Racial Discrimination and Substance Use: Results from a 2023 Survey of Racism and Public Health in the United States

Racial/ethnic disparities in substance use outcomes continue to widen in the US. Despite increasing evidence of the myriad ways that racism impacts health, this has not been extensively studied with respect to substance use outcomes. The current study explores the association between self-reported exposure to racial discrimination across the life course and substance use disorders among US adults. We analyzed data from a web-based cross-sectional survey of adults in 13 states and Puerto Rico in March–April 2023. Exposure to racism in childhood, adolescence, adulthood, and within the past year was measured on a cumulative life course scale (range 0–4). Analyses were restricted to respondents identifying as White, Black, and/or Hispanic (<i>N</i> = 4,338). Multivariable models estimated the adjusted association between cumulative racial discrimination and lifetime substance use disorder (SUD) diagnosis. Among those with exposure to racial discrimination (<i>N</i> = 1,895), we explored correlates of coping with any form of discrimination by using substances. We detected evidence of an interaction between race/ethnicity and cumulative racial discrimination, with a higher predicted probability of SUD associated with discrimination among those racialized as Black (non-Hispanic Black and Afro-Hispanic). There was evidence of a dose-response relationship between cumulative racial discrimination and the likelihood of coping through increased substance use. Experiences of racial discrimination over the life course may contribute to disparities in substance use outcomes. More research is needed to disentangle multiple, overlapping forms of discrimination faced by people who use different substances and how they may explain variation in outcomes among them.