Highlights

• Addiction research has increasingly mentioned race while racism is rarely mentioned.

• Since protests of the murder of George Floyd, racism has been discussed more often.

• Addressing addiction inequity will require discussing racism in the literature.

• Ethics review not required for this study.

1. Introduction

Structural racism has shaped American systems since its foundation. Racial health inequities, in addiction and more broadly, have been documented in medical literature for decades. The 2001 Institute of Medicine Report “Unequal Treatment” was a galvanizing moment for recognizing these inequities, yet recent research indicates that inequities have since worsened, even as the multidisciplinary literature on health inequity increases (Caraballo et al., 2023; Odlum et al., 2020; Smedley et al., 2003). Recently, Nancy Krieger, Rhea Boyd, and colleagues argued that discussions of racism as a cause for inequity have been ignored in the medical literature (Boyd RW et al., 2020; Krieger et al., 2021); despite increases in descriptions of race-related health inequities in the literature, few papers mention racism.

Race is broadly understood in the scientific literature to be a social construct rather than as a stand-in for genetic differences though how race is interpreted in the scientific literature is complicated (Amutah et al., 2021; Duello et al., 2021; Jones, 2000). Meanwhile, racism has been defined in numerous ways, with one useful definition being “the relegation of people of color to inferior status and treatment based on unfounded beliefs about innate inferiority, [including] unjust treatment and oppression of people of color, whether intended or not” (Braveman et al., 2011). Further, when operating at a structural level, racism is “pervasively and deeply embedded in and throughout systems, laws, written or unwritten policies, entrenched practices, and established beliefs and attitudes that produce, condone, and perpetuate widespread unfair treatment of people of color” (Braveman et al., 2011). Krieger and colleagues (2021) argue that when race-based differences are assessed, neglecting to mention racism as a potential cause of those differences is an important and notable omission.

Although there are other structural factors, including socioeconomic status, language, and citizenship, among others, that intersect with racism and contribute to health inequity, racism has played a major part in shaping addiction policy, treatment, and outcomes (Bailey et al., 2017, 2021; Dean and Thorpe, 2022; Mendoza et al., 2019; Pineda et al., 2017; Williams et al., 2019). Tobacco, alcohol, and opioid use are major contributors to morbidity and mortality in the US, but health effects are distributed inequitably, with the heaviest burden among people of color (Kariisa et al., 2022; Shield et al., 2013; Trinidad et al., 2011). These inequities vary among different communities of color. For example, recent statewide data from Massachusetts indicate sharp increases in opioid-related overdose deaths among Black communities, alongside high mortality rates for American Indian/Alaska Native groups (Massachusetts Department of Public Health, 2022). Historically, policy and media rhetoric linked substances to specific ethnic groups—e.g. the Chinese Exclusion Act in the context of Chinese immigrants being vilified for opium—with political aims (Yamatani, 2017). The War on Drugs has done significant damage to Black communities specifically, leading to incarceration rates far beyond rates in most countries around the world; the drug policies of the 1980s and 1990s have been explicitly racialized for political gain, as demonstrated by statements made by government officials at the time (Netherland and Hansen, 2016). Structural racism has also shaped addiction treatment, particularly methadone, an effective medication for the treatment of opioid use disorder (Andraka-Christou, 2021). The requirement of daily attendance, penalties for use of other substances, and a low-threshold for termination of treatment have given methadone the nickname “liquid handcuffs,” rhetorically linking this treatment to incarceration (Malvini Redden et al., 2013). Shaped by structural racism in the US, methadone is more available in segregated Black and Hispanic/Latino communities, while the less-regulated, less-stigmatized medication buprenorphine is more readily available in whiter communities (Goedel et al., 2020). Thus, when examining patterns of health inequities in addiction outcomes by race, omission of the term racism would be ignoring history.

The analysis done by Boyd, Krieger, and colleagues suggests an increasing trend in the mentioning of racism with the racial reckoning that began after the murder of George Floyd (Boyd RW et al., 2020). His murder, and the exposure of racism in nearly every system in the US, started a culture of introspection around race and racism in health care (Merchant et al., 2021). Indeed, after June of 2020, major medical journals showed an increase in the use of the term racism in research papers (Boyd RW et al., 2020).

Identifying and naming racism as an explanatory factor for race-based addiction disparities is an obvious and necessary first step to addressing those inequities. Given the uniquely important and historical role of racism in the approach to people with addiction, we sought to explore how often addiction journal articles mention “race” and “racism.” Further, we explored how often articles that mention race concurrently mention racism. Finally, we sought to determine whether the frequency of those terms changed with the racial reckoning after the murder of George Floyd.

2. Materials and methods

We identified five representative addiction-focused journals based on suggestions from addiction fellowship-trained physicians, h-index metrics, and prior research (Gorman and Huber, 2022): Addiction, Addictive Behaviors, Drug and Alcohol Dependence, Journal of Substance Abuse and Treatment (name changed in 2023 to Journal of Substance Use and Addiction Treatment), and International Journal of Drug Policy. Then, we created a program to download all published articles from these journals from 1990 to 2022.

We created a text-processing algorithm within the statistical programming language R to analyze the textual data. From these articles, we identified the year of publication and counted the number of mentions of the word “race” and “racism.” We also measured mentions of words associated with specific races, including “African American,” “ethnic,” “Hispanic,” and “Latin-,” for comparison to mentions of “race.” The algorithm then categorized each article into one of four article types: empirical research, opinion/commentary, review articles, or other. The categories were assigned based on the journal's own labelling system or the presence of methods/results sections, as these subsections often indicate empirical research. To further validate the accuracy of this algorithm, two blinded members of our research team manually processed 250 randomly selected articles; this subsample size was chosen based on prior research on power for assessing reliability (Borg et al., 2022; Donner and Eliasziw, 1987; Sim and Wright, 2005; Walter et al., 1998). We then assessed the validity of our algorithm results in multiple ways: absolute agreement, two-way random effects, absolute agreement intraclass correlation coefficients (ICC) and Cohen's kappa (κ) (Hallgren, 2012; Koo and Li, 2016).

We determined both the number and proportion of articles published that mentioned “race” or “racism.” Further, because we believe that articles that use the term “race” should also talk about racism, we described the number and proportion of those articles that mentioned both race and racism. We stratified our results by journal and article type, employing binomial regression models to estimate differing rates. We conducted an interrupted time series (ITS) analysis using binomial regression to investigate associations between social movements of 2020 and frequency of mentioning race/racism, adjusting for temporal trends. Finally, we conducted negative log-likelihood ratio tests for binomial regression models to assess different temporal patterns across article types. All tests of significance were conducted as two-tailed tests with a threshold of significance of P = .05 in the statistical language R.

3. Results

We identified 32,052 articles in the five journals from 1990 to 2022, including 22,669 (70.7%) research articles, 5212 (16.3%) opinion/commentary articles, 1004 (3.1%) non-systematic reviews, and 1705 (5.3%) other files (Table 1). The “other” category included volume tables of contents, author indices, book reviews, editorial board listings, advertisements, and other materials that likely do not contribute the same level of scientific impact as the other categories. Further, when we included these files, they did not meaningfully affect overall estimates or interrupted time series models As such, subsequent analyses excluded these files, leaving a final sample of n = 30,347.

Table 1 Descriptive data of all articles included in this analysis, including year of publication, type of article, and rates of mentioning race and racism from 1990 to 2022. Note that Journal of Substance Abuse Treatment changed its name in 2023 to Journal of Substance Use and Addiction Treatment.

Based on the randomized sample of 250 articles, our text processing algorithm demonstrated high reliability and accuracy when compared to human categorization. With regards to publication year, our algorithm demonstrated 91.5% absolute agreement with very strong inter-rater reliability (ICC(2,k) = 1.00); these small differences between human and algorithmic classifications in year overwhelmingly occurred when articles were published around December/January of particular year, as journals sometimes publish articles in advance of when they are dated. Further, detection of mentions of racism was also highly reliable (ICC(2,k) = 0.8, 95% CI [0.74, 0.84], absolute agreement: 99.6%). Though slightly less accurate than detecting mentions of racism, our algorithm demonstrated high accuracy of detecting mentions of race (ICC(2,k) = 0.8, 95% CI [0.69, 0.86], absolute agreement: 85.2%). On further inspection, the algorithm was more inclusive of mentions of the word “race” than human categorization, with the majority of discrepancies occurring due to presence of the same letters in larger words (“intracellular” and “racemic”) or due to the mention of “race” in the references section, which human raters did not include. We did not remove these classifications for three primary reasons. First, the algorithm still retained high accuracy and did not fail to detect a single mention of race that were identified by human categorization, suggesting we are capturing nearly all mentions of “race” as a standalone term that humans would detect. Second, because the files varied in formatting over the course of three decades and across multiple publishers and journals, if we only included mentions of “race” with spaces/punctuation before and after the term, we would risk undercounting mentions of race; for example, a paper from the 1990s, when papers were formatted differently than more recently published papers, may convert “descriptions by race are provided” to “descriptionsbyraceareprovided” when processed by the algorithm, which would then be missed with a more stringent classification system. Third, we believe our “race” measure is actually an undercount of discussions of race/ethnicity, as discussed below, and it may thus serve as a lower bound estimate of how often race is mentioned in these articles. Finally, the algorithm demonstrated high levels of agreement and moderate reliability for identifying article type (e.g. opinion/commentary, review, or research) (Cohen's κ = 0.66, 95% CI [0.56, 0.75], absolute agreement: 86.1%).

Mentions of specific racial groups or associated terms (e.g. “African American”, “Hispanic”. “latin”, and “ethnic”) occurred 50% more often than mentions of “race”; mentioning “race” represented a related but distinct pattern from this broader collection of terms (ICC(3) = 0.32, 95% CI [0.31, 0.33]). To mirror prior work and provide an initial examination of the concepts of race, our analysis subsequently focused primarily on mentions of “race”, acknowledging that this likely underestimates how often race and ethnicity are implicated.

3.1. Patterns of mentioning race and racism separately

Journal articles have shown increases in rates of mentioning race and mentioning racism since 1990 (Fig. 1). Across included articles (n = 30,347), 11,651 (38.4%) of articles mentioned race, with annual increases now reaching over 50% of articles published in 2022. Though articles have increasingly mentioned racism, this occurred far less often than mentions of race; 450 (1.5%) of all articles mentioned racism during this 33-year period, findings consistent across different journals (Fig. 2). Assessing the change in usage of these terms after the racial reckoning of 2020, we found that articles published in 2020 or later were more likely to mention racism compared to years prior (5.1% vs. 0.9%, OR = 1.09, 95% CI: [1.01, 1.17], P = .03). Accordingly, half of articles that mention racism have been published in 2020 or after. This relatively small increase in mentioning of racism, however, remains far below increases in the rates of mentioning race.

Fig. 1. Trends in the number (left) and proportion (right) of articles mentioning either race or racism in addiction research published from 1990 to 2022.

Fig. 2. Trends in the proportion of articles mentioning race (left) or racism (right) in addiction research published from 1990 to 2022, stratified by journal.

3.2. Patterns of mentioning race and racism concurrently

When examining mentions of race and racism together, of 11,651 articles mentioning race, only 373 (3.2%) also mention racism (Fig. 3). Like the pattern of mentioning racism alone, the pattern of mentioning both race and racism together is a recent phenomenon. In 2022, 81 (10.8%) of articles mentioning race also mentioned racism, while from 1990 to 2009, only 66 (1.7%) did so; articles mentioning race and published since 2020 were more than three times as likely to also mention racism compared to before 2020 (OR = 3.21, 95% CI: [2.39, 4.32], P < .001).

Fig. 3. Trends in the proportion of articles mentioning race and racism together in addiction research published from 1990 to 2022. Since the protests of 2020, there has been a significant increase in the rate of mentioning race and racism together (OR = 3.21, 95% CI: [2.39, 4.32], P<.001).

3.3. Patterns of mentioning race and racism by article type

Trends over time for mentioning race and racism in published articles from 1990 to 2022 vary by the type of article (Fig. 4). Research articles (10,429 articles, 46%) demonstrated the highest rates of mentioning race, compared to 885 (17%) opinion/commentary articles and 337 (33.6%) review articles (33.6%) (Fig. 4a). Compared to research articles, opinion/commentary articles (OR = 0.24, 95% CI: [0.22, 0.26], P < .001) and review articles (OR = 0.59, 95% CI: [0.52, 0.68], P < .001) were significantly less likely to mention race. Further, increases over time in rates of articles’ mentioning race varied significantly based on article type (χ²(6) = 116.4, P < .001). Increasing rates of mentioning race was primarily driven by increasing rates in empirical research articles, as both review and opinion/commentary articles largely maintained stable rates; for example, in 1990, 61 research articles (23.2%) used the word “race,” while in 2022, 707 (58%) did.

Rates of mentioning racism were similar across article types. From 1990 to 2022, 353 research articles (1.6%), 74 opinion/commentary articles (1.4%), and 23 review articles (2.3%) mentioned racism (Fig. 4b). Compared to research articles, opinion/commentary articles (OR = 0.91, 95% CI: [0.71, 1.17], P = .47) and review articles (OR = 0.67, 95% CI: [0.44, 1.03], P = .07) were similarly likely to mention racism. In all three categories, mentions of racism remained low until substantial increases since 2020. This statistically significant increase was similar across article types.

When examining the rate of co-mentioning race and racism across different article types, we found a similar pattern as the overall pattern; rates of mentioning both terms are low, but increased rates are a recent phenomenon since 2020 (Fig. 4c). For research articles, from 1990 to 2019, only 132 research articles (1.6%) mentioned race and racism together, while since 2020, 171 research articles (5.9%) have done so. Among articles mentioning race, compared to research articles, both opinion/commentary articles (OR = 2.09, 95% CI: [1.54, 2.82], P < .001) and review articles (OR = 1.89, 95% CI: [1.16, 3.07], P = .01) were significantly more likely to also mention racism. Frequency of mentioning race and racism together after the social movements of 2020 was similar across article types; there was no difference in changes since 2020 for the increased rate of mentioning race and racism together when comparing research articles and opinion/commentary articles (P = .96). Thus, while opinion/commentary and review articles more commonly discuss both race and racism together compared to original research articles, all three types of articles appear to have increasingly mentioned “racism” alone and when mentioning “race” since 2020.

4. Discussion

Examining a large sample of the addiction literature from 1990 to 2022, we found that authors increasingly mention race and rarely discuss racism. We demonstrated that this lack of discussion of racism occurs across journals and pervades both commentary and empirical pieces. Following the increased societal awareness of the need to confront racism after the murder of George Floyd, the addiction literature has become slightly more likely to talk about race and racism together. However, these increases, though statistically significant, remain small and have not filled the large gap between rates of talking about race and talking about racism.

Our findings echo the broad findings of Krieger et al. (2021). Given the strong racialization of addiction in the media and policy (Netherland & Hansen, 2016, 2017), we conjectured that addiction medicine journals may discuss racism more frequently, but this was not the case. We are encouraged by the increased discussions of racism after 2020, and by statements by organizations and journals committing to naming and being committed to addressing racism across the substance use continuum (Hagle et al., 2021). However, we must be wary that these increases may be temporary, and that in absolute numbers, these increases are quite small.

It is difficult to separate the effects of the protests surrounding the murder of George Floyd from the recognition of racial disparities in health and socioeconomic outcomes exacerbated by the COVID-19 pandemic. Though racialized police violence and racial health inequities have long been documented, both became increasingly acknowledged in academic, popular, and social media outlets in early 2020. This new awareness, particularly for powerful institutions and white populations, may have reinforced a shift in how we mechanistically consider the role of structural racism, even though researchers have noted this for decades before this (Burnes Bolton et al., 2004; Harrell et al., 2011; Kwate, 2014). In this article, we assert that the protests have affected our language in addiction studies, but it is likely the combined effects of both movements that contribute to why our language has shifted.

The most striking finding of this analysis is the large discrepancy between how often researchers discuss race without the mention of racism. Race is broadly accepted by scientific organizations to be a social construct, rather than a stand-in for genetic differences between groups (Churchwell et al., 2020). Yet whether in medical education, clinical calculations, or in research, race is commonly used as a stand-in for biological differences between populations (Amutah et al., 2021; Delgado and Powe, 2022; Duello et al., 2021; Hoffman et al., 2016). The concern with this mis-framing is that researchers often explore race as a stratifying variable without mentioning how racism may be implicated. If researchers do accept race as a social construct, and are using race as a stratifying variable, then it stands to reason that racism should be discussed as a possible explanatory factor for any race-based differences.

Discussing racism in a vanishingly small fraction of papers that mentions race may suggest a purposeful avoidance of the concept. We believe that one reason for this reluctance is that physicians and researchers are reluctant to appear as if they are calling themselves and their colleagues racist, to the extent that editors of leading journals claim that no physicians are racist (McFarling, 2021). But the concept of structural racism itself does operate—and should be named—regardless of the presence of interpersonal racism in medicine, which carries a taboo.

Interestingly, we also saw different results spanning article types, with opinion/commentary and review articles often exhibiting higher rates of mentioning racism and race together compared to empirical research articles. We believe there are multiple possible reasons for this. First, empirical research articles are often encouraged or required to provide baseline and demographic characteristics of their sample, either due to grant funders such as the NIH or to represent the sample for readers to examine the external validity of their results (National Institutes of Health, 2021). Opinion/commentary articles and review articles do not have such tables, and as such, their rates of mentioning race are notably lower. Second, empirical researchers, as well as reviewers and editors, may not be as comfortable discussing race and racism together, as it is likely outside their expertise, in comparison to those who are making editorial claims about race/racism (or who may be tasked with reviewing such papers). As a result, there may be pressure, from reviewers or editors, to downplay or omit mentions of racism in empirical pieces due to this discomfort or reluctance; we have many personal experiences of this during publications of other critical works in various medical fields. Third, the populations writing these different types of articles may be relatively distinct and differ along racial/ethnic lines. A recent study of millions of published articles suggested that Black authors are over-represented in articles about racism and discrimination (Kozlowski et al., 2022). Further, prior research has indicated under-representation from minoritized racial groups, especially Black communities, in NIH grants and faculty positions (Ginther et al., 2011; Li and Koedel, 2017); it is therefore possible that the population of authors discussing racism in commentary pieces is distinct and more racially diverse than the population of authors conducting general empirical research.

What are the dangers of failing to discuss racism in the addiction literature? First, the absence of talking about racism inaccurately suggests that racism was not important in the history of addiction policy and is not relevant to treatment today. Second, it fosters ignorance of the role of racism in current addiction treatment and policy among experts. This “scientific ignorance” can affect policy and research, as argued more generally by Krieger and colleagues (Krieger et al., 2021; Mills, 2008). Indeed, current scientific ignorance around the issue of the role of racism in inequities in addiction outcomes is part of a long history of structural enforcement of differential power manifested in health care. Physicians and scientists were active participants in creation of the “knowledge” justifying racial hierarchies that propped up slavery, and subsequently, segregation (Soled et al., 2021; Yearby et al., 2022). Scientific ignorance can be viewed as an extension of historical ways in which science has supported structural power differentials that reinforce power differentials and social hierarchies.

Overdose death rates among Black individuals, American Indian and Alaska Native individuals, and Hispanic individuals have risen sharply in recent years, with overdose death rates in the first two groups surpassing those of white individuals in recent years for the first time (Friedman and Hansen, 2022). In the context of addiction medicine, interventional research can further perpetuate inequities when equity concerns are not considered early. Stratifying data collection, ensuring timely translation of study materials, and pre-specifying equitable outcomes across racial groups are some practices that require applying an equity lens (Chatterjee et al., 2022).It is also important to recognize that while racism can affect all communities, some groups, especially the Black and Native communities in the United States, have been particularly singled out by structurally racist policies. Interrogating the reasons for these inequitable death rates, in the setting of inequitable access to evidence-based treatment, is vital.

The mis-framing of inequities as due to biologic differences, rather than considering the role of structural racism, leads to investment into inappropriate solutions to the devastating opioid crisis (Goedel et al., 2020; Lagisetty et al., 2019). For example, scientific explanations that fail to acknowledge the role of racism in addiction can lead to increased resources for developing new biologic solutions (e.g., vaccines, genetic screening) that may have minimal impact on the disparities they were made to address (Hatoum et al., 2023; Shen et al., 2012). Neglecting to adequately discuss the role of racism with race in population-based addiction research can also place blame on the behaviors of individuals and groups for racial inequities in addiction-related outcomes, rather than considering the broader systemic, and racist, upstream structural determinant forces (Brown and Homan, 2023). These missed opportunities impede the ability of funders and policymakers to address ongoing inequities because it can direct their attention towards interventions that address the symptoms of addiction and away from antiracist policies that can help eradicate the underlying causes of the inequity. Thus, when articles report on racial differences without adequate discussion of racism, they promote a form of scientific ignorance that maintains the status quo and may be yet another example of structural racism.

There is growing literature that provides recommendations for possible ways to discuss racism in the medical literature (Beech et al., 2021; Boyd RW et al., 2020; Churchwell et al., 2020; Krieger et al., 2021; Williams et al., 2019; Williams and Mohammed, 2009). Authors, peer reviewers, and journal editors should consider a variety of steps to ensure thoughtful consideration of the use of race and racism in medical literature. One strategy that authors may take, which should be encouraged by journals, is to think collaboratively from the beginning of a project to create a diverse authorship team, which has been associated with higher impact papers (AlShebli et al., 2018). Journals should also embrace recommendations for improving engagement with the topic of racism, such as dedicated issues for exploring the topic and specific questions about how a manuscript engages with issues of race and racism during the submission process. Hardeman and colleagues mention that qualitative research also plays a critical role in the understanding of structural racism and its impact on health (Hardeman et al., 2022); another recommendation for journals to improve engagement with structural racism is to increase word limits for qualitative research to allow for more in-depth understanding of lived experience. Some of this reform may require introspection—we concur with Krieger and colleagues’ recommendation that this sort of analysis be extended to rejected articles, and that reviewer comments and editorial decisions be examined to better understand their role in shaping what is discussed in the addiction medicine literature (Krieger et al., 2021). Diversifying editorial staff to improve decisions around discussions of race and racism may be an important tool as well; working with experienced reviewers when a paper discusses racism is crucial. However, not every journal will have access to such reviewers, most of whom are from Black and other communities of color, and reliance on their unpaid labor may further exacerbate the “minority tax,” which is the extra responsibility placed on scholars from minoritized communities to address issues of diversity, race, and racism (Kozlowski et al., 2022; Rodríguez et al., 2015); this underscores the importance of further educating and training current editorial staff and reviewers to better equip them to discuss and understand the interconnectedness of racism and health.

At the level of the manuscript, researchers may feel compelled to include race as a stratifying variable in manuscripts, however, as Boyd and others have argued, it is necessary that authors specify the reason for which they are including race as a variable (Boyd RW et al., 2020). Research involving racial inequity in addiction-related outcomes that aims to inform how to address that inequity should also entail a thoughtful discussion of the structural factors and variables most salient to the issue being studied. Indeed, researchers across various disciplines have discussed potential methodological considerations and approaches (Adkins-Jackson et al., 2022; Lett et al., 2022; Saloner and Cook, 2013). For example, if structural factors were included in a regression model, the discussion may include an explanation of how those variables contribute to the inequity being reported. As well, other salient unmeasured factors can be discussed and not solely listed in the limitations section. Finally, being explicit in author guidelines about ways in which authors should use the terms “race” and “racism” is warranted. Not only will this help improve our language and subsequent behaviors, but also it can push us to explore how structural racism acts as a causal factor leading to inequity.

There are several limitations to this study. First, though our sample is large, there are influential journals that we excluded, which may bias our results. Second, the automatic classification of articles mentioning “race,” while highly accurate, may represent only a subset of articles speaking about the concept, as compared to specific mentions of racial groups, and underestimate the chasm between mentioning race and racism. Here, we chose to focus on the general term race as it reflects what was previously reported by Krieger et al. (2021) and offers a first glimpse into this discrepancy between concepts of race and racism. Future studies may wish to examine how these patterns may differ with reference to specific racial and ethnic groups, as there may be meaningful variation in how racism is implicated with respect to different communities. Third, future studies may wish to examine the ways in which racism are described in the literature, including varying definitions and levels of racism, as well as the context in which racism is mentioned, something we did not explore. Fourth, though we attempted to estimate the causal effects of the protests around the murder of George Floyd using ITS, our data is observational and is at risk for bias due to unmeasured confounding. In a few years, researchers may wish to explore this further and assess if this uptick in mentioning racism is a temporary phenomenon.

5. Conclusions

Despite the role that racism has played in the US in shaping approaches to addiction, addiction medicine journal articles rarely mention racism. The trend has shifted slightly since the racial reckoning of 2020, but addiction medicine journals may be contributing to ignorance about the role of racism in addiction-related systems. This literature-informed ignorance may be precluding appropriate interventions at a time when overdose deaths are disproportionately affecting racially marginalized communities. For authors, centering equity early in study design and in all steps of study execution and manuscript writing will be important. For journals, undertaking reforms to ensure the appropriate use of the term race, and encouraging the discussion of the role of racism when race-based differences are explored, will be important. At a time of worsening racialized inequities in addiction outcomes, we must re-examine how we produce knowledge related to racism and addiction.

Contributors

None.

Funding

None to report.

Prior presentations

AMERSA national conference, November 2023.

CRediT authorship contribution statement

Spencer Dunleavy: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Jeremiah Douchee: Writing – review & editing, Validation, Formal analysis, Conceptualization. Tina Liu: Writing – review & editing, Validation, Formal analysis, Data curation. Natrina L. Johnson: Writing – review & editing, Supervision, Resources. Miriam Komaromy: Writing – review & editing, Supervision, Resources. Avik Chatterjee: Writing – review & editing, Writing – original draft, Supervision, Resources, Methodology, Conceptualization.

Declaration of competing interest

None to report.

Data availability

Data will be made available on request.

Summary

This study analyzes a large corpus of addiction literature (1990-2022) to assess the frequency of "race" and "racism" mentions and their correlation. The research investigates temporal trends and variations across article types, identifying a significant increase in "racism" mentions post-2020, although the overall frequency remains low compared to "race" mentions. The implications for addressing addiction inequities are discussed, emphasizing the necessity of acknowledging racism's historical and ongoing influence.

Patterns of Mentioning Race and Racism Separately

A comprehensive analysis of 30,347 articles from five prominent addiction journals reveals a striking disparity. While mentions of "race" have increased substantially since 1990, reaching over 50% of articles in 2022, mentions of "racism" remain considerably lower (1.5% overall). A notable increase in "racism" mentions is observed post-2020 (following the George Floyd protests), but this increase, while statistically significant, remains proportionally small compared to the rise in "race" mentions.

Patterns of Mentioning Race and Racism Concurrently

The study further examines articles mentioning both "race" and "racism" concurrently. A mere 3.2% of articles mentioning "race" also mentioned "racism" (1990-2022). Post-2020, a significant increase (OR = 3.21) in this co-mention rate is observed, yet it remains proportionally low.

Patterns of Mentioning Race and Racism by Article Type

Analysis by article type (empirical research, opinion/commentary, review articles) reveals differing trends. Empirical research articles exhibit the highest rate of "race" mentions, but this is still not matched by mentions of racism. Opinion/commentary and review articles show proportionally higher rates of co-mentioning "race" and "racism," although the increase post-2020 is consistent across all article types. The researchers suggest that this may be related to differences in publication requirements and the composition of the authors in those article types.

Discussion

The findings highlight a persistent underrepresentation of "racism" in addiction literature, despite the historical and ongoing impact of racism on addiction policy and treatment outcomes. While a post-2020 increase in "racism" mentions is noted, the disparity between "race" and "racism" discussions remains substantial. The study underscores the need for explicit acknowledgement of racism's role in perpetuating addiction inequities. Several limitations are acknowledged, including potential bias in journal selection and the inherent challenges of automated text analysis.

Conclusions

The study concludes that the relative absence of "racism" discussions in the addiction literature perpetuates a form of scientific ignorance that impedes effective interventions against racialized addiction disparities. The authors propose recommendations for authors, peer reviewers, and journal editors to promote more comprehensive and nuanced engagement with the topic of racism within addiction research, including diversifying authorship, reviewing processes, and explicit author guidelines.

Summary

This study analyzes the frequency of "race" and "racism" mentions in addiction research journals from 1990-2022. The analysis reveals a significant disparity, with "race" frequently mentioned while "racism" is rarely discussed. Post-2020, mentions of "racism" increased, though this increase remains relatively small. The study explores these patterns across different article types and suggests implications for addressing addiction inequities.

Patterns of Mentioning Race and Racism Separately

A substantial increase in the mention of "race" in addiction research publications is observed from 1990 to 2022. Conversely, mentions of "racism" remain significantly lower throughout the study period. However, a notable increase in "racism" mentions is detected following the 2020 racial reckoning, suggesting a correlation between societal events and scholarly discourse. This increase, while statistically significant, does not close the substantial gap between the frequency of "race" and "racism" mentions.

Patterns of Mentioning Race and Racism Concurrently

The co-occurrence of "race" and "racism" in addiction research articles is infrequent. A significant increase in the simultaneous mention of both terms is noted post-2020, mirroring the overall trend of increased "racism" discussion. Despite this increase, the proportion of articles mentioning both terms remains relatively low, highlighting the continued underrepresentation of "racism" in discussions involving "race."

Patterns of Mentioning Race and Racism by Article Type

The frequency of "race" and "racism" mentions varies across different article types (empirical research, opinion/commentary, reviews). Empirical research articles demonstrate the highest rate of "race" mentions, while opinion/commentary and review articles show higher rates of mentioning both "race" and "racism" concurrently. The increase in mentions of both terms after 2020 is consistent across all article types, though the overall frequency remains notably low.

Discussion

The study highlights a persistent underrepresentation of "racism" in the addiction literature, despite the historical and ongoing impact of racism on addiction patterns. The increased mention of "racism" after 2020, while statistically significant, remains insufficient to address this substantial gap. The authors discuss potential reasons for this discrepancy, including researcher discomfort, editorial pressures, and demographic variations among article authors. The consequences of this omission include perpetuating scientific ignorance, hindering effective interventions, and misdirecting resources. The authors provide recommendations for improvements in addressing the role of racism in addiction research and publications.

Conclusions

This study underscores the critical need for greater attention to the role of racism in addiction research. The significant disparity between the mention of "race" and "racism" highlights a potential blind spot in the field. Improvements in scholarly discourse are vital for accurate representation and development of effective interventions for addressing addiction inequities. The authors emphasize the need for changes in authoring practices, journal policies, and research methodologies to overcome this gap.

Summary

Studies increasingly note racial disparities in addiction but rarely discuss the role of racism. The 2020 racial justice protests spurred more frequent discussion of racism in research. Addressing addiction inequities requires acknowledging racism's influence. This study did not require ethics review.

Introduction

America's history of systemic racism has created persistent racial health inequities, including in addiction. While acknowledging racial disparities, addiction research often overlooks racism as a root cause. This omission is significant, as racism profoundly shapes addiction policies, treatments, and outcomes, impacting communities of color disproportionately. The disproportionate burden of addiction falls on people of color, with stark increases in opioid-related deaths among Black and Native American communities. Historically, substance use has been unfairly linked to specific racial groups for political purposes, further highlighting the interconnectedness of race, racism, and addiction. The War on Drugs had a devastating impact on Black communities, leading to mass incarceration. Even addiction treatment methods, such as methadone, have been impacted by structural racism.

Materials and methods

Researchers analyzed articles from five leading addiction journals (1990-2022) using a text-processing algorithm. The algorithm identified mentions of “race” and “racism,” as well as terms associated with specific races. Articles were categorized as empirical research, opinion/commentary, reviews, or other. The algorithm's accuracy was validated by comparing its results to those of human coders. Statistical analyses, including binomial regression and interrupted time series analysis, investigated trends in mentioning "race" and "racism" over time and across different article types.

Results

Of 30,347 analyzed articles, 38.4% mentioned "race," while only 1.5% mentioned "racism." Mentions of specific racial groups were more frequent than mentions of "race." Since 2020, articles mentioning "racism" increased significantly, yet the number remains small compared to mentions of "race." A small percentage of articles mentioning "race" also mentioned "racism." The increase in mentions of both terms since 2020 was statistically significant but still relatively low. Research articles had the highest rate of mentioning "race," while opinion/commentary and review articles were more likely to mention "racism" concurrently with "race".

Discussion

The study confirms that addiction research frequently mentions race but rarely addresses racism. While the 2020 racial justice movement led to a slight increase in discussions of racism, the gap between mentions of "race" and "racism" remains significant. This omission perpetuates a form of scientific ignorance, hindering efforts to address addiction inequities. The study highlights that the omission of racism in addiction research risks misinterpreting racial disparities as solely biological, neglecting the crucial role of systemic racism.

Conclusions

Addiction research needs to move beyond simply noting racial disparities to explicitly address the role of racism. The post-2020 increase in discussions of racism is encouraging, but substantial changes are still needed. Authors, reviewers, and editors should actively work to integrate discussions of racism into research and publications. Addressing the complex interplay of race and racism is crucial for developing effective interventions and achieving health equity in addiction treatment.

Summary

Studies about addiction often talk about race, but rarely about racism. Since the protests after George Floyd's death, racism is mentioned more, but not enough. To fix unfairness in addiction treatment, studies need to discuss racism. This study didn't need special permission.

Introduction

For a long time, racism has affected things in America. Doctors have known about unfair health differences for many years, especially in addiction. A big report in 2001 showed these problems, but they've gotten worse. Many studies talk about race differences, but not many mention racism as a cause.

Materials and methods

Researchers looked at articles from five important addiction magazines from 1990 to 2022. They used a computer program to count how many times the words "race" and "racism" were used. They also checked for words like "African American" and "Hispanic." The program also figured out if each article was a study, an opinion piece, or something else. To make sure the program worked right, two people checked 250 articles.

Results

They found 32,052 articles. Almost 40% mentioned "race," but only about 1.5% mentioned "racism." After 2020, articles were more likely to mention "racism," but still not often enough. Studies mentioned "race" more often than other types of articles.

Discussion

This study showed that articles talked about race more than racism. After 2020, things changed a little, but the difference is still big. Not talking about racism means we don't fully understand addiction problems and how they affect different groups.

Conclusions

Addiction studies don't discuss racism enough, even though it's a major part of the problem. Things have gotten slightly better since 2020, but more needs to be done. Studies need to consider racism when looking at differences between groups.