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Vulnerable Black women’s substance use

How Do Intersecting and Overlapping Social, Environmental, Political and Economic Factors Affect Vulnerable Black Women’s Substance Use?

Liesl A. Nydegger and Kasey R. Claborn

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Black women generally have higher rates of infections, diseases and mental health problems – such as HIV, cardiovascular disease, depression and substance use issues – than other groups in the United States. Systemic racism and economic and educational discrimination contribute to these health disparities. Moreover, increased rates of sex work, substance use, and intimate partner violence significantly increase Black women’s already high vulnerability to HIV infection, homelessness, and other severe adverse life experiences.

Given these intersecting and overlapping social, environmental, political and economic factors that negatively affect Black women’s lives, using syndemic theory can help to better understand vulnerable Black women’s substance use experiences. A syndemic approach recognizes that two or more physical or mental health problems can and often do adversely interact with each other, and are made even worse by social and economic injustices experienced by the individual. This synergy of health problems and inequity leads to increased vulnerability and even worse health outcomes. In other words, syndemics focuses on understanding the ways in which a person’s context affects her health outcomes. For example, previous research has demonstrated that housing instability and homelessness – inequalities caused by structural racism and other factors – co-occur with sexual risk behaviors and sexual coercion.

Some individuals use substances to cope with the injustices and challenges they face in their lives, such as experiences of child maltreatment and other traumas, unemployment or underemployment, living in neighborhoods with high crime rates, and lack of health insurance. Moreover, Black women who experience high levels of trauma, including intimate partner violence, have a greater need for substance use and mental health treatment. However, due to entrenched inequalities, Black women have less access to care.

In order to explore the impact of syndemic factors on substance use and increased HIV risk among vulnerable Black women, the authors conducted in-depth interviews with 31 Black women in Milwaukee, Wisconsin. To be eligible for the study, women had to have experienced at least one of the following (though due to syndemic factors, most had experienced more than one): intimate partner violence in the past three months; sex exchange or survival sex in the past three months; problematic substance use in the past 30 days defined as any illicit drug (except for marijuana), eight or more drinks of alcohol per week or four or more drinks on one occasion, or marijuana use 14 or more times per month.

All Black women who participated in the study experienced poverty. In addition, the authors identified two groups of participants: (1) women who misused their drug of choice during the study; and (2) women in recovery from their drug of choice, the majority of whom misused alcohol or marijuana during the study.

Key Findings

  • Women who misused their drug of choice during the study:
    • used substances more often in response to housing, employment, poverty, and recent adverse life experiences; See selected quotes below.
    • reported more instances of using substances as a coping mechanism.
  • Women in recovery from their previous drug of choice:
    • used other substances at lower frequencies and did not relapse during the study
    • coped with urges and cravings through a focus on self-improvementto avoid negative consequences previously experienced as a result of illicit drug use;
    • However, they experienced more intimate partner violence.

Black women who misused their drug of choice during the study used substances to cope with multiple intersecting traumas and challenges

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Policy Implications

Policies to address structural, social, and individual factors affecting Black women with low incomes are urgently needed. Local, state and federal policymakers must expand housing opportunities for low-income Black women that make it possible for them to easily search, apply and qualify for affordable housing. Black women with low incomes also need more opportunities to participate in employment training programs at no or low cost. Funding for programs to address intimate partner violence should be increased to facilitate women’s ability to detect, respond to, and leave abusive relationships.

In addition, mental health treatment, safe sex practices, and substance use recovery opportunities must be expanded and made available to low-income Black women. Substance use treatments for vulnerable Black women will likely be more successful if they are tied to the individual’s moral framework and focus on life purpose, goals, and avoiding negative consequences. Finally, healthcare providers must be trained in trauma-informed care to ensure women receive resources and opportunities to live a healthy life.


Nydegger, L.A. & Claborn, K.R. Exploring patterns of substance use among highly vulnerable Black women at-risk for HIV through a syndemics framework: A qualitative study. (2020). PLOS One. DOI: 10.1371/journal.pone.0236247

Suggested Citation

Nydegger, L.A. & Claborn, K.R. (2020). How do intersecting and overlapping social, environmental, political and economic factors affect vulnerable Black women’s substance use? PRC Research Brief5(6). DOI: 10.26153/tsw/9562.

About the Authors

Liesl A. Nydegger (Liesl.Nydegger@gmail.com) is an assistant professor in the Department of Kinesiology and Health Education and faculty research associate in the Population Research Center at The University of Texas at Austin; Kasey R. Claborn is an assistant professor in the Department of Psychiatry at Dell Medical School at The University of Texas at Austin and an adjunct assistant professor of medicine at The Warren Alpert Medical School of Brown University. The authors contributed equally to the work.


This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2C HD042849), awarded to the Population Research Center at The University of Texas at Austin; Liesl Nydegger received additional support from the National Institute of Mental Health (T32 0MH19985 and P30 MH52776). Kasey Claborn received support from the National Institute on Drug Abuse (K23DA039037). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.