Racial and Ethnic Community Composition and Geographic Distance to Substance Use Disorder Treatment Across the Rural and Urban Divide

To examine whether geographic driving distance to substance use disorder (SUD) treatment varies by racial/ethnic concentration of residents in urban and rural communities. We conducted a cross-sectional analysis at the ZIP Code Tabulation Area (ZCTA) level using data from the Substance Abuse and Mental Health Service Administration (SAMHSA) 2021 Behavioral Health Treatment Services Locator. We conducted logistic regressions to examine rural-urban differences in driving distances to SUD treatment facilities among ZCTAs with a high relative concentration of a single racial/ethnic group. Urban ZCTAs with a high concentration of Black or Hispanic residents had greater odds of having a SUD treatment facility (odds ratio [OR] = 2.39, confidence interval [CI] [2.04, 2.81] and OR = 2.20, CI [1.86, 2.61], respectively), while ZCTAs with a high concentration of White and American Indian/Alaska Natives (AI/AN) communities had lower odds (OR = 0.26, CI [0.23, 0.30] and OR = 0.55, CI [0.47, 0.63], respectively), compared to all other ZCTAs. SUD treatment facilities, which have historically faced heavy stigmatization, are more likely to be placed in communities with a high concentration of Black and Hispanic residents. Consequently, White ZCTAs were less likely to have a SUD treatment facility nearby than other communities. This is important evidence to explore in determining whether stigmatization may play a role in treatment availability.