OBJECTIVE: Substance use disorders (SUD) affect approximately 19.3 million adults in the United States. Of adults with SUDs, only 5% perceive the need for SUD treatment and 10% utilize specialty SUD treatment. The literature evidences racial disparities in utilization of SUD treatment yet presents mixed outcomes regarding race/ethnicity (i.e., White, Latinx, and Black/African-American) and gender (i.e., male, female) differences in perceived need for SUD treatment, specialty SUD treatment utilization, and barriers to SUD treatment. In addition, interaction with healthcare systems for chronic medical conditions like diabetes or hypertension may facilitate connection to SUD treatments for individuals with co-occurring SUD and chronic medical conditions, but little research exists that explores this potential facilitator. This dissertation addresses the following questions, with a focus on race/ethnicity and gender, and their interaction: 1.) What characteristics are associated with perceiving a need for SUD treatment among adults with SUD? 2.) What are the characteristics of adults who do not engage in specialty SUD treatment among those who perceived a need for SUD treatment? What were the most commonly reported barriers to specialty SUD treatment? and 3.) Is receipt of a chronic medical condition diagnosis among individuals with SUD associated with a greater likelihood of specialty SUD treatment utilization? METHODS: This study uses data from the National Survey on Drug Use and Health (NSDUH) from years 2005 through 2017. Simple and multivariate logistic regressions were conducted and interactions were tested using multiplicative terms with race/ethnicity and gender. Analyses adjusted for weights to account for the survey’s complex sampling design. RESULTS: No significant racial/ethnic or gender differences were found in association with perceived need for SUD treatment. Among adults who perceived the need for SUD treatment, less than 20% in any racial/ethnic category utilized specialty SUD treatment services. Black/African-American adults, compared to White, were more likely to utilize specialty SUD treatment and less likely to name stigma as a barrier to treatment. Black/African-American adults with co-occurring chronic medical conditions and SUD were more likely to perceive a need for SUD treatment, but similarly likely to utilize specialty SUD treatment in comparison to White adults. Women and men did not significantly differ on perceived need for SUD treatment, utilization, or barriers. CONCLUSIONS: Differences in SUD treatment utilization patterns exist in association with race/ethnicity, though not with gender. Study findings suggest the presence of specialty SUD treatment utilization disparities, with stigma contributing to lower utilization for Whites compared to Blacks/African-Americans. Higher rates of treatment utilization among Blacks/African-Americans may reflect the presence of strengths uniquely attributed to this group.