In 2013, the National Survey on Drug Use and Health (NSDUH) estimated that among Americans over the age of 12, 23.6 million abused or were dependent on drugs or alcohol. Because of cultural differences, different ethnic or racial groups may view addiction differently than others, making it more challenging to treat.
In 2014, The Substance Abuse and Mental Health Services Administration (SAMHSA) investigated and published the following statistics on current drug use (defined in their survey as having used illicit drugs during the preceding month) among minority populations:
A common definition of “substance abuse” used by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) is “a progressive disease marked by a state of powerlessness and the inability to manage one’s life,” and that dependence on alcohol or any other mind-altering drug results from a mindset that traps the user in a downward spiral of addiction and self-destruction. Substance Use Disorder is the clinical term for drug addiction.
According to the New York State Office on Alcoholism and Substance Abuse Services, addiction is a highly treatable disease. About 10 percent of all Americans of ages 18 and older are self-reported to be recovering from a substance abuse disorder.
The symptoms of a substance use disorder are very similar among all ethnic and racial groups. They may include:
Prevention of substance abuse is of paramount importance in any community. It is important to develop culturally sensitive methods of assessment to identify risk factors and substance use patterns in a community in order to prevent drug use. Data collection must also take into account the community’s traditions and customs. It is also important to disseminate information about the harmful effects of drug use in order to change a specific population’s attitudes toward drug use and prevent its abuse.
As of 2014, there were 44.5 million African Americans in the U.S., accounting for 14.2% of the population. According to the National Survey on Drug Use and Health (NSDUH):
There are many factors that may increase African Americans’ vulnerability to drug and alcohol abuse.
Prevalence of undiagnosed mental illness is greater among African Americans than Caucasians. Individuals with undiagnosed anxiety, bipolar disorder, or depression are more likely to self-medicate with drugs or alcohol.
Living in areas where drugs are easily available can result in early drug experimentation and addiction. As well, the prevalence of liquor stores in African American neighborhoods may contribute to the heavy use of alcohol.
African Americans are more likely than their Caucasian counterparts to be exposed to trauma such as witnessing and/or experiencing emotional abuse, physical abuse, sexual abuse, or violence. These experiences can lead to posttraumatic stress disorder (PTSD). PTSD is characterized by acute anxiety. Untreated, PTSD sufferers are more likely to self-medicate and are at higher risk of substance abuse behavior.
Impoverished communities traditionally have high levels of drug and alcohol use. Poverty often leads to stress and mental illness such as depression.
African Americans often experience discrimination and racism. These can lead to stress and stress-related illnesses. Drugs and alcohol can be used as a coping mechanism.
At the beginning of the 1980’s, most of the cocaine being imported into the U.S. was coming through Miami from the Dominican Republic and the Bahamas. An enormous glut of the drug caused the prices to drop dramatically. With a huge surplus and falling prices, drug dealers began converting the cocaine powder into “crack cocaine,” a solid form of cocaine that was smoked by users. Crack cocaine was easy to produce with the aid of baking soda or ammonia and could be sold in smaller quantities at a cheaper price.
Crack was a purer form of cocaine than the powder, and therefore more highly addictive. In 1984, cocaine powder that was about 55 percent pure sold for $100 per gram. Crack cocaine was about 80 percent pure and sold for the same price. A single dose of crack could be purchased for about $2.50, making it easy for even the poorest people to afford.
Between 1985 and 1986, crack cocaine was available in almost every major city in the U.S. In 1987, it was available in all but four states in the U.S., and correlated with higher crime rates.
The African American community also experienced a 100% increase in fetal mortality, low birth-weight babies, weapons arrests, and the number of children in the foster care system. The reason for these huge increases in crime was because the majority of crack distribution was in poor inner-city neighborhoods, a consequence of its low price. As well, the low cost of the drug allowed lots of new dealers to start selling crack. The initial investment was low, and the competition was fierce. This caused increased violence and crime as new drug dealers protected the investment they had in their burgeoning business.
The Reagan Administration’s war on drugs increased sentencing for drug-related crimes, especially for crack. The U.S. Congress created laws that made the sentences for possession or sale of crack cocaine 100 times harsher than the drug’s powder form. The sentences were 2-4 times harsher even than those issued for heroin-related crimes. Since crack users and dealers were disproportionately African American, this had the unfortunate consequence of vastly increasing the number of young African American men serving long prison terms.
In the U.S., Caucasians are more likely to have used illegal drugs than African Americans, but blacks are more often prosecuted for drug offenses. The only illegal drug that is more abused by African Americans than by whites is crack cocaine. The Human Rights Watch reported in 2009 that African Americans are arrested more than three times as often as whites for drug possession. Among inmates serving time in state prisons for drug offenses, African Americans accounted for 45 percent while whites accounted for only 30 percent.
One of the reasons for this discrepancy is that police make the majority of their drug arrests in low-income neighborhoods. Once someone has an arrest, or a “prior,” sentencing is higher the next time they are arrested. Many states have passed laws which give judges the discretion to charge people convicted of drug offenses with a misdemeanor rather than a felony. They can then send the offenders to substance abuse treatment centers rather than prison.
These new guidelines can help the people who need it most. Former prisoners convicted of felonies can be barred from housing, education, and employment, the very things that they need to become productive members of society. Public housing can be denied to those with a conviction record for felony drug offenses. They are also barred from receiving federal financial aid for education. Applicants for jobs are often required to disclose any criminal record. Removing these barriers help those with substance abuse issues recover and lead normal, healthy lives.
African Americans who abuse drugs and alcohol are adversely affected in many ways.
African Americans are more likely to suffer cardiovascular disease, esophageal cancer, liver disease, and pancreatitis as a result of drug addiction. African American women are also more likely to drink during pregnancy and have higher rates of fetal alcohol syndrome.
African American males make up 42% of the U.S. prison population and are about eight times more likely to be imprisoned than their white male counterparts. The incidence of incarceration of African Americans due to drug-related offenses is higher than other ethnic groups.
Alcohol abuse directly correlates to higher rates of domestic violence among African American couples.
Those affected by substance abuse in the African American community may be less likely than other ethnicities to seek substance abuse for several reasons. These reasons include failure to recognize the signs of addiction, stigma, distrust, lack of available childcare, cost, and not knowing what services are available to them.
Failure to recognize the symptoms of substance abuse spans all cultural groups. Addicts and those closest to them may know that a problem exists, but they may minimize the seriousness of the problem or simply ignore it.
African Americans (and the general population) may view addiction as a sign of weakness or a lack of control. This stigma may cause shame and may deter many from seeking help. African Americans have a long history of racial discrimination and may distrust the government and its agencies. They may even distrust the healthcare agencies mandated to help those with addiction problems.
Many in the African American community with addiction issues may not seek treatment because of lack of available childcare (or its high cost). This is most common in single-parent households. Some treatment programs do offer a child care component. The expense of substance abuse treatment programs can also be a deterrent to those in need. As with childcare, there are often ways to successfully manage the cost of these programs, even for those living in poverty. Many people (of all ethnic and racial groups) are simply unaware of the treatment services that are available. Education in the community is paramount to getting those with substance abuse issues the treatment that they need.
Culturally sensitive treatment has often been associated with better outcomes for the treatment of substance abuse as well as other health issues. Successful treatment of substance abuse among African Americans should take into account their internal realities, and understand how their community works.
The inclusion of spirituality in the treatment of substance abuse among the African American community has been demonstrated to be associated with better outcomes and lower relapse rates. In the African American community, spirituality can also treat cultural pain and alleviate some of the hardships in the lives of drug users, which are often precursors of drug use. It is also important to take family relationships into account. While these relationships may suffer because of substance abuse, African Americans often stay connected to their families, despite fraying relationships. Family should be offered the opportunity to be included in therapy sessions and recovery meetings.
There are other services that the African American community may also benefit from in conjunction with substance abuse treatment. These services help to alleviate stress in the patient’s lives, helping recovery and preventing relapse. Employment assistance and job training can help to provide financial stability, and housing assistance can help to alleviate homelessness, both major sources of stress that may have led to drug dependence in the first place.
There is a wide array of groups available that are adept at helping African Americans with substance abuse issues. Two of them are The Office of National Drug Control Policy and Narcotics Anonymous.
The Office of National Drug Control Policy offers a storehouse of information about drug addiction, treatment, and prevention. Their pamphlet Keeping Your Teens Drug Free, A Guide for African American Parents and Caregivers is an excellent resource for parents to proactively start the conversation about drug use with their children. They also suggest visiting the Substance Abuse and Mental Health Services Administration’s treatment finder.
Narcotics Anonymous was founded on the principle that anyone who has a substance abuse problem (including alcohol) is welcome, regardless of race, ethnicity, gender, etc.. Narcotics Anonymous promotes its existence in various communities by participating in community events and outreach programs.
Hispanic Americans number 52 million in the U.S. comprising about 16.7% of the total population. By 2050, the Latino population in the U.S. is expected to reach 132.8 million, or about 30% of the total population.
Data from the 2015 National Survey on Drug Use and Health shows that among Hispanic Americans:
There are many reasons that Hispanic Americans may have substance abuse issues. These include:
Statistics demonstrate that Latinos may be more likely to use or abuse certain substances more than the national average. These include:
Many Hispanic Americans do not drink alcohol, but among those who do, Hispanic Americans use alcohol to a greater degree than do non-Hispanic Americans.
Young Hispanic Americans are more likely to use marijuana. A 2011 study reported that 50% of Hispanic American teens self-reported using marijuana in the past year. Only 35% of white teens and 40% of black teens had used the drug in the same period.
According to SAMSHA, Hispanic American men and women were more likely to seek treatment for opioid abuse (heroin or prescription painkillers) than were non-Hispanic Americans.
Use of cocaine in the Hispanic American community differ by ethnicity. Puerto Rican men and women were more likely to use the drug than either Cuban or Mexican Americans.
Although people of every racial and ethnic group suffer the consequences of heavy substance abuse, Hispanic Americans may be particularly vulnerable to certain conditions such as:
Many of the barriers to gaining access to treatment in the Hispanic American community are similar to those of other ethnic and racial groups with a few exceptions.
Many Hispanic Americans view access to rehabilitation services difficult to access. Lack of access may be as simple as a language barrier, or they may lack financial resources. As well, according to the Henry J. Kaiser Family Foundation, young Hispanic Americans are more likely to be uninsured than other ethnic or racial groups.
The lack of Hispanic providers (or those who are culturally competent) may make Latinos who need treatment uncomfortable. This is more than just a language barrier, as many bilingual health service providers are not culturally competent. The language barrier may also be an issue with support groups. As well, Hispanic Americans rely on a huge network of extended family for many aspects of their lives, including health care decisions. When treatment providers are not culturally competent, they may not understand the importance of extended family in Hispanic American culture and may put off patients’ receiving treatment.
As with all other groups, refusal to admit that they have a substance abuse problem may deter those in need of treatment from seeking it. Lack of knowledge of treatment programs may also be a deterrent for many seeking treatment.
Fear of deportation is more likely among undocumented Hispanics than in other ethnic/racial groups. Many undocumented Hispanic Americans are afraid of using the healthcare system because they do not want to be reported to the immigration authorities.
As with any ethnic/racial group, treatment that is tailored to the culture being served is one of the keys to success. In 2015, a study showed that Mexican Americans were 11 times more likely to return for a second session of a treatment program when the program was ethnicity-specific to them, rather than mainstream.
In order to be culturally competent, providers of treatment programs that cater to Latinos need to:
There are many places for Hispanic Americans to receive help with substance abuse problems. Two resources are SAMHSA and The National Latino Behavioral Health Association.
SAMHSA offers a number of publications aimed at the Latino demographic. Many of these informational pamphlets are available online and are offered in Spanish and English. They cover topics such as drug use and HIV as well as how to find addiction treatment.
The National Latino Behavioral Health Association is an advocacy organization aimed at increasing the quality of services for Latinos and providing cultural competency training for healthcare professionals.
Pacific Islanders and Asian Americans suffer lower rates of substance abuse than other minority populations. This has given them the stereotype as a “model minority.” This stereotype (as with all stereotypes) does the group a great disservice as it minimizes the problems that they have as a community. Asian Americans, as a group, are less likely to seek professional help when they need it. They may feel shame about their addiction, and they may not have access to culturally competent care.
As of 2010, there were about 18.2 million Asian Americans and 1.4 million Native Hawaiians or Other Pacific Islander (NHOPIs) in the U.S., and according to the U.S. Census in 2010, Asian Americans are the fastest growing racial group in the country.
Some substance abuse statistics among Asian Americans and NHOPIs in 2014:
Asian Americans and Pacific Islanders may become dependent on drugs for many reasons, including:
Many Asian Americans may have been exposed to trauma in their native countries. Torture, war, and separation from family members are not uncommon. Trauma can lead to Post Traumatic Stress Disorder (PTSD) which often manifests itself in the form of anxiety and depression. Many people who suffer PTSD self-medicate with alcohol or other illicit drugs.
The adoption of a new culture and language can be stressful for individuals in many ways. Shifting attitudes and cultural values can cause stress in families because not all members acculturate to the same degree or at the same time. This contributes not only to tobacco and alcohol use but can also lead to problematic gambling.
Asian Americans are no less likely than other ethnic groups to suffer from mental illness, but they are more likely to exhibit somatic complaints (stomach distress, headaches) than to talk about what is bothering them. As with other cultural/racial groups, Asian Americans may use drugs and alcohol to self-medicate.
Asian American families may live in poverty due to lack of education and limited job opportunities for immigrants. This can result in intergenerational stress and adolescents may experiment with drugs and alcohol.
Asian Americans who have been the victims of racism are more likely to become alcoholics than those who have not.
Parents play a crucial role in determining whether their children will experiment with illicit drugs and alcohol. Asian American children whose parents communicate their disapproval of drug and alcohol use are far less likely to use alcohol and drugs. Children who have been separated from their parents due to immigration, war or any other reason are at higher risk of using drugs and alcohol.
Recent research has found that substance use is not the same among all subgroups of Asian Americans.
Pacific Islanders and Asian Americans may be addicted to many things:
Asian Americans who need treatment for drug addiction face similar barriers as other minority groups do. These include:
Asian cultures are acutely aware of both personal and family honor. Many Asian Americans view drug addiction and alcoholism as moral weakness.
Asian Americans who are not fluent in English are more likely to seek help if services are available in their native language.
Poverty or lack of insurance may deter many Asian Americans from seeking treatment.
As with other minorities, Asian Americans greatly benefit from culturally competent services. In addition to offering treatment services in the patient’s native language, addiction treatment providers need to understand the cultural, religious, and family attitudes of Asian Americans. As with Hispanic Americans, extended family members are often included in medical and addiction treatment, and should be offered the opportunity to be included in the process.
Asian Americans may also benefit from other services specifically needed by their community. These services may include employment services and/or job training for recent Asian American immigrants, citizenship assistance.
The Asian Community Mental Health Services (ACMHS) is an advocacy group that empowers the most vulnerable members of the Asian American community to lead healthy lives by ensuring that multicultural and multilingual services are available to them. ACMHS offers treatment services, mental health care, wellness care, and community outreach.
The Asian Counseling and Referral Services (ACRS) provides multilingual and multicultural programs for Asian Americans and Pacific Islanders by providing addiction treatment, mental health care, care for the aging, Childhelp development, citizenship assistance and employment training and services.
As with finding any healthcare provider, a little legwork is necessary. It is always a good idea to:
Depending on the stage of recovery (and the extent of substance dependence), there are several different kinds of addiction treatment.
Many people who need treatment for substance abuse do not get it because they assume that the cost is beyond their reach. While the cost of substance abuse treatment can be high, there are government-funded programs as well as not-for-profit programs that are no-cost or low-cost options for those in need. Among the not-for-profit programs are those provided by The Salvation Army Harbor Light Centers and those offered by Catholic Charities.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers an online service to help find low-cost or free services for those in need. Health insurance can help cover the cost of substance abuse treatment. For those without health insurance can become insured through the Affordable Care Act.
Some treatment programs offer financial assistance to those who cannot pay for treatment. This financial help may be in the form of sliding scale payments (based on the patient’s income and household size), payment programs, and rehab scholarships for patients who are highly motivated to recover successfully.
Aftercare is a plan to ensure that anyone being treated for a substance abuse issue continues to stay sober and continue to heal, even after the initial treatment program has ended. It implements a plan to reduce triggers to use drugs and to increase the patient’s support. Aftercare plans may target housing, support groups, and continued treatment.
Group homes or halfway houses provide safe, drug-free housing for recovering addicts. They have stringent rules in place to help residents remain on the path to recovery. Residents are obliged to obey curfews and to submit to random drug testing.
Developing a support network is also an important component of staying substance-free. Groups like Alcoholics Anonymous and Narcotics Anonymous set up a peer support group where members can share the challenges they face and cope with urges to do drugs. Both organizations offer meetings that are “open” and “closed.” “Open” meetings are for anyone who wants to attend, while “closed” meetings are only for those who have a substance abuse issue and want to recover.
Continued treatment is also an important component of recovery from addiction. Private or group therapy can provide motivation for staying drug-free. For more information on addiction recovery treatment programs available, contact The Substance Abuse and Mental Health Services Administration (SAMHSA).