In 2022, 133 people died of drug overdoses in the city of New Haven. 56 of the fatal overdose victims were Black, 31 were Hispanic and 45 were white. This breakdown shows deaths are skewed across the city’s ethnic communities: Black New Haveners make up about 33.9 percent of the city’s total population, but they comprised about 42 percent of the lives lost to overdoses that year.

Hurting communities and barriers to treatment

The News spoke to local addiction treatment experts and care workers who presented several social health determinants as explanations for the racial disparities in overdoses. 

Traci Norman, a program manager of Yale’s Addiction Treatment in the Black Community study, connected the disparities to other challenges that disproportionately affected Black people during and beyond the pandemic, including higher rates of underlying health issues, worsening mental health and civil unrest in response to structural racism and police brutality.

“Racism isn’t new… but seeing it in your face, seeing people getting murdered, hearing people being disproportionately impacted by COVID. And not knowing what’s going to happen tomorrow,” Norman said. “I think all of that compounding on one another definitely led to a lot of increased substance use, as well as relapses for some people, too.”

Former University chaplain Rev. Dr. Frederick J. Streets DIV ’75,  who works to support people of color in New Haven through addiction recovery, also emphasized an “explosion of racial animosity,” as well as the acute phase of the pandemic and political polarization, as stressors and sources of anxiety. These unique pressures and fears, Streets said, made many people turn toward self-medication. 

Depression, anxiety and other mental health problems surged across demographic groups during the pandemic. However, this rise did not impact all ethnic groups equally: according to the Datahaven report, Black and Latino individuals were 2.3 times and 1.6 times more likely to report feeling depressed than white people were, respectively.

“If you’re a person struggling with mental health or substance use history, now you’re isolated,” said treatment care worker Sylvia Cooper. “People are feeling like, ‘Am I gonna die? I have substance use, and I have health issues — it’s coming for me.’ So it really creates a hysteria of ‘what else is there left to do?’”

Beyond mental health stressors, physical health issues that disproportionately affect people of color were also exacerbated by the pandemic. COVID-19’s mortality rate among Black individuals was over double that of white people in the Greater New Haven region, according to the 2023 Datahaven report. Norman added that even though people of all racial backgrounds consume drugs and alcohol at similar rates, racial disparities regarding the incidence of other health complications caused a higher risk of overdose deaths for people of color.

“We typically have greater health challenges and health occurrences, underlying things such as hypertension rates, high cholesterol and diabetes, that also play a role in why we face greater mortality in regards to substances,” Norman explained. “I personally saw how black people were being disproportionately impacted by COVID-19.”

Local minority communities often see a lack of access to treatment services, especially as they face higher levels of economic inequality compared to white people. 

Assistant Professor of Psychiatry at the Yale School of Medicine Fabiola Arbelo Cruz said that barriers to care include a lack of physical proximity or transportation to treatment centers, high insurance costs, daily financial pressures and social stigma.

“If someone’s unemployed and with unstable housing, you give an appointment for a follow-up,” Arbelo Cruz explained. “But meeting the basic need of going to work and getting money might be a reason for them missing an appointment.”

Arbelo Cruz added that bed closures, long waitlists, limited walk-in appointments and reduced group therapy options also cut access to in-person addiction treatment centers. As these centers implemented social distancing regulations to protect patients from the spread of COVID-19, many of those struggling with substance use disorder — especially those who already faced barriers to in-person care —  also had issues accessing telehealth services. 

In a statement to the News, YSM Professor of Psychiatry Chyrell Bellamy also noted that Black and Latino people have less access to medication-assisted treatment for substance use disorder, which includes methadone and buprenorphine treatments that relieve withdrawal symptoms. 

According to one study conducted by JAMA Psychiatry, Black and Latino patients also tend to be prescribed MAT for shorter durations than white people do. Receiving MAT for an appropriate duration is often vital in patients’ survival — studies have shown that these medications may cut the overdose death rate in half among those struggling with opioid addictions, and receiving at least six months of treatment is associated with better recovery outcomes.

“We now have a very good treatment strategy for opioid use,”  Mark Costa, associate research scientist in psychiatry at the School of Medicine, told the News. “We have medication that is very helpful … But the way we offer these treatments is not impacting the Black and Latino community how it’s impacted the white community.”

The legacy of discrimination in clinical mental health and addiction treatment

Racial discrimination in the health care system has already long discouraged those of minority backgrounds from seeking treatment for substance use disorders, according to experts who spoke to the News. Datahaven’s 2023 CWI supports such claims — compared to 3 percent of white residents, 7 percent of Latino residents and 16 percent of Black residents in Greater New Haven reported that they had been discriminated against in the health care system. 

For Bridgett Williamson, who formerly battled substance use disorder and now works with those in recovery, the issue of racial discrimination and abuse in addiction treatment hits close to home. When she received methadone to treat her drug addiction in the 1980s and early 1990s, treatment workers said that one of her urine samples tested positive for drugs, even though Williamson maintains she did not consume any substances. She received an ultimatum from the criminal courts: be admitted to the state’s in-patient mental health treatment facility or go to prison for five years. 

When she entered the facility, staff members exerted control over what she could and couldn’t do. For instance, although they allowed white patients to step outside to smoke cigarettes or make trips to the store, they barred Williamson and other Black patients from doing the same. They told her they were afraid she wanted to step outside to purchase drugs, but they never raised this concern with the white patients — including those who Williamson said actually did bring drugs inside. 

Trapped on the third or fourth floor of the facility for over a month, Williamson’s mental and physical health deteriorated. She said she was forced to stay without any means of escape as she endured experiences that still traumatize her three decades later, including witnessing other patients harm themselves, finding mice in her bed and having her health and safety concerns constantly ignored by staff and doctors. 

“Caring and controlling is two different things,” Williamson said. “Do you think I trust the hospital? Hell no, I don’t even go. So that’s how they treat us people of color.”

Streets named a long history of suspicion toward traditional clinical care models among minorities that persists through the current crisis. Oftentimes, he told the News, people of color seeking help are cast as criminals and treated as “people who are problems” instead of people experiencing problems. 

Over 30 years after Williamson’s experience in the state facility, the state’s Department of Mental Health and Addiction services boasts a Health Disparities Initiative on its website. The page raises questions about a “culturally competent system of care” and asks readers to reflect on steps the Department has taken “toward developing culturally relevant programming.” 

At the same time, state mental health facilities collectively employ 70 police officers, many of whom show up to work armed. By having armed police officers on their premises, state mental health and addiction treatment centers may heighten the fear of seeking help among Black and Latino people in Greater New Haven, who were far more likely to report experiencing discrimination at the hands of the police in the Datahaven CWI. Only 45 percent of Black and 54 percent of Latino residents of Greater New Haven reported that they approved of the local police, as opposed to 76 percent of white residents. And although Black residents make up 16 percent of residents in Greater New Haven, they comprised 45 percent of drivers who were searched by police from 2018-2020.

The presence of police may also discourage people who have had previous experiences with the criminal justice system, Costa noted. The Yale-affiliated Connecticut Mental Health Center in New Haven, where Williamson was mandated to go decades ago, currently hosts a team of armed cops and features metal detectors at its entrance. 

Streets stressed that existing clinical models must prioritize hospitality toward minority patients in order to truly make them feel comfortable enough to receive medical care during a crisis. Clinical models, others added, must also become more accessible to all people struggling with addiction regardless of race or class.

“Here’s the dilemma: as you work and encourage people not to feel bad about feeling bad, not feeling bad about needing help, what happens when a person goes to a system that then treats them inhumane?’” Streets said. “It’s a catch-22.” 

Ethnic churches, multidimensional treatment and peer support

After coming to Connecticut for treatment, Bellamy’s cousin died from an overdose in August 2022. Bellamy told the News that she, her colleagues and other community members are motivated to work on “culturally responsive” treatment efforts because of their life experiences.

“​​I do the work because as a professor and as a person with my own lived experiences, we are all on a recovery journey either personally or with family, friends, neighbors, roommates, classmates, co-workers and colleagues,” Bellamy wrote to the News. “I know far too many people that hide their use of drugs because of the shame and fear of reaching out.”

Bellamy serves as the director of the Yale Program for Recovery and Health, or PRCH, which aims to foster inclusion and trust through culturally responsive approaches to care. These efforts often center around building connections between people in recovery and peer mentors of their own backgrounds who have been in recovery themselves. 

Williamson and Youins, who both work with PRCH, said their personal experiences with addiction drive their need to give back to others in the community through one-on-one mentoring. Williamson shared that sharing her experiences of substance use disorder and trauma helps demonstrate the realities of addiction in the long term, motivating people to continue recovery. It also helps combat the shame and stigma around substance use disorder on a more personal level, she said. 

“I stayed in the streets, I stayed in crackhouses, so this is why it’s so easy for me to let a person know that you don’t have to be ashamed for where you’ve been,” Williamson said. “I don’t care what you did three minutes ago. How can we move forward today, right now?”

Youins emphasized the importance of receiving care from people who “look like you,” especially as treatment and addiction recovery outreach efforts have often been led by white people “who have no connections in the community” and do not understand the social factors that influence substance use. He stressed that Black leadership has been crucial to bolstering recovery efforts in his community.

Created in 2017 by Bellamy and Assistant Professor Adjunct of Psychiatry Ayana Jordan, the Imani breakthrough project study was specifically designed to target people of color looking for recovery, though treatment for substance use is open to all. Using Black and Latino churches in the state, providers and care coordinators have tried to create a comfortable faith-based treatment environment while still being “non-proselytizing,” according to Streets, who helped facilitate the program at the Dixwell Avenue Congregational United Church of Christ.

“It’s a natural outgrowth of faith communities, as a matter of the basic principle and ethics of supporting the neighbor and assisting those who are more vulnerable,” Streets said. “It’s a public health approach, which combines the whole notion of empathy and an appreciation for our struggle as human beings.”

Dixwell UCC also promotes other community-centered approaches to combating the rise of substance use disorder and overdoses. The church has worked to educate congregation members about the the nature of substance use and the signs of potential suicide, as well as hosting trainings on administering Narcan and other harm reduction methods. Some congregation members have also stepped up to help lead the meditation sessions for those in addiction recovery through the Imani program.

“Those same people are advocates with their own families and in the wider community,” Streets observed. “If you replicate that by hundreds of churches or organizations throughout the community, you… advocate for a better atmosphere in which treatment can be offered and addiction could be understood.”

Gayle Brown began recovery treatment with Imani when she ran into a few counselors at Varick Memorial A.M.E. Zion Church about five years ago, right across the street from the Dixwell UCC. After the counselors asked her whether she knew anyone who had experienced substance use disorder, abuse, poverty or other hardship who would be interested in participating in a paid study, she boarded the bus and began spreading the word. Soon enough, she and dozens of other local residents gathered in Varick Memorial’s basement for their first session.

Cohorts of patients have gathered to receive weekly treatment through education on the harms of substances and racial disparities in overdoses, computer-based cognitive behavioral therapy, group support, a clinical treatment program staffed with doctors, one-on-one wellness coaching and self-reflection exercises. 

Shellina Toure, who currently facilitates the program at Varick Memorial with Sylvia Cooper, said that the self-reflection activities that happen during sessions are “intense.” Her facilitator training, which featured the same mindfulness strategies as the treatment sessions, had such a strong impact on her that it brought back her memories of almost becoming addicted to painkillers.

The church setting and group component, which Toure said becomes more comfortable as people build relationships over the course of several weeks, can help combat much of the distrust associated with traditional addiction treatment in hospitals. The room used for treatment also features a “Comfort Zone Agreement” on the wall, which Toure said instills ground rules and a culture of mutual respect during sessions. 

Sessions, Brown said, prioritize seeing one’s own experiences through the lives of others and understanding why they experience substance use disorder. As she continued to engage in self-reflection and open dialogue with others, Brown unearthed experiences from her traumatic childhood and her family’s history of addiction, reckoning with their influence on her life in the present.

“All of the people that was in this one program at that one time — I could fit into each one their shoes,” Brown said. “I’ve been through it, mentally abused, physically abused, sex abused. After all these many years, it started bringing up my childhood, what happened to me.”

The program also directly targets the social determinants that put minorities at a higher risk for fatal overdoses, aiming to provide people with basic needs to eliminate barriers to treatment access. Toure said she has personally helped patients find emergency housing, look for rental assistance programs, earn their high school diplomas and get their driver’s licenses.