Exploring the Lived Experience of Black Americans and Substance Use Treatment: Structural, Community, and Individual Factors

Abstract Despite decades of research on substance use, the unique experiences of Black Americans remain underexamined and often fragmented across subgroups and substance types. Existing studies have shed light on how racism shapes substance use patterns within certain populations, yet they leave critical gaps in understanding the broader landscape of risk, resilience, and treatment among Black communities. The purpose of this study was to fill that gap by exploring the lived experiences of Black adults with substance use histories to identify risk, protective, and treatment factors associated with alcohol and drug use. Qualitative interviews were conducted with 18 Black adults, and rapid qualitative coding and thematic analysis were used to evaluate the interview data. Risk factors were represented by themes addressing psychosocial and structural catalysts for initial substance use (Theme 1) and race-related stressors that increased substance use (Theme 2). The primary protective factor identified was Black collectivism (Theme 3). Prominent treatment themes included therapeutic rapport with the substance use provider: Black providers and lived experience with substance use (Theme 4), the utility of coping skills and group therapy (Theme 5), and factors that facilitate and impede Black substance use treatment participation (Theme 6). This qualitative study provides clinical and empirical guidance for developing culturally specific, multilevel approaches to address substance use in Black American communities.