LATINO/HISPANIC AMERICANS AND ADDICTIONCourtney Austin, Jaycee Carroll, Kristina Gordon,

Christopher Menster, Kelly Rhinesmith, & Stephanie WeisenthalMulticultural Psychology

"ACCULTURATION RANKED AT A HIGH LEVEL OF BEING A RISK FACTOR FOR SUBSTANCE USE/ABUSE. BILINGUAL LATINO/HISPANIC ADOLESCENTS APPEARED TO HAVE HIGHER RATES OF SUBSTANCE USE/ABUSE THAN DID INDIVIDUALS WITH LOW AND HIGH LEVELS OF ACCULTURATION. RESEARCH CONDUCTED…PROVED A PREDICATIVE AMOUNT OF SUBSTANCE USE/ABUSE OUTCOMES FOR LATINO/HISPANIC ADOLESCENTS“(VALENTINE-BARROW, 2011). 

“DURING THE LAST 10 YEARS, LATINOS HAVE BEEN IDENTIFIED AS THE FASTEST-GROWING POPULATION ENTERING SUBSTANCE ABUSE TREATMENT (SAT) IN THE UNITED STATES, COMPRISING 12% OF THE TOTAL RECEIVING TREATMENT (GUERRERO 2010). LATINOS IN THE UNITED STATES ALSO REPORT HIGHER RATES OF SUBSTANCE USE DISORDERS (9.7%) COMPARED TO WHITES (8.9%) AND AFRICAN AMERICANS (8.2%, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) 2012)” (GUERRERO, 2015).

DEMOGRAPHIC PROFILE There are about 52 million Hispanics or Latinos in the United States. By

2050, the number of people in this population group is expected to double to about 132.8 million, making up approximately 30% of the total U.S. population.

Regarding substance abuse among Hispanics or Latinos, data from the 2014 NSDUH indicates: The rate of illicit drug use in the past month among Hispanic individuals ages 12

and up was 8.9%, while the national average was 10.2%. The rate of binge alcohol use among Hispanics or Latinos within this age group

was 24.7%. Alcohol use in the last year among people ages 12 to 17 was 23.9% for Hispanic

youth.

http://www.samhsa.gov/specific-populations/racial-ethnic-minority

RESEARCH & LITERATURE SAYS Sokol Katz and Ulbrich (1992) observed no relationship between family

structure and alcohol or drug use among adolescents of Cuban heritage, but found that Mexican and Puerto Rican youth had more drug involvement when they were living in female-headed households.

NHSDA 2000 estimates, Puerto Ricans were more likely to be current illegal drug users (10.1 percent) than their counterparts in the general population age 12 years and older (Substance Abuse and Mental Health Services Administration 2001a).

Interestingly, Cuban Americans were less likely to be illegal drug users (3.7 percent), and intermediate values were observed for Americans of Mexican heritage (5.5 percent) and Central or South American origin (4.1 percent).

Therefore, attention to diversity within the Hispanic population is an important but often neglected feature of our national statistical summaries on the drug experiences of racial and ethnic minority groups in the United States.

www.drugabuse.gov

ACCULTURATION “What do we know about Latino/as and substance abuse? Not yet enough.

Amaro and Iguchi (2006) report concern about the apparent lack of rigorous work specifically targeting Hispanic populations and alcohol and drug use”(Vasquez, 2009).

“There are differences between U.S.-born and foreign-born Hispanics; U.S.-born Hispanics report higher rates of experimental drug use, abuse, and dependence than immigrants do”(Vasquez, 2009).

“Data reported by Warner et al. (2006) from the national Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2002) showed that rates of past month illicit drug use in the Hispanic population ranged from 10.1% for Puerto Ricans to 3.7% for Cuban Americans, with the rates for Mexicans and Central or South Americans at 5.5% and 4.1%, respectively”(Vasquez, 2009).

ACCULTURATION CONTINUED “Despite their lower rates of illicit drug use, Latinos reported higher rates of

substance abuse or dependence (9.7%) than Whites (8.9%) and African Americans (8.2%; SAMHSA, 2011)”(Guerrero, 2013).

“U.S.-born Hispanics report higher rates of drug use, abuse, and dependence than Hispanics born outside the U.S”(Amaro & Cortes).

“Our analyses demonstrated that Hispanics had significantly shorter inpatient stays than the other two groups”(Delphin-Rittmon, 2012).

“The shorter stays for Hispanics in our study may be attributable to the limited availability of bilingual and bicultural staff in inpatient settings, which may result in shorter inpatient stays for Hispanics and referral to outpatient clinics where bilingual and bicultural staff are available”(Delphin-Rittmon, 2012).

“However, Unger (2002) found an association between familyism and substance use. Family plays a huge role in the development of culture for Latino/a youth. As the center of adolescent development, the family socializes the child to cultural norms and expectations. Part of this socialization includes acculturation into mainstream society. This acculturation to a new environment has led to increases in drug use in first-generation Hispanic youth (Szapocznik et al., 2007)”(Balkin, 2014).

ADDICTION Food Gambling Alcoholism Tobacco Cocaine Heroin Prescription Medications Marijuana Inhalants Amphetamines

FOOD “Interest in the concept of food addiction has recently received greater attention, in

part due to the similarities between the behavioral indicators of addiction and binge eating disorder (BED), such as diminished control over consumption and continued excessive consumption despite negative consequences”(Gearhardt, 2011).

Latinos have elevated rates of any binge eating and binge eating disorder but low prevalence of anorexia nervosa and bulimia nervosa (Alegria, 2007).

Information about the prevalence of eating disorders in ethnic minority groups, particularly Latinos, is virtually unknown. Yet, several studies have reported higher rates of eating disorder symptoms among Latino groups than among non-Hispanic whites or among other ethnic minority females (Alegria, 2007).

For example, studies have reported a higher and more severe prevalence of binge eating among Latino females compared to White, African American, and Asian American women (Alegria, 2007).

A study conducted by Smith and Krejci19 found that 12.8% of young Hispanic males engaged in binge eating at least once a month (Reyes-Rodriguez, 2011).

FOOD CONCLUSIONS Food addiction is not included in the DSM-V under substance-related and addictive

disorders, however, binge eating disorder is now included in the DSM. For this reason, binge eating disorder has been more widely studied than food addiction.

There are many similarities between addiction and binge eating disorder (BED), such as diminished control over consumption and continued excessive consumption despite negative consequences.

Behavioral addictions such as gambling, shopping, or eating are also known as process addictions.

Although studies of eating disorders in minorities are still in the early stages, studies have reported a higher and more severe prevalence of binge eating among Latino females compared to White, African American, and Asian American women.

It is not only Latinas but also Latino males that struggle with Binge Eating Disorder. Latinos have higher rates of Binge Eating Disorder but very low rates of anorexia

nervosa and bulimia nervosa.

GAMBLING One national survey and two community studies have found higher than

average rates of problem gambling among Hispanics(Winfree, 2013). One barrier to serving this population is the limited set of assessment

measures available for clinicians who work with Spanish-speaking gamblers(Winfree, 2013).

The Gambling Self-Efficacy Questionnaire (GSEQ) is a 16-item self-report measure that was designed to efficiently identify perceived self-efficacy to control gambling in high-risk situations(Winfree, 2013).

According to Bandura, perceived self-efficacy refers to ‘beliefs in one’s capabilities to organize and execute the courses of actions required to produce given attainments’. Gambling self-efficacy can be defined as one’s perceived ability to resist an opportunity to gamble in a particular situation(Winfree, 2013).

GAMBLING CONCLUSIONS Hispanics have been found to have a higher than average gambling

addiction. Only in the current edition of the DSM (DSM-V) has gambling been changed

from Impulse Control Disorder to Addiction Now with Gambling being identified as an addictive disorder, perhaps more

studies that include minorities will be done on the topic

ALCOHOLISM Higher-density households and living arrangements found in Hispanic-

dominant urban neighborhoods with fewer socioeconomic advantages also influence family and individual stress levels, which may influence alcohol use patterns. It is clear that stress experiences associated with alcohol use among Hispanic adolescents are multifaceted and not well understood (Goldbach, 2015).

Research with Latino immigrants indicated that ethnic discrimination was associated with an increased number of drinking days and binge drinking. Further evidence has reported that Latinos who experienced ethnic discrimination had 62% greater odds of engaging in binge/heavy drinking. A similar pattern has emerged among Latino adolescents in which reports of discrimination were associated with greater substance use and intentions to use substances (Torres, 2015).

ALCOHOLISM CONTINUED Compared with those who did not drink, adolescents who reported using alcohol

had significantly higher scores on family economic, culture and educational, acculturative gap, discrimination, community and gang violence, and family and drug-related stress subscales (Goldbach, 2015).

Adolescents who engage in drinking have a higher prevalence of involvement in criminal activity, abuse of other substances, and depression and report poorer academic outcomes and more frequent risky sexual behavior. Adolescent alcohol use has been linked to poor cognitive functioning, lower mood states, and poor decision-making, particularly among individuals who begin drinking at an early age (Goldbach, 2015).

More than one quarter of Hispanic adolescents in the United States report using alcohol during the previous 30 days. Compared with their non-Hispanic White counterparts, Hispanic adolescents report higher rates of binge and heavy drinking(Goldbach, 2015).

ALCOHOLISM CONCLUSIONS To better understand alcoholism in Hispanics, we must take a

multidimensional approach. High density households, living arrangements, stress and discrimination all

are contributing factors as to why Hispanics participate in dangerous drinking habits.

With the higher levels of dinking, adolescents are more susceptible to criminal activity, depressions and abuse of other substances.

Drinking at an early age can result in poor cognitive functioning and poor decision making.

Hispanics have a higher prevalence of drinking than their other counterparts.

TOBACCO National surveys show that the overall prevalence of current cigarette smoking among Hispanic adults in the United States is relatively low, with values below 20.0% in 2008 and 2009 and consistently lower than those of other population groups (O’Hegarty, 2013).

Recent analysis of 2002 to 2005 data from the National Survey on Drug Use and Health (NSDUH) revealed that there are marked differences within Hispanic Latino subgroups in the United States. Mexican American respondents reported the prevalence of past-30-day cigarette smoking was 23.8% whereas for those self-identified as Puerto Rican respondents, the prevalence was 31.5% (O’Hegarty, 2013).

Becoming fully acculturated resulted in a greater than twofold increased risk for lifetime use of tobacco (West, 2013).

TOBACCO CONTINUED In many cultures, strong gender differences in tobacco use exist. We observed that prevalence of tobacco use increased considerably with acculturation in women, Mexican-born Spanish speaking, while changing little among men. This finding suggests that as women from some cultures become more acculturated, they are more likely to report current tobacco use. This could be explained by increasing numbers of women adopting this behavior and/or increasing acceptance of tobacco use coinciding with acculturation (Parker, 2010).

TOBACCO CONTINUED

(SAMHSA, 2013)

TOBACCO CONCLUSIONS In general, tobacco use among Hispanic/Latinos is usually lower than other

ethnic groups, below 20%. However, among subgroups in the Hispanic/Latino community there seems

to be some variance. For Instance, Mexican-Americans reported that in the past 30 days, 23.8%

have smoked cigarettes, while among Puerto Ricans, they reported that in the last 30 days 31.5% had smoked cigarettes.

It was also found that with acculturation, females tended to have a higher prevalence of tobacco use, however, acculturation does not affect tobacco use in men much.

COCAINE “Racial minorities were at low risk for powder cocaine use and Hispanics were at low risk

for crack use “(Palamar, 2015). “Hispanic teens’ rate of abuse is higher than Caucasian or African-American adolescent

drug use. In a survey of teens Hispanic teens that have used cocaine or crack at least once was 12%, whereas Caucasians were 5%, and African Americans were 4%“(Drugfree.org).

“Use of cocaine is associated with acculturation among Mexican Americans and Puerto Ricans”(Vega, 1994).

“In urban and diverse areas, Cubans and Puerto Ricans reported higher use of heroin and cocaine” (Guerrero, 2013).

“On the East Coast, use of cocaine was higher among Latinos than any other group”(Guerrero,2013).

COCAINE CONCLUSION As Latino/Hispanic-Americans become more acculturated, the use of

cocaine becomes more prevalent. Powder cocaine use tends to be more prevalent than crack use among

Hispanic-Americans. Also, the more urban the area, the more prevalent cocaine use becomes. On the East Coast of the United States, cocaine use is higher among

Latino/Hispanic-Americans than any other subgroup. Hispanic teens are much more likely than other ethnic groups to have tried

cocaine.

HEROIN “In 2006, in urban and ethnically diverse areas such as Los Angeles

County, California, Latinos were more likely to report using heroin than other drugs. In other areas highly populated by Latinos, such as Texas, heroin use was also most common among Latinos. In urban and diverse areas, Cubans and Puerto Ricans reported higher use of heroin and cocaine”(Guerrero, 2015).

“Among Hispanic opiate users, heroin is the preferred illicitly obtained opiate, and injection heroin use is most common in older Mexican American men (Valdez, Neaigus, & Kaplan, 2008)”(Flores, 2013).

“More significantly, U.S. heroin consumption has risen due to increased regulations on prescription opiates and inexpensive heroin from Mexico (Riordan & Rappleye, 2012; U.S. Department of Justice National Drug Intelligence Center, 2011)”(Flores, 2013).

HEROIN CONTINUED Non-injection heroin use is increasing in younger opiate users(Lankenau et

al., 2012)”(Flores, 2013) “Mexican Americans are among the largest number of injection heroin users

(Estrada, 1998, 2005; Martinez, Bluthenthal, Flynn, Anderson, & Kral, 2011)” (Flores, 2013).

“Consequences of long-term injection drug use include overdose, incarceration, homelessness, depression, human immunodeficiency virus, Hepatitis C, and suicide ideation (Devlin & Henry, 2008; Musto, 1999; Torres, Kaplan, & Valdez, 2011; Valdez, Neaigus, & Cepeda, 2007)”(Flores, 2013).

“Of Hispanics who do seek and are admitted for treatment, heroin was the primary substance in 26% of admissions compared with 12% for Whites (Reif, Horgan, & Ritter, 2008)”(Flores, 2013).

HEROIN CONCLUSIONS Heroin use has become more common due to it being inexpensive and

easier to obtain than prescription opiates. Injecting heroin is more common in older Latino/Hispanic-Americans while

younger Latino/Hispanic-Americans tend to snort or smoke heroin. Of those Latino/Hispanic-Americans injecting heroin, Mexican Americans

are the largest group. In urban areas such as L.A., Ca. as well as areas highly-populated by

Latinos, heroin is the drug of choice by Latino/Hispanic-Americans. Among Latino subgroups, Cubans and Puerto Ricans report higher use of

heroin. Although Latino/Hispanic-Americans are less likely to seek treatment, when

they do, heroin is the primary substance in a quarter of admissions.

PRESCRIPTION MEDICATIONS Hispanic college students were more likely to engage in substance use and

prescription drug misuse when they also exhibited heightened anxiety and distress. It may be inferred that barriers to prescription drug access may be beneficial in preventing prescription drug misuse, but it will not limit access to other substance abuse (Cabriales, 2013).

Barriers such as those to healthcare, religious beliefs, and cultural norms influence the development of prescription misuse among the Latino immigrants. Individuals who fall under these categories may be more willing to take on riskier behaviors, such as sourcing medications from other countries (Coffman, 2008).

Hispanic citizens have a higher odd of developing future prescription drug abuse and dependence compared to other races and ethnicities if they engage in early non-medical use of prescription drugs (McCabe, 2007).

PRESCRIPTION MEDICATIONS CONTINUED The Hispanic race has a higher odds ratio of abusing prescription opioids

than those of the White, Black, and Other races (Vietri, 2014). While the ethnicity does not have the highest odds, it is the second highest

evaluated in the study conducted by Vietri, Joshi, Barsdorf, and Mardekian (2014).

This may indicate a need for better screening practice when administering prescription opioid medications, not just among certain races, but also for individuals who may fall under a certain risk factor set (Vietri, 2014).

PRESCRIPTION MEDICATION CONCLUSION Prescription drug misuse and abuse has not be studied very closely in

relation to ethnicity or race, but it does pose a factor in the development of other substance abuse and addictive behaviors among the population.

When researching this topic, one may find more information concerning the topic of self-medicating among the Hispanic ethnicity than misuse or abuse of drugs.

While the Hispanic ethnicity has been shown to have a higher risk of developing addictions or misusing both prescription and over-the-counter medications, it may be more pertinent to evaluate the need to prevent the occurrences through proper medical care and reducing the barriers of access to adequate medical care.

MARIJUANA In a survey of individuals participating in substance abuse treatment, data collected

between 1993 and 2003 and findings obtained that 36% of Latinos report marijuana as their preferred substance of choice.

Urban adolescents are expected to use marijuana more than rural adolescents(Ramirez, 2004).

The analysis of gender showed that males were significantly more likely than females to use marijuana on both lifetime- and current-use indices. Odds ratios showed that male adolescents were 2.15 times more likely than females to have ever used marijuana and were 3.48 times more likely to be current marijuana users(Ramirez, 2004).

Analysis of lifetime marijuana use suggested that low-acculturated Hispanic Americans were 2.57 and 2.88 times more likely to have ever used marijuana than Anglo Americans and highly acculturated Hispanic Americans, respectively. Moderately acculturated Hispanic Americans were 3.56 times more likely than Anglo Americans and 3.99 times more likely than highly acculturated Hispanic Americans to have ever used marijuana(Ramirez, 2004).

MARIJUANA CONCLUSIONS Lower acculturation and living in a urban area is associated with a higher

rate of marijuana use in Hispanics. Marijuana is the drug of choice for a large percentage of Latinos. Men are significantly more likely to use marijuana over a lifetime than

woman.

INHALANTS Examining age of first use for various substances revealed that the overall

sample reported onset of inhalants as between the ages of 12 and 16 years(Rojas, 2012).

More highly acculturated Hispanic American adolescents appear more prone to use inhalants than do their less acculturated Hispanic American peers(Ramirez, 2004).

Research indicates that rural adolescents were roughly five times more likely to be current inhalant users than were adolescents who lived in urban areas(Ramirez, 2004).

For lifetime inhalant use, the analysis supported two of the predicted interactions. Consistent with hypotheses, a significant interaction of knowledge by parental monitoring revealed that parental monitoring was associated with lower inhalant use for adolescents who possessed high knowledge(Ramirez, 2004).

INHALANT CONCLUSIONS The opposite of marijuana, inhalants are more likely in high acculturation

Hispanics that live in more rural areas. It appears that inhalants are more widely used in adolescents from 12 to

16 years old that do not have the proper adult supervision.

AMPHETAMINES Rates of drug use and abuse have increased in the Hispanic population,

treatment admissions rose from 9.9% to 13.8% from 1992 to 2009 with PCP and amphetamines most frequently reported drugs being abused.

While all meth-abusing patients were treated either in outpatient drug free or residential programs, 13.3 percent of Hispanics and 30.5 percent of whites receiving residential treatment, and the remainder of patients attending outpatient drug-free programs(Niv, 2006).

Meth-abusing Hispanics entering drug treatment were less educated than whites. Hispanics also reported more employment-related problems(Niv, 2006).

A study of meth users found that being Hispanic (compared with white) was a significant predictor of time to relapse following treatment(Brecht, 2000).

AMPHETAMINES CONTINUED Examining for gender differences in rates of individual drug endorsement,

statistical significances were not detected. However, when amphetamines and cocaine were combined to form a stimulant category, Latinas were more likely to report problem use compared to their Latino counterparts(Rojas, 2012).

An assessment of Latino gay men also showed that sexual enhancement was a primary reason for methamphetamine use(Diaz, 2005).

Use of amphetamines during sex also increased the lack of protection, thereby increasing HIV infection

AMPHETAMINES CONCLUSIONS Hispanic/Latino Meth abusers are more likely to go to outpatient treatment

as opposed to inpatient treatment for their addiction. They also have a higher relapse rate than their Caucasian counterparts. As a group, Hispanics/Latinos that use meth tend to have less education

and more employment problems than their Caucasian counterparts. More Latinas tend to say amphetamines are their drug of choice as

opposed to Latinos. Latino Gay men are likely to use Methamphetamines as a sexual

enhancement. It has been researched that when Meth is used during sexual intercourse, users are less likely to use protection and have an increased risk of HIV transmission.

TREATMENT “Research suggests that Latinos underutilize substance abuse treatment

services when substance use and abuse issues are present (Feaster et al., 2010 and Mulvaney-Day et al., 2012) and display poorer treatment response compared to other ethnic groups in the United States (Amaro, Arévalo, Gonzalez, Szapocznik, & Iguchi, 2006)”(Fish, 2015).

Among individuals seeking help for substance abuse issues, waiting to enter treatment is the most commonly cited barrier and treatment access and retention are critical predictors of reduced posttreatment substance use(Guerrero, 2015).

Racial and ethnic minorities such as African Americans and Latinos often fare worse than their White counterparts in terms of wait time and retention(Guerrero, 2015).

Programs that understand their community’s service needs may become more responsive to clients’ treatment access needs(Guerrero, 2015).

.

CONCLUSION Substance abuse specific to Latinas is not well studied. Although it appears to be

less intense than among their male counterparts, research on acculturation issues suggests that Latinas are at increased risk for substance abuse (Rojas, 2012).

Results from family history analysis suggest that Latinas have extremely high rates of substance use disorders within their families (91%). These data clearly speak to the need for treatment interventions to focus on the extended family system. However, the common barriers to treatment (e.g., finding services, paying for services) will need to be addressed (Rojas, 2012).

Female participants were significantly more likely to report depressive symptoms in the moderate/severe range compared with males. Approximately 63% of Latinas reported major depressive disorder within the context of alcohol and drug use compared with 35% of Latinos (Rojas, 2012).

There is some indication that substance abuse among Hispanics is increasing. National surveys of adolescent populations suggest that the younger the respondents are, the more likely it is that Hispanics have higher rates of illicit substance use relative to whites and Blacks (Vasquez, 2009).

CONCLUSION CONTINUED There are differences between U.S.-born and foreign-born Hispanics; U.S.-born Hispanics

report higher rates of experimental drug use, abuse, and dependence than immigrants do(Vasquez, 2009).

One of the most notable findings in regard to risk factors thus far is confirmation of what we already know, namely that acculturation is basically bad for your health. Being born outside of the United States had a protective effect; in the same ethnic group, someone born in the United States was significantly more likely to have a behavioral disorder than an immigrant (Vasquez, 2009).

Both groups abstained out of concern for personal health; however, non-Hispanic whites were more likely to cite moral reasons for abstaining, but Hispanics attributed abstaining to the influence of family and friends. Thus, there are familial and cultural reasons for not using drugs and alcohol among Latino/as, regardless of acculturation (Vasquez, 2009).

Drug use among adolescents in Mexico has tripled. Since 9/11, drug traffic through Mexico and into the United States has slowed down due to increased Homeland Security measures, and therefore those drugs are more readily available and less expensive in Mexico than before. As a result, drug use rates are now increasing in this population (Vasquez, 2009).

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http://www.attcnetwork.org/find/news/attcnews/epubs/addmsg/march2013article.asp http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342681 http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.htm#4.4 2012 The Partnership at Drugfree.org

QUIZ 1.) In a survey of individuals participating in substance abuse treatment, data collected between 1993 and 2003 and findings obtained that 36% of Latinos report __________ as

their preferred substance of choice.

a) Tobaccob) Amphetaminesc) Marijuanad) Inhalants

2.) One of the most notable findings in regard to risk factors thus far is confirmation of what we already know, namely that acculturation is basically _________ for your health.

a.) good b.) bad c.) has no affect d.) has very little affect

QUIZ3.) Mexican and Puerto Rican youth had more drug involvement when they were

living in _____________ households.

a.) female-headedb.) male-headed c.) multi-familyd.) low income

4.) Hispanics _____________ report higher rates of drug use, abuse, and dependence than Hispanics _____________.

a.) born in the U.S., born outside the U.S.b.) born outside the U.S., born in the U.S.c.) with high acculturation, with low acculturationd.) with low acculturation, with high acculturation

QUIZ5.) Although Latina/Hispanic-Americans are less likely to seek treatment,

when they do, __________ is the primary substance in a quarter of admissions.

a.) Heroinb.) Alcoholc.) Methamphetamines d.) Marijuana

Answer Key: 1: C , 2: B , 3: A , 4: A, 5: A