Barriers to substance use disorder treatment among Asian Americans in New York City: A qualitative study of provider perspectives

Abstract

Substance use disorders (SUDs) are a major mental health and public health concern in the United States, yet research and services for Asian American populations remain sparse. Although SUD prevalence among Asian Americans is not consistently higher than in other racial groups, treatment utilization is markedly lower, and the aggregation of diverse ethnic groups into a single category and the “model minority” stereotype obscure heterogeneity in needs and contribute to underdiagnosis, undertreatment, and limited culturally competent care. We conducted one-on-one, semi-structured interviews with eight healthcare and community-based providers serving Asian American clients with SUD across clinical and community settings in New York City (NYC) between December 2022 and May 2023. Participants were recruited through purposive sampling. Interviews lasted 45–60 minutes, were audio-recorded and transcribed verbatim, and were analyzed using a combined deductive–inductive thematic approach, alongside multiple researchers independently coding the data and reconciling themes through team-based discussion. Six interrelated themes emerged: types of services provided; substance use trends; barriers to care; community needs; existing interventions tailored to Asian Americans; and client engagement strategies. Providers described a wide spectrum of inpatient, outpatient, and court-mandated services, but identified pervasive shortfalls in cultural and linguistic competence. Substance use patterns differed by age, with growing ketamine use among younger clients and persistent alcohol use among older clients. Key barriers included stigma rooted in cultural beliefs about mental health, limited bilingual capacity, opaque communication from court-mandated treatment pathways, and intersecting socioeconomic pressures including housing instability and food insecurity. Providers also noted that aggregation of Asian American subgroups in data collection obscured distinct needs and impeded program planning. Findings highlight a pressing need for culturally and linguistically tailored SUD treatment, stronger collaboration between treatment programs and the legal system, sustained investment in community-based organizations, and disaggregated data collection across Asian American subgroups.