Social Determinants of Health, Intersectionality, and Implicit Bias: Addressing Substance Use Disorder

Social determinants of health (SDH) include (but are not limited to) gender inequality, structural racism, stigma, poverty, citizenship status, education, housing, transportation, health systems and services, social safety network, food insecurity, unemployment/employment and working conditions, public safety, and social exclusion/inclusion. These SDH accumulate and intersect to either promote the health and well-being of communities or to prevent individuals and communities from reaching health equity. Our experiences with SDH impact implicit bias and manifest in our personal and professional lives. This training will explore how SDH create differential impacts around substance use disorder, the opioid epidemic, and the current COVID-19 pandemic and how implicit bias can impact healthcare systems. Participants will be encouraged to reflect on examples from their own experiences and discuss not only challenges, but also ways to overcome these challenges individually, and as an organization.


Learning Objectives:     

At the end of this module, participants will be able to: 

  1. Review and define terms related to diversity, equity and inclusion (DEI) and social determinants of health (SDH). 
  2. Explore data on the impact of DEI and SDH issues on health care access, experiences, and outcomes. 
  3. Describe how social determinants can explain disparities in substance and opioid use disorder (SUD/OUD) prevalence and the recovery continuum. 
  4. Outline the meaning of DEI and SDH for approaching SUD and OUD prevention, treatment, and recovery. 
  5. Identify implicit vs. explicit bias in various settings. 
  6. Discuss implicit bias as a contributing factor to health and healthcare disparities. 
  7. Outline effective strategies for engaging in dialogue around implicit bias. 


Module Structure:

This module is self-paced and available to any user who registers with the Maine Medical Association, Center for Quality Improvement Learning Lab. The estimated time to complete is approximately 90 minutes. The module consists of multiple sub-sections or units and will contain various elements, including hyperlinks to readings and web resources, video lessons, and pre-and post-assessments needed to obtain a CME Certificate or a CME Certificate of Participation.

The Maine Medical Education Trust designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity qualifies for 1.5 credits of the 3 CME credit requirement for opioid medication education found in P.L. 2015, Chapter 488, Maine’s legislation to address the opioid drug crisis.

This activity qualifies for 1.5 hours of the 8 hours of training on opioid or other substance use disorders and the appropriate treatment of pain required by the MATE Act.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Maine Medical Education Trust and Maine Medical Association, Center for Quality Improvement. The Maine Medical Education Trust is accredited by the Maine Medical Association Committee on Continuing Medical Education and Accreditation to provide continuing medical education for physicians.

None of the planners or presenters for this activity have relevant financial relationships to disclose.

Duration & Fee:  FREE for Maine Clinicians 

Estimated Time to Complete: 90 minutes

(note: the module is divided into short digestible units [10-20 mins] which can be completed in small increments)

Hardware/Software Requirements:

  • Computer with Internet connection
  • Current version of Chrome, Firefox or Safari browser. You must have JavaScript enabled.
  • The quiz tool within the online modules are not fully compatible with smartphones or tablets. To avoid issues, such as answers not being recorded, we recommend using a computer to complete the pre- and post-tests.

Assessment and Grading:

This learning module begins with a Pre-Test that will test your knowledge and allow you to gauge your baseline understanding of the topics to be covered. Your pre-test score will not count toward your overall grade. At the end of the module, there is a Post-Test that will determine your final grade. A comparison of your Pre-Test score and Post-Test score will help to assess how much knowledge you’ve gained. You will have three attempts to complete the Post-Test. Your score must be 75% or better in order to receive the 1.5 AMA PRA Category 1 Credits™. Please complete the evaluation survey at the conclusion of the learning module.

To Obtain a CME Certificate or a CME Certificate of Participation:

  • Complete the entire learning module.
  • Complete the pre-test, post-test, and Survey Monkey evaluation at the end of the module.
  • Earn a score of 75% or higher on the post-test in order to receive a certificate.

Upon completion of the evaluation in Survey Monkey, including the required demographic information, a CME Certificate will be emailed to M.D.s and D.O.s and a CME Certificate of Participation will be emailed to all other learners. These certificates will be emailed within 10 business days of completing the evaluation.

Table of Contents:  The units will consist of the following: 

  1. Introduction 
  2. Pre-Assessment 
  3. Unit: SDOH, Intersectionality, & Implicit Bias: Addressing SUD
  4. Post-Assessment 


Disclosures: The planners and presenters for this module have no relevant financial relationships to disclose. 

Name Deena Murphy, PhD 

Advanced Implementation Specialist
Organization Opioid Response Network 

Amy Carter, BSHA-M
Maine Medical Association, Center for Quality Improvement

Marshall McLaughlin
Project Manager
Maine Medical Association, Center for Quality Improvement

This module is made possible by the generous support and funding from our partners at the Maine Board of Licensure in Medicine. Funding for this initiative was made possible (in part) by grant no. 6H79TI080816 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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