From Counseling Microaggressions to Substance Use: Indirect Pathways Through Help-Seeking and Psychological Distress

Racial-ethnic minoritized individuals face persistent disparities in mental health service utilization, which are shaped by structural and interpersonal racism. This study examined whether racial microaggressions in counseling were indirectly associated with substance use through their impact on help-seeking intentions and psychological distress. A serial mediation model was tested using self-report data from a community-based sample of racial-ethnic minoritized adults (N = 223). Results indicated that prior experiences of racial microaggressions in counseling were associated with lower help-seeking intentions, which in turn were linked to greater psychological distress and increased substance use. Although the total effect of racial microaggressions on substance use was not significant, the indirect pathway was significant, underscoring the importance of examining mediating mechanisms that impact substance use outcomes. These findings highlight how interpersonal racism in therapeutic settings may contribute to adverse mental health outcomes and emphasize the need for culturally humble, affirming mental health care. Implications for clinical practice and equity are discussed using frameworks from Critical Race Theory and the Social Determinants of Health framework.