Addressing Inequalities: The Vital Role of DEI in Addiction Medicine

Avik Chatterjee, MD, MPH, has seen firsthand the harms caused by structural and interpersonal racism, as well as the benefits of incorporating DEI (diversity, equity, and inclusion) principles into society and societal institutions.  

Dr. Chatterjee first realized the potential influence of DEI programs when he moved away from the progressive and diverse North Carolina school district in which he grew up. 

While attending college in Boston, he volunteered at a local public school and quickly noticed how the system segregated students by income and race.  

“I realized how these practices shaped the school I went to and the opportunities I had as I was growing up,” said Dr. Chatterjee, medical director of South Hampton Street Shelter Clinic in Boston. 

While Dr. Chatterjee said he has not experienced structural racism, he has experienced interpersonal racism.  

“When I applied to medical school, I was asked how I might distinguish myself from all the other Indian applicants who seemed to be the same to the interviewer,” he said. “I’ve had patients say, ‘Go back to your country’ if they didn't agree with the advice I was giving them. Race is not something that's invisible.” 

DEI in Health Care 

In addition to his work at the shelter clinic, Dr. Chatterjee is an assistant professor at Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center; associate epidemiologist in the Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital; and a part-time lecturer at Harvard Medical School, with a particular interest in institutional and structural racism in medicine and medical education.  

As an addiction medicine specialist, Dr. Chatterjee became interested in DEI around 2017. Today, he says this aspect of his work is as important as ever, especially at the shelter clinic. 

“Overdose is the leading cause of death in our patients,” he said. “Our patients are disproportionately Black, Native American, and Hispanic. So, when we talk about racialized inequities and addiction treatment and outcomes, we're talking about my patients having worse outcomes, overdosing more, and not being able to access treatment. Changing these patterns is very important for the people I see on a daily basis.” 

The concept of addiction is commonly racialized in society and the media; stories about minorities with a substance use disorder often include negative images and headlines. 

“But when it's White people dealing with opioid addiction and overdose, we see headlines that say, ‘Anyone Can Suffer from Opiate Addiction,’” he said. “We need a more compassionate public health approach, especially when it comes to marginalized patients.”  

Dr. Chatterjee notes a key component to changing the narrative is diversifying the health care field with increasing numbers of physicians and other practitioners who represent minority populations.  

“There's really good data showing that physicians of color take care of more patients of color and that there are improved relationships, outcomes, and recommendations around racial concordance,” Dr. Chatterjee said. “That says to me -- and I think it should be obvious -- that our physician and health care provider workforce should reflect the diversity of the country, whether it's based on language, ability, or culture.” 

ASAM’s DEI Modules  

ASAM has taken steps to educate its members on systemic racism in addiction medicine through its new DEI education modules. 

“In the modules, we deal with the impact of racism and structural racism on addiction treatment, how to understand it, and how to work to improve outcomes for your patients of color,” said Dr. Chatterjee, who helped develop the courses.  

ASAM’s first two DEI modules are Setting the Stage: Racism in the History of Substance Use and Addiction and Health Disparities in Substance Use Disorder. Two additional modules will be released in the near future. 

“I think modules 1 and 2 provide an excellent introduction to the history and epidemiology of racialized inequities and how they affect addiction treatment and outcomes,” Dr. Chatterjee said, “Modules 3 and 4 will then provide a framework to attempt to repair those historical inequities.” 

Dr. Chatterjee said the ASAM modules, which take about an hour to complete, are important because physicians, including addiction medicine specialists, are not immune to racism and other social issues that shape society. 

He added that he is thankful that ASAM helps its members focus on issues of diversity, equity, and inclusion in a sensitive yet practical way.  

“This approach is key to thinking about the difference between interpersonal and structural racism. I think a lot of people are sensitive about these issues, (thinking) that we're saying that a certain person or a certain clinic, for example, is racist,” Dr. Chatterjee said. “That's not what we’re saying. These racialized differences exist just based on history and laws, so I'm very happy that ASAM is continuing to support efforts surrounding this critical issue.”