction recovery center. She's been fighting a substance use disorder for the past five years and finally made the decision to get help. She's lined up care for her children and someone to pay bills while she's away. Her employer has agreed to provide paid time off and insurance will cover the cost of treatment.

The above scenario is not representative of most people's experience with seeking assistance with an SUD, especially Black men and women. Complex issues such as an individual's family and financial pressures and diversity within the staff at the treatment facility may determine if a Black client finishes treatment. Black Americans struggle with finishing a recovery program, more so than their white counterparts, according to a 2013 Health Affairs article, "Blacks And Hispanics Are Less Likely Than Whites to Complete Addiction Treatment, Largely Due to Socioeconomic Factors."Of the 2 million people who attend publicly funded substance abuse program, about one-third do not complete treatment. This same study states that Black clients have the lowest completion rates for intensive outpatient and nonintensive outpatient programs and were a close second for noncompletion in residential programs: "Using national data, we found that Blacks and Hispanics were 3.5 to 8.1 percentage points less likely than whites to complete treatment for alcohol and drugs," the study notes. Cultural pressures to remain silent Jahmela Headley, a licensed mental health counselor since 2014, has been with Recovery First Treatment Center in Hollywood, Florida, for the past two years. She's been in recovery for 10 years. Recovery First is under the parent company American Addiction Centers. Recovery First's services include medical detox, residential programs and an intensive outpatient program, and it serves a variety of people from South Florida. Some of Headley's Black clients may have the financial and employer support to obtain treatment, but internal and external pressures have kept them from pursuing or finishing the program. "Within the Black community, it is very hard to express when we need help," Headley says. "There's this notion of, ‘I can protect my privacy.'" After the detox process, talking about the reasons a client has an SUD is an important part of recovery. Headley notes that discussing childhood abuse or trauma to understand how it affected their addiction is taboo in the Black community. "‘Now, I'm having to look at the flaws of my parents,'" Headley's clients say. "‘And I've only been told that is disrespectful and ungrateful.'"A lack of representation Headley is often the only Black practitioner her clients will see during treatment. Plenty of people of color work at the center throughout the day, but it's important to recognize medical staff who look like them and are in recovery and successful, Headley says. "I am one of two Black therapists who are in recovery," she says. "I think that's a huge piece of it: They (clients) don't see themselves represented."

The Office of Behavioral Health Equity Within Substance Abuse and Mental Health Services Administration published "The Opioid Crisis and the Black/African American Population: An Urgent Issue" in 2020. It states, "When the cultural context is ignored or misunderstood, respect for the patient is lacking, little hope is provided, and a lack of Black/African American practitioners who treat OUD exists, it becomes very difficult for a Black/African American with OUD to engage in treatment."‘A crisis in itself'Even if a client completes detox and residential treatment, the much-needed after care, such as PHP and IOP, may seem impossible because of too many factors: distance to find care, financial burden and time to participate. Questions about short- and long-term disability, job security and child care costs could make the situation seem hopeless. "It's a big ask when there's already so many unknowns," Headley says. Prior to joining the Blue Meridian Partners in New York City, clinical psychologist and attorney Scott Nolen was director of the Addiction and Health Equity Program at the Open Society Institute of Baltimore. "The number one way to improve access to treatment is to place services where people can easily connect with them and ensure very low thresholds to receive those treatments," Nolen says in Pew Charitable Trusts' 2020 article titled "African Americans Often Face Challenges Accessing Substance Use Treatment.""That means reducing barriers such as cost, travel time, insurance pre-authorizations, fear of incarceration, and fear of losing health or other social services benefits – such as housing, job training or SNAP (Supplemental Nutrition Assistance Program) – because of a relapse."Ja Marr Funderburg, a Charlotte, North Carolina-based licensed clinical social worker with Charlotte Counseling and Consulting since 2009, has seen patients leave inpatient treatment due to financial pressures. Clients wonder who will pay the bills while they are away. "That becomes a crisis in itself," Funderburg says.

First published in Black Mental Health Today, Fall 2022 (Vol. 5).