Addiction Treatment in Hispanic Communities: How We Can Do Better

By Tessie Castillo 06/11/19

Numerous cultural norms and expectations reinforce the collective silence on substance use. Among many Latinx people who are first generation immigrants, there is a desire or expectation to be a “model minority.”

Young Latinx man, searching for harm reduction services or addiction treatment.
Few materials on harm reduction or drug treatment programs are crafted to target Latinx people. Photo 82594497 © Kadettmann -

Evan Figueroa Vargas wears the scars of a hard-knock life in his voice. In gravely intones the Philadelphia native recounts years of criminal justice involvement and chaotic drug use that followed his brother’s sudden overdose death in 2002. It’s not easy to find help when drugs, incarceration, and the streets intertwine, he says. But it’s even harder when you’re Hispanic.

“In the Latino community you come from a place where machismo rules,” Figueroa explains over the phone. If you admit to mental health or substance use issues, “somebody is going to call you a loco.”

Culture of Silence Around Drug Issues

Many people who identify as Latinx (originating from Latin American countries) or Hispanic (from Spanish-speaking countries) describe a culture of silence around drug issues. Particularly for men, asking for help or admitting vulnerabilities can be seen as a weakness to be ridiculed or exploited.

Numerous cultural norms and expectations reinforce the collective silence on substance use. Among many Latinx people who are first generation immigrants, there is a desire or expectation to be a “model minority.” Communities may emphasize the importance of hard work, education, family loyalty, and showing your new country that you are an asset. Drug use, especially chaotic use of illicit drugs, is seen as running counter to these goals.

Tanagra Melgarejo, who came to the mainland U.S. from Puerto Rico at 17 years old and now works for the Harm Reduction Coalition, cites a popular Latinx idiom: Los trapos sucios se lavan en casa. Basically, don’t air your dirty laundry in public. Drug issues are hard to bring up because “you feel like you’re betraying a cultural norm,” Melgarejo explains. “You are exposing something and then you are bringing shame to yourself and other people.”

The desire to hide drug use may have pragmatic roots. Among immigrants and people of color, who are often the target of police or other state institutions, openness about illicit drug use might attract unwanted attention, including raids, harassment, and incarceration. Avoiding illicit activities or hiding any that may occur becomes a necessity for undocumented immigrants as well, who may fear deportation.

But reluctance to speak about drug use exists not just within the Latinx community, but in external discussions that focus on this community as well. In the United States, the rhetoric around race and ethnicity revolves around dichotomies, with Latinx populations often excluded from the dominant narrative on drug use and other structural issues such as incarceration, housing, and health care access.

“Anyone who is not black or white is invisibilized in this discourse,” explains Melgarejo. While culture wars rage about how black Americans were treated during the crack epidemic versus how white Americans are treated during the opioid epidemic, Hispanics, who are affected by both, are often left out of the discussion entirely.

The silence not just among Hispanics but also about them is what motivated Angelo Lagares, a Florida resident whose family is from the Dominican Republic, to quit his day job in 2015 to found Latino Recovery Advocacy (LARA). LARA’s mission is to provide linguistic and culturally appropriate resources to Latinx people who use drugs and to stimulate discussion about how drug policy affects them.

“I went through all that shit,” says Lagares, whose passion blazes through his speech. “When you are using cocaine, and the cocaine runs out at 3 a.m., that desperation, that pain [has] no language…People don’t have help. Everything is in fucking English.”

Now 53 years old and in recovery, Lagares says he is still haunted by the memories of his community decimated by drugs, AIDS, and incarceration when he lived in New York City during the 1980s. He works to honor “the people who died in the barrio.” He says the first step is to raise awareness about how drugs and drug policy are affecting Latinx people.

Overdose Deaths Increasing Fast

In general, reports of illicit drug use among Hispanics or Latinos aged 18 and older are lower than the national average, but that is changing. While U.S. overdose death rates are climbing among all races and ethnicities, mortalities are increasing fastest among Latinos, Native Americans and black Americans. From 2016 to 2017, overdose deaths in these groups increased 12%, 13%, and 25%, respectively, compared to an 11% increase among white Americans.

But despite these increases, few materials on harm reduction or drug treatment programs are crafted to target Latinx people. Even the SAMHSA Behavioral Health Treatment Services Locator, the largest national collection of online resources for people seeking treatment, does not offer a Spanish version of their website (though they do have interpreters available by phone).

Many programs for people who use drugs claim to offer Spanish-language services on site, but often this consists of one or two employees who speak Spanish. Support groups, guest lectures, and other group programming are almost always in English.

Language can be an obvious barrier to Latinx populations seeking services, but even that obstacle is more complex than it seems. Not everyone from Latin America speaks Spanish. Some speak Portuguese or indigenous languages. Further, even Latinx people who speak fluent English can be turned off by the lack of services available in their native tongue.

“I understand English very well but when I speak about difficult issues I prefer to speak in Spanish,” says Haner Hernandez, who is Puerto Rican-born but currently directs a program in Springfield, Massachusetts that trains Hispanics to become certified drug use counselors. He explains that when dealing with issues as sensitive as mental health and substance use, people feel most comfortable speaking their first language.

Lack of cultural awareness can also be a barrier to effectively engaging with Latinx people. It’s important to recognize the diversity of culture throughout Latin America. Someone of Cuban descent raised in Miami will have a vastly different background than someone who recently fled violence in Guatemala. There are however, some cultural norms that many Latinx people have in common. For example, religion, especially Catholicism, can play a critical role in how the Latinx community views drug use.

Melgarejo explains that Catholicism teaches about the purity of the body, so drug use is often perceived as morally wrong. “There is this shame [about drug use] that comes with religion,” she says. “If people are not aware of that, it makes it difficult for them to be able to connect with folks in a way that allows them to speak to that and feel safe engaging in services.”

Cultural views on womanhood also influence how people react to drug use in their communities. Although the Latinx culture may frown on men with mental health or substance use issues who seek help, the worst stigma is reserved for women.

Latinx people often emphasize marianismo, or female purity, “the dichotomy of the saint or the whore,” says Melgarejo. Women who engage in substance use “are punished for being women, they are punished for being women of color, Latinas, and they are punished for violating that role in the community, for not being pure.”

Citing the work she did with victims of domestic violence in Puerto Rico, Melgarejo says that when it comes to drug use, the culture is rife with double standards. Mothers who used drugs were often stripped of their maternal rights, while fathers who used drugs were still allowed to interact with their children.

Programs engaging with Latinx populations should also be aware that many people, especially those who have recently emigrated from Central America, may be fleeing violence and state-sponsored oppression. This trauma can stoke strong fears about any program connected to the government or perceived as such. It can take time and effort to build trust among populations that are initially suspicious. And not all programs are up to the task.

“We look at these populations and we say ‘Oh they are hard to reach,’” says Hernandez. “They are hard to reach for the people who don’t have experience working in these communities. For those of us who are from these communities, who work in these communities and live in these communities, those populations are not hard to reach.”

How Programs Can Improve Outreach

Claiming that a population is difficult to engage is one way for service providers to recuse themselves from having to make the extra effort. But lack of participation or retention of underserved communities may signal not that the population is hard to reach for the program, but that the program is hard to reach for the population.

The first step towards bridging this divide is humility. It’s easy to blame “them” for “not wanting” to engage with services instead of looking inward. Organizations should conduct a self-inventory of the populations in their community and note those who are effectively engaging and those who are not. Growth can’t happen all at once, but there are many small steps organizations can take to improve their outreach.

Some questions to ask are: Do staff speak the languages of the community (not necessarily just Spanish)? Do staff practice cultural humility and recognize the diversity in the Latinx population? Does the organization hire Latinx people and place them in positions of leadership? Are program services located in areas easily accessible to Latinx communities? Can the organization partner with others who have built trust in the Latinx community?

Hernandez stresses the importance of having active and visible Latinx involvement in program development and implementation. Regarding behavioral health, he says, “The majority of people working in the field are white and baby boomers. The majority of the people seeking services are younger and more diverse, so the needs of the people seeking services are not in line with the folks who work in the field.”

It can be challenging to engage underserved populations, especially those driven underground by various forms of institutionalized oppression. Navigating the diversity and complexity of these communities can seem overwhelming at times. It is easy to give up. But the real measure of an effective program is not how well it serves people who are easy to reach, but how well it engages the ones who need it most.

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Tessie Castillo is a writer and drug policy advocate in Raleigh, North Carolina. Her articles explore topics such as criminal justice reform, drug policy, and harm reduction. Castillo previously served as the Advocacy and Communications Coordinator for the North Carolina Harm Reduction Coalition (NCHRC), a statewide nonprofit that advances drug policy and criminal justice reform. During that time, she played a pivotal role in helping to legalize syringe exchange programs and expand access to naloxone, a medicine that reverses opioid overdose. Find Tessie at her website or on Facebook, TwitterInstagram, and LinkedIn.