Addiction on the Rise in the Hispanic Community

By Jeanene Swanson 11/02/14

Latinos have reduced access to treatment programs and lower participation and retention rates.

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Over the last 40 years, the Hispanic, or Latino, population in the United States has been steadily increasing. "Hispanic or Latino" refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. At 50.5 million people, according to 2010 US census data, Latinos now make up 16% of the US population. In fact, more than half of the growth in the total population of the United States between 2000 and 2010 was due to the increase in the Hispanic population. The majority—about three-quarters—is comprised of Mexican (63%), Puerto Rican (9%), and Cuban (4%) origin. The other 25% include a large number of different peoples, from the Dominican Republic, Central America, and South America. In other words, a diverse group—with diverse backgrounds, histories, and substance use patterns.

Evidence shows that substance use is increasing among Latinos who do not get treatment as often and don’t follow through as much. With the Latino population expected to increase to over 30% of the US population by 2050, more effective treatment services need to be developed.

Cultural influences on prevalence rates

Substance abuse prevalence rates for Latinos generally mirror those of the general U.S. population. In particular, however, rates of use are increasing among the Latino population. In 2010, the rate of current illicit drug use was 8.1% among Latinos aged 12 or older, that number grew to 9.7% of Latinos reporting substance dependence or abuse in 2011. Treatment admissions for Latinos have increased from 9.9% to 13.8% between 1992 and 2009.

Some factors that influence the rates of substance use disorders in the Latino community are: nativity or age of immigration, first-generation or US-born, sub-ethnic group, gender, among other factors.

“The rates vary dramatically nationwide,” says Dr. Margarita Alegría, director of the Center for Multicultural Mental Health Research at Harvard Medical School. In one paper, Alegría found that substance use disorders were less prevalent among all Latinos, at 11.3%, than in US-born Latinos, at 18.9%. The rates gradually decreased as immigration age increased: for people arriving between 0 and 6 years old, the rate was 11.3%; age 7 to 17, 5.4%; and age 18 or older, 4.9%. In general, her studies show that second-generation (and beyond) Latinos experience more substance use, and in first-generation, older Latinos have fewer problems with substance use.

Other evidence supports the idea that foreign-born Latinos have fewer substance use disorders than those being born or living in the US. Multiple studies have shown higher rates of substance abuse among Latinos who speak English, which may reflect level of acculturation—which could also influence their connection to family and culture, and the stresses that come with losing support and identity in a foreign place. “We see a very strong relationship with other co-morbidities like depression, anxiety, and PTSD,” Alegría says. In the Latino community, substance use could be a “way of coping with isolation [and] solitude,” especially in situations where the family and social networks have been fragmented. These family obligations help “to create a buffer” against substance use.

Not all Latinos are alike, as is evidenced by the diversity in the census data. This diversity among sub-ethnic groups is represented in the way substance use affects each group in a different way. In a recent study, Michigan State University’s Carlos Ríos-Bedoya found that the rate of alcohol use disorders in Mexican-Americans, Puerto Ricans, and Cuban-Americans in the US varied noticeably. Cubans have the lowest rate, at less than 1%, while Mexicans were more than two times as likely and Puerto Ricans almost three times as likely to develop problematic drinking than whites. 

Research shows that Mexican-Americans and Puerto Ricans may be at higher risk of substance abuse and dependence than other Latinos, and possibly European and African-Americans. This could be related to attitudes toward substance use that lead to regional differences as well as how different immigrants are able—or not—to assimilate to the US. Immigration status, poverty/living conditions, and access to services are just a few differences that can affect different sub-groups' experience coming in the US.

Both Ríos-Bedoya and Alegría have noticed Puerto Rican rates of substance use to be higher than that of Mexican-Americans. “The view of alcohol [in Puerto Rico] is not as restrictive or forbidden as it is in the US, so that’s one of the cultural aspects that could have an influence,” says Ríos-Bedoya, who is of Puerto Rican descent. Cubans, which his study found to have the lowest AUD rate, have it easier than most Mexicans—which can influence environmental stress factors that contribute to addiction. “There are several programs targeting them to make the transition into the US easier or less cumbersome,” whereas “most Mexicans are here illegally, looking for a better life,” he says. Living at the margins of society alongside a fear of deportation might work in sync to contribute to higher risks for developing and perpetuating substance use disorders.

While there are key similarities, there are differences based on the country of origin, says Ana Moreno, who works as a multicultural substance abuse treatment provider at Family Recovery Specialists and Lucida Treatment Center in Florida. “Migration plays a role in how these families cope with the change; level of education is also a factor,” she says. “In Central and South America people tend to start drinking at a very early age and it is common to see. As we know, most people who develop a substance abuse issue began to consume in the adolescent years.”

Finally, “gender matters quite dramatically,” Alegría says. In general, Latinas are more likely than Latinos to abstain from using alcohol and illicit drugs, and Latinas are less likely to drink heavily and become dependent on alcohol. Cultural pressure that forbids women from using plays into this. “There is evidence that the low patterns of women drinking have to do with the norms being radical, and thinking about women drinking as not the right thing to do in certain countries,” Alegría says.

Other factors that predict higher rates of substance use among Latinos include being young, unmarried, unemployed, and facing discrimination at work.

Toward improved treatment for Latinos

Despite their growing numbers, Latinos fare worse in substance abuse treatment programs—they have reduced access to these programs, worse participation, and lower retention rates. This disparity is only worsened by the fact that one of every three Latinos lacks health insurance, as compared to 11% of white non-Hispanics and 20% of Afro-Americans. The Affordable Care Act is expected to increase health insurance coverage for at least six million Latinos.

How can treatment programs be tailored better for Latinos? For starters, it’s important to understand that, in general, there are several cultural factors that must be addressed—and utilized to their advantage—in a therapeutic setting. Specific Latino cultural values include family, respect, personal relationships, downplaying conflict in relationships, trust, spirituality, and gender roles, which emphasize the appearance of patriarchy.

More than ethnicity [or] race, I think the language concordance is very important,” Alegría says. Speaking Spanish—and being able to understand someone’s circumstances—is key to effective treatment. And, she concedes, “it is not that easy to get services in Spanish.” There are only seven places in the entire state of Massachusetts that offer Latino-focused treatment programs, and Lucida sells its “Multicultural Addiction Treatment for Spanish Speakers” program as “one of the nation’s only multicultural, bilingual substance abuse and mental health treatment programs.”

Lucida’s program is based on the “collective” experience of Latinos—that addiction is a family problem and not one an individual should solve alone. While traditional programs, which are based in white culture, might work for whites, Moreno has found that they don’t necessarily work for Latinos. “I have found that [traditional] programs tend to misdiagnose Latino families as enmeshed, and controlling,” she says. “While there may be some truth, sometimes it is the culture based on the collective. When these families receive family therapy, they may feel programs are trying to 'break' the family. As professionals we know that is not the case.” She encourages the family and even pastors or priests to take an active part in the recovery process.

That’s not to say that the work toward creating egalitarian treatment hasn’t begun— Alegría’s large and growing body of research exploring differences in mental health and addiction treatment among the Latino population in the US speaks for itself. “There are treatments already in place [for Latinos] and the evidence seems to show that they work quite well.” She would improve treatment for everyone, and not just Latinos, by addressing the need for earlier interventions—at the problem use, or binge drinking, stage—as well as providing people with virtual self-assessment and treatment options, “[for example,] treatment by computer or tele-psychiatry.”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about substituting addictionserasing your traumas and alcoholism and genetics.

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Jeanene Swanson is a science journalist who specializes in mental health and addiction. As a science writer with a background in biotechnology, she enjoys turning complex subjects into stories that everyone can understand—and apply to their lives. You can find Jeanene on Linkedin.

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