Intersectionality and Addressing Disparities - Revision history

BasilSavitsky: /* Key Information */

2025-03-24T19:12:48Z

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← Older revision		Revision as of 12:12, 24 March 2025
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	* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalence of Fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalence of Fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Linguistic disparities affect a large portion of the approximately 26 million people who have limited English proficiency (LEP). One survey found that adults with LEP report worse health status and increased barriers in accessing health care compared to English-proficient adults. One out of three say they have faced language barriers when seeking health care. Twice as many LEP adults than English-proficient adults report not having a usual source of healthcare and almost twice as many report having fair or poor health.		* Linguistic disparities affect a large portion of the approximately 26 million people who have limited English proficiency (LEP). One survey found that adults with LEP report worse health status and increased barriers in accessing health care compared to English-proficient adults. One out of three say they have faced language barriers when seeking health care. Twice as many LEP adults than English-proficient adults report not having a usual source of healthcare and almost twice as many report having fair or poor health. <ref>https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/</ref>
	<ref>https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/</ref>

	Inequitable impacts are also well documented across the following identities:		Inequitable impacts are also well documented across the following identities:

BasilSavitsky: /* Key Information */

2025-03-24T19:12:00Z

Key Information

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	Increased awareness of disparities and disproportionalities impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this recent crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:		Increased awareness of disparities and disproportionalities impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this recent crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

	* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, ~~disproportionatly~~ higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>		* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionately higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
	* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the ~~prevalance~~ of ~~fentanyl~~ has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalence of Fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
			* Linguistic disparities affect a large portion of the approximately 26 million people who have limited English proficiency (LEP). One survey found that adults with LEP report worse health status and increased barriers in accessing health care compared to English-proficient adults. One out of three say they have faced language barriers when seeking health care. Twice as many LEP adults than English-proficient adults report not having a usual source of healthcare and almost twice as many report having fair or poor health.
			<ref>https://www.kff.org/racial-equity-and-health-policy/poll-finding/language-barriers-in-health-care-findings-from-the-kff-survey-on-racism-discrimination-and-health/</ref>

	~~Inequitabe~~ impacts are also well documented across the following identities:		Inequitable impacts are also well documented across the following identities:
	*A majority of pregnant people who use substances who do receive appropriate prenatal care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers, as their honesty around their circumstances often leads to criminal reporting or an inability to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

			* Socioeconomic Status (SES). In a summary of research within NIH funded by the National Institute on Minority Health and Health Disparities (NIMHD), two “pillars of health disparity science” were identified. The first encompasses the racial and ethnic disparities described above. The second pillar relates to SES which “contributes to health disparities through limited resources and opportunities to engage in health-promoting activities relative to high educational attainment and income.” <ref>https://jamanetwork.com/journals/jama-health-forum/fullarticle/2812750</ref> Lower SES was found to be strongly linked with health outcomes, including mortality. <ref>https://www.pnas.org/doi/full/10.1073/pnas.2024777118</ref> More specifically related to SUD disparities, SAMHSA data indicates that in 2019 the uninsured populations had a 7.3% rate of alcohol use disorder compared to a 5.0% rate for the insured. <ref>https://www.samhsa.gov/data/sites/default/files/reports/rpt35328/2021NSDUHBHEReport.pdf</ref>

			* Geographic Disparities. The Rural Health Information Hub documents higher rates of binge drinking in rural areas as well as use of tobacco, methamphetamines, and opioids. Challenges faced in rural communities include lower number of behavioral health and detoxification services and a decreased range of services in centers which can be accessed. Greater distance to substance use disorder treatment often results in lower completion rates of substance use treatment programs. <ref>https://www.ruralhealthinfo.org/topics/substance-use</ref> This is compounded by a differential among rural health providers in a negative perception of treatment for substance use disorder. <ref>https://www.tandfonline.com/doi/full/10.1080/00952990.2019.1694536</ref>

			* A majority of pregnant people who use substances who do receive appropriate prenatal care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers, as their honesty around their circumstances often leads to criminal reporting or an inability to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

			* Older Adults. An evaluation by the Office of Disease Prevention and Health Promotion within US-HHS on the social determinants of health lists several factors which amplify health disparities for older adults. These include increased isolation for singles aged 65+ as well as decreased ease of access to services and increased need for services, particularly associated with a higher rate of chronic health conditions. <ref>https://odphp.health.gov/our-work/national-health-initiatives/healthy-aging/social-determinants-health-and-older-adults#health</ref> In 2020, consumers aged 65 and older averaged out-of-pocket health care expenditures of $6,668, and older Americans spent 14% of their total expenditures on health, compared to 8.4% among all consumers. <ref>https://acl.gov/sites/default/files/Profile%20of%20OA/2021%20Profile%20of%20OA/2021ProfileOlderAmericans_508.pdf</ref> This forces difficult choices in prioritizing health needs within families which might delay or eliminate pursuit of SUD services.

			* Youth. Risk factors for youth(18-25) having higher substance use rates than adults over 25 years old are commonly recognized. For example 2023 data indicate that 18% of youth had a drug use disorder in the past year, compared to 8.6% for adults 26 or older — more than twice the rate. <ref>https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables</ref> The disparities that youth face in protective factors is less understood. For example, access to alternatives to substance-free activities is based on a variety of social determinants, such as transportation to extracurricular activities and family or community funding to foster equitable access to athletic, artistic, or social functions that promote protective factors such as self-esteem and pro-social bonding. <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6601618/</ref>

			* Veterans. One in five veterans experience behavioral health problems and veterans are twice as likely to die from overdose than non-veterans. <ref>https://www.safeproject.us/veterans/</ref> In terms of social determinants of health, one research meta-analysis concluded that “veterans enrolled in VHA services are more medically complex, have lower physical and mental health functioning, and have lower socioeconomic resources, as compared with either non-Veterans or Veterans not engaged in VHA care.” <ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6153229/</ref>

			* Persons with disabilities are 2-4 times more likely to experience alcohol and substance use disorder. <ref>https://americanaddictioncenters.org/rehab-guide/addiction-disability</ref>

	'''Intersectionality'''		'''Intersectionality'''

Tracy: /* Key Information */

2025-03-18T17:11:35Z

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	= Key Information =		= Key Information =

	Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in ~~the~~ screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, ~~when examining these gains through another lens~~, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.		Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience thesse differences in navigating screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented and impacted by systemtic inequities over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, upon further examination, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

	Increased awareness of disparities and ~~disproportionality~~ impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. For example, the majority of pregnant people who use substances who do receive appropriate care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers have little success, as their honesty and vulnerability around their circumstances often leads to criminal reporting or they are unable to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>		Increased awareness of disparities and disproportionalities impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this recent crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

	The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

	* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionatly higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>		* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionatly higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
	* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. Tribal lands often have limited infrastructure impacting service delivery. Oftentimes, resources off reservations can be a transportation barrier and lack cultural competency to effectively serve Native Americans. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalance of fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalance of fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

			Inequitabe impacts are also well documented across the following identities:
			*A majority of pregnant people who use substances who do receive appropriate prenatal care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers, as their honesty around their circumstances often leads to criminal reporting or an inability to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>


	'''Intersectionality'''		'''Intersectionality'''

Tracy: /* Key Information */

2025-03-18T16:54:18Z

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	Coalitions have a responsibility to work towards the well-being and protection of all individuals in our communities, ensuring equity and inclusion in all efforts. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>		Coalitions have a responsibility to work towards the well-being and protection of all individuals in our communities, ensuring equity and inclusion in all efforts. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

	In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. ~~These data point~~ to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.		In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth, as compared to their heterosexual peers. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. Factors around discrimination, trauma, stigma, and lack of services available to meet their needs often double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

	One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.		One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

Tracy: /* Key Information */

2025-03-18T16:46:39Z

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	Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, when examining these gains through another lens, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.		Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, when examining these gains through another lens, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

	Increased awareness of disparities and disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. For example, the majority of pregnant people who use substances who do receive appropriate care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often have little success, as their honesty and vulnerability around their circumstances often leads to criminal reporting or they are unable to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>		Increased awareness of disparities and disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. For example, the majority of pregnant people who use substances who do receive appropriate care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear of criminalization and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often face significant barriers have little success, as their honesty and vulnerability around their circumstances often leads to criminal reporting or they are unable to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

	The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:		The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:
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	'''Coalition Responsibilities When Addressing Disparities'''		'''Coalition Responsibilities When Addressing Disparities'''

	Coalitions have a responsibility to work ~~to protect everyone~~ in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>		Coalitions have a responsibility to work towards the well-being and protection of all individuals in our communities, ensuring equity and inclusion in all efforts. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

	In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.		In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

Tracy: /* Introductory Paragraph */

2025-03-18T16:42:26Z

Introductory Paragraph

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	= Introductory Paragraph =		= Introductory Paragraph =

	This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity~~, and the~~ material below centers on strategies in the field of substance use which are associated with populations impacted by systemic inequities.		This is the second in a pair of related articles on health equity centered around disparities and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity. The material below centers on strategies in the field of substance use which are associated with populations impacted by various systemic inequities.

	= Key Information =		= Key Information =

Tracy: /* Key Information */

2025-03-18T16:40:07Z

Key Information

← Older revision		Revision as of 09:40, 18 March 2025
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	The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:		The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

	* Black people ~~do not~~ use cocaine at ~~higher~~ rates ~~than~~ other groups, ~~yet~~ the cocaine~~-related overdose rate~~ for Black ~~people is triple that of~~ White ~~people~~. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>		* While studies show that Black people use cocaine at similar rates to other racial and ethnic groups, the overdose rates related to cocaine for Black individuals, disproportionatly higher compared to White individuals. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
	* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Latinx overdose rates ~~doubled~~ between 2018 and 2022, ~~in large part to~~ the ~~proliferation~~ of ~~Fentanyl~~. ~~Linguistic~~ barriers ~~which reduce~~ access ~~to prevention~~ and ~~harm reduction programs and are compounded by disparities associated with~~ documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* Latinx communities have experienced significant challenges with rising overdose rates (doubling between 2018 and 2022), especially as the prevalance of fentanyl has increased. This is compounded by barriers to care, such as language access and documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

	'''Intersectionality'''		'''Intersectionality'''

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	= Introductory Paragraph =		= Introductory Paragraph =

	This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with ~~marginalized~~ populations.		This is the second in a pair of related articles on health equity and disproportionality. The first article titled, “Apply a Health Equity Lens,” focused on resources associated with building health equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref> This requires an active commitment to remove obstacles for groups that are more impacted by inequity, and the material below centers on strategies in the field of substance use which are associated with populations impacted by systemic inequities.

	= Key Information =		= Key Information =

Tracy: /* Key Information */

2025-03-18T16:34:29Z

Key Information

BasilSavitsky: /* Key Information */

2025-03-01T01:24:30Z

Key Information

← Older revision		Revision as of 18:24, 28 February 2025
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	'''Intersectionality'''		'''Intersectionality'''

	Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. It has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>		Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since then, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

	'''Coalition Responsibilities'''		'''Coalition Responsibilities'''

← Older revision		Revision as of 09:34, 18 March 2025
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	= Key Information =		= Key Information =

	Addressing disparities begins by acknowledging that we are all unique and ~~that a community look through~~ multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use, because some groups have been more marginalized ~~than~~ others. For example, ~~in looking at~~ recent overall statistics~~, there is positive news —~~ a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, examining these gains through ~~a disparities~~ lens, it becomes apparent that the recent decrease in the ~~opioid~~ overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.		Addressing disparities begins by acknowledging that we are all unique and hold multiple identity lenses. Likewise, as members of different groups within our communities, we experience differences in the screening, diagnosis, treatment, and recovery supports. This is particularly relevant in the historical context of substance use because some groups have been more marginalized or historically underrepresented over others. For example, recent overall statistics demonostrate a 14.5% decline in national overdose deaths for the 12-month period ending June 2024. <ref>https://www.safestates.org/news/687677/CDC-Data-Shows-a-Decline-in-Overdose-Deaths.htm</ref> However, when examining these gains through another lens, it becomes apparent that the recent decrease in the overdose rate is not uniformly distributed. Positive trends predominantly benefit White people.

	Increased awareness of disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with ~~low~~ socio-economic status, and pregnant people. For example, the majority of pregnant ~~substance-using~~ people who do receive appropriate care and intervention are older and ~~white~~ with private health insurance. ~~They~~ are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are ~~marginalized~~ and do seek treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>		Increased awareness of disparities and disproportionality impacts the way communities can address substance use in relation to the specific needs of youth, military-connected families, LGBTQI+ individuals, people with disabilities, those with lower socio-economic status, and pregnant people. For example, the majority of pregnant people who use substances who do receive appropriate care and intervention are typically older and White with private health insurance. These people are less likely to be reported to social services, creating significant disparities. People who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are disproportionately impacted by social and health disparites, and do seek treatment, often have little success, as their honesty and vulnerability around their circumstances often leads to criminal reporting or they are unable to find available and affordable treatment programs that meet their specific needs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> See SAFE Solution article titled, "Expand Perinatal Treatment and Support for People with SUDs" for more information. <ref>https://www.yoursafesolutions.us/wiki/Expand_Perinatal_Treatment_and_Support_for_People_with_SUDs</ref>

	The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:		The Drug Policy Alliance reports that the US has lost over one million lives to drug overdose during this crisis — yet, even though people of all races and ethnicities use drugs at similar rates, racial and ethnic disparities are evident:

	* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose for ~~Blacks~~ is triple that of ~~Whites~~. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment (MAT). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>		* Black people do not use cocaine at higher rates than other groups, yet the cocaine-related overdose rate for Black people is triple that of White people. Clear racial differentials exist in access to harm reduction programs and medicated-assisted treatment/recovery (MAT/MAR). <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnBlackCommunitiesFactSheet-InDesign-NEW.pdf</ref>
	* Native Americans ~~overdose death rates~~, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions associated with methamphetamines, versus opioids. In 2022, the national Native American overdose ~~death~~ rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* The overdose rate for Native Americans, between 2021 and 2022, increased by 15% while they decreased for Whites. While national overdose rates in 2020 were comparable for Whites and Native Americans, most recent data reflect Native American rates are almost double the rate for Whites. Some of this difference is attributable to limited resources on tribal lands. A large component is associated with variability in overdose interventions are associated with methamphetamines, versus opioids. In 2022, the national Native American overdose fatality rate associated with methamphetamines was more than double the rate for Whites. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnNativeCommunitiesFactSheet-InDesign-Interactive.pdf</ref>
	* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>		* Latinx overdose rates doubled between 2018 and 2022, in large part to the proliferation of Fentanyl. Linguistic barriers which reduce access to prevention and harm reduction programs and are compounded by disparities associated with documentation status. <ref>https://drugpolicy.org/wp-content/uploads/2024/08/DPA-ImpactOnLatinxCommunitiesFactSheet-InDesign-Interactive.pdf</ref>

	'''Intersectionality'''		'''Intersectionality'''

	Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than and should not be confused with the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination, because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since ~~then~~, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>		Intersectionality is a complex topic that warrants a full understanding by anyone engaged in social change work. Intersectionality runs deeper than, and should not be confused with, the type of inter-sectoral work found in promoting environmental justice by both environmentalists and social justice activists. Intersectionality describes a method for defining the mix of social identities with more accuracy than single identity formulations allow. For example, everyone is a blend of gender, race, class, and ability categories as opposed to being a type of member in different categories. Intersectionality has become associated with social and political correlations with privilege and marginalization. The term, intersectionality, was coined by Kimberlé Williams Crenshaw in three legal cases in 1989. Although each of the cases were lost, her position has been adopted widely in the social justice community and is often linked with its formative roots in Critical Race Theory. Crenshaw made a case in law suits for black women that this newly defined form of discrimination transcended racial and gender discrimination because black women were being judged in the legal system separately both as women and as members of a minority rather than as black women. In the decades since, the term has become politically controversial, because it has moved outside of the generally agreed upon ''descriptive'' nature of discriminatory patterns to a ''prescriptive'' call to action to address sources of structural power differentials. It has been critiqued both for the scope of change for which intersectional advocates calls and for the difficulty in measuring success in conditions which are inherently multi-variable. <ref>https://www.vox.com/the-highlight/2019/5/20/18542843/intersectionality-conservatism-law-race-gender-discrimination</ref>

	'''Coalition Responsibilities'''		'''Coalition Responsibilities When Addressing Disparities'''

	Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>		Coalitions have a responsibility to work to protect everyone in our communities. The first step in implementing this responsibility is to recognize that history points to long-term patterns of inequity. The next step is to realize the scope and diversity within health inequity. This includes incorporating people with lived experience in the decision making process and implementing trauma-informed approaches. Specific recommendations for practicing cultural competence and humility and for applying a health equity lens in strategy planning are detailed in the section titled “Building Capacity for Health Equity” within the SAFE Solution article on Health Equity. <ref>https://www.yoursafesolutions.us/wiki/Apply_a_Health_Equity_Lens</ref>

	In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and questioning ~~members of the LGBTQ+ has~~ been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with ~~low~~ socio-economic status.		In addition to the statistics on racial and ethnic disparities detailed above, there are several constituencies within communities for which substance use statistics are less documented. For example, collection of data on the transgender and people questioning their gender identity have been more difficult to collect, particularly for youth. However, limited data have been collected by SAMHSA in its annual surveys on people who identify as lesbian, gay, or bisexual. These data point to double or triple use rates by LGB respondents, for all substances. <ref>https://clearbrook.banyantreatmentcenter.com/news/lgbtq-substance-abuse-facts-and-tatistics/</ref> When a coalition examines the membership of its community, it should look at not only the specific needs of racial, ethnic, and LGBTQ+ communities, but also evaluate the concerns of military-connected people, individuals with disabilities, and those with lower socio-economic status.

	One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment. However, Chris’s parole officer maintains that Chris cannot use any substances, MAT or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.		One example might help to humanize what may seem to be abstract demographic characteristics. This points to the complexity of systems which are faced in one specific case. Someone named Chris has just been released from prison and is returning home. Chris is fortunate enough to have been supported in developing a recovery plan which includes medication-assisted treatment/recovery (MAT/MAR). However, Chris’s parole officer maintains that Chris cannot use any substances, MAT/MAR, or otherwise. Instead Chris is required to do x, y, and z, none of which are in the recovery plan. A lack of re-entry services and laws in Chris’s state precluded applying for Medicaid in advance. Chris left jail with three days of medication, but cannot see a doctor for a week. Chris is unable to find recovery housing with nearby transportation who will accept someone with a criminal background, so has not yet found employment. Without a job and without prescription coverage, Chris cannot afford to get more medication. The doctor wants to prescribe medications which the parole officer will not allow. If coalition members understand how their local systems are not working together and are working against people, then they can begin to see how difficult daily life might be for undocumented people or LGBTQ+ youth who are ready but uncertain as to how to access substance use services.

	= Relevant Research =		= Relevant Research =