The month of February is dedicated to Black history. This month-long observance is celebrated annually as it gives us the chance to celebrate Black achievements while also taking stock of systemic racism and how organizations can continue to create change.

As we reflect on the purpose behind Black history month, it is important to continue to take care of Black communities as it relates to substance misuse and the issues of equity and equality that amplify these issues. It is said that opioid-related overdose death rates in the United States tend to differ by both demographic and geographic characteristics.¹ While this opioid crisis had devastating impacts on all communities across the country, there are still particular challenges in communities of color. African Americans tend to face more barriers to substance use treatment when compared to the general population when you factor in stigma, bias and socioeconomic status.² Between 2015 and 2016, there were significant increases in opioid-related overdose death rates experienced by nearly all racial/ethnic groups as this rate grew by 21%. Amongst African Americans, this rate increased by 40%.³ From 2014 to 2017 , the rate of death from synthetic opioid use increased by 818% among the African American Populations which is reported to be a higher increase than for any other racial group.⁴ The increased disparities in opioid related deaths established a need for culturally competent interventions in public health practice. Cultural competence is defined as the ability to understand, appreciate and interact with people from different cultures and belief systems.⁵ It is a term established by Cross et al., in 1989 with a framework that is applicable across multiple systems.⁶

The practice of cultural competence amongst providers and practitioners can be proven beneficial to their work in the prevention and treatment of substance misuse. However, taking it a step further and practicing cultural humility alongside cultural competence is key when addressing issues of substance misuse in minority populations. Coined in the late 1990s, cultural humility moves away from the idea of being completely “competent” in one’s culture and encourages a lifelong process of self-reflection, self-critique and acknowledgement of one's biases.⁷

Combining the practice of cultural humility with prevention strategies to decrease substance misuse in minority communities may include, but are not limited to:⁸

1. Understanding the challenges of different minority groups while also engaging in intentional conversations with the community
2. Increase awareness of microaggressions and cultural insensitivity
3. Examining the safety of the environments in which target populations live in as this may play a crucial role in prevention programming

Furthermore, prevention efforts may also include considering social and cultural factors in order to implement programming that is beneficial for the population of interest. Alongside the practice of self-reflection and self critique of bias, here are a few things that preventionists and practitioners can do to ensure that factors impacting prevention efforts are addressed:

1. Consider a multicultural staff in prevention efforts. African Americans benefit from having a person of color that can advocate for them.⁸
2. Consider the location of prevention programming and how accessible they are to target populations⁸
3. Lastly, in order to further practice cultural competence and cultural humility, consider spirituality as a coping mechanism as studies have shown that utilizing spirituality is associated with more positive outcomes⁹

The Central East PTTC provides a webinar that can further educate on Understanding and Addressing the Social Determinants of Health in Prevention.

1. Lippold KM, Jones CM, Olsen EO, Giroir BP. Racial/Ethnic and Age Group Differences in Opioid and Synthetic Opioid–Involved Overdose Deaths Among Adults Aged ≥18 Years in Metropolitan Areas — United States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:967–973. DOI: http://dx.doi.org/10.15585/mmwr.mm6843a3
2. African Americans Often Face Challenges Accessing Substance Use Treatment. Pewtrusts.org. https://www.pewtrusts.org/en/research-and-analysis/articles/2020/03/26/african-americans-often-face-challenges-accessing-substance-use-treatment. Published 2020. Accessed January 28, 2022.
3. Substance Abuse and Mental Health Services Administration: The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001. Office of Behavioral Health Equity. Substance Abuse and Mental Health Services Administration, 2020.
4. Substance Use in the African American Community. Gateway Foundation. https://www.gatewayfoundation.org/addiction-blog/african-american-substance-use/. Published 2021. Accessed January 28, 2022.
5. DeAngelis, T. (2015, March). In search of cultural competence. Monitor on Psychology, 46(3). http://www.apa.org/monitor/2015/03/cultural-competence
6. Definitions of Cultural Compentence. Curricula Enhancement Module Series. https://nccc.georgetown.edu/curricula/culturalcompetence.html#:~:text=The%20seminal%20work%20of%20Cross,during%20the%20past%2015%20years. Accessed January 28, 2022.
7. Khan S. Cultural Humility vs. Competence — and Why Providers Need Both. Health City. https://healthcity.bmc.org/policy-and-industry/cultural-humility-vs-cultural-competence-providers-need-both. Published 2021. Accessed January 28, 2022.
8. Ethnic, and Sexual Minority Populations.” Alcohol research : current reviews vol. 38,1 (2016): 47-54.
9. Brome, D.R., Owens, M.D., Allen, K., and Vevaina, T. (2000). An Examination of Spirituality among African American Women in Recovery from Substance Abuse. Journal of Black Psychology, 26(4), 471-486.