Demographic and socioeconomic factors influencing the adoption of telehealth services for substance use treatment.

The COVID-19 pandemic accelerated the adoption of telehealth (TH) for substance use disorder (SUD) treatment, but disparities in TH access remain. Using data from the 2021 and 2022 National Survey on Drug Use and Health (NSDUH), we analyzed demographic and socioeconomic predictors of TH utilization among adults receiving SUD treatment. It should be noted that NSDUH 2021 and NSDUH 2022 are not comparable for the aims of the current study due to necessary changes to substance use treatment survey questions. In 2021, educational attainment showed a strong dose-response association with TH use. By 2022, significant disparities emerged based on age, race/ethnicity, insurance type, and employment status. Non-Hispanic Black and Non-Hispanic Asian/Hawaiians/Pacific Islanders individuals had significantly lower odds of receiving TH care, compared to non-Hispanic Whites, while Medicaid users had higher odds than those with private insurance. Our findings indicate that TH use for SUD treatment is shaped by evolving structural determinants. To promote equitable access, public health policies must address digital divides, improve cultural competence, and support infrastructure expansion. Targeted strategies are essential to avoid deepening existing inequities in SUD care.