Barriers beyond behavior: structural determinants of behavioral health treatment disparities among Hispanics in the U.S.

Background Persistent disparities in substance use treatment access undermine efforts to achieve equitable public health outcomes in the United States. Hispanic populations, who report lower prevalence of substance use, nevertheless face systemic barriers to care. This study examines how socioeconomic status, insurance coverage, and ethnicity influence treatment utilization and perceived barriers, with attention to structural and sociocultural factors shaping disparities. Methods This cross-sectional study analyzed data from the 2023 National Survey on Drug Use and Health ( N = 56,705). Logistic regression assessed associations between ethnicity, insurance coverage, substance use, and treatment utilization, adjusting for demographic and socioeconomic covariates. Results Hispanic respondents had significantly lower odds of reporting SUD (OR = 0.68), illicit drug use (OR = 0.68), and alcohol use disorder (OR = 0.78), and were less likely to receive behavioral health treatment (OR = 0.67) or medication-assisted treatment (OR = 0.59). Structural barriers, notably lack of insurance (47%) and high costs (40%), surpassed stigma-related barriers among Hispanics. While Medicaid (OR = 1.14) is positively associated with treatment access compared to being uninsured, substantial gaps persisted relative to private insurance. Conclusion Structural policy reforms emphasizing expanded insurance access, affordable treatments, and culturally tailored harm reduction strategies are critical to addressing disparities. Health education and targeted community interventions may be able to effectively overcome systemic barriers to behavioral health care for Hispanic communities.