Sarcouncil Journal of Arts Humanities and Social Sciences

Abstract: Substance-use disorders (SUDs) disproportionately affect racially, ethnically, and culturally diverse populations in the United States, where exposure to individual, collective, and structural trauma is highly prevalent. Traditional substance-use treatment models often inadequately address cultural context, historical trauma, and systemic inequities. In response, culturally responsive trauma-informed care (CR-TIC) has emerged as a promising framework to improve engagement and outcomes among marginalized populations. This systematic review synthesized peer-reviewed evidence published between 2020 and 2025 on trauma-informed substance-use interventions that explicitly incorporate cultural responsiveness for diverse U.S. populations. Following PRISMA guidelines, studies were identified through searches of PubMed, Scopus, Web of Science, PsycINFO, Google Scholar, and ClinicalTrials.gov. Thirty studies met inclusion criteria for qualitative synthesis, of which eighteen provided quantitative data suitable for meta-analytic inclusion. Due to substantial heterogeneity in study designs, populations, and outcome measures, a narrative synthesis was prioritized, with quantitative findings summarized descriptively. Across studies, culturally adapted trauma-informed interventions were consistently associated with improved treatment engagement, therapeutic alliance, perceived safety, and psychosocial outcomes. However, the overall certainty of evidence was moderate, constrained by small sample sizes, reliance on self-reported outcomes, and limited longitudinal follow-up. The findings support CR-TIC as a critical evolution in substance-use treatment, while underscoring the need for rigorous, standardized evaluation and systems-level implementation to advance equity and effectiveness in behavioral health care.