Article

Heterogeneity among Latinas and Latinos entering substance abuse treatment

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Abstract

The current study examined differences in 30-day and lifetime substance use for a sample of Mexican American, Puerto Rican, and Cuban American men and women from the Drug Evaluation Network System, a national database on individuals seeking substance abuse treatment. There were significant gender and ethnic differences in recent and lifetime substance use after controlling for age, years of education, employment, medical, and psychological problems. Lifetime and 30-day substance use rates found in this study do not coincide with prevalence rates found in community samples of Latinas/os, indicating that the patterns of substance use may be different among individuals who seek substance abuse treatment than among those in the general population. The results of this study highlight the heterogeneity of Latinas/os who abuse substances.

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... Though recent estimates suggest that black-white disparities in IDU have declined, IDU is still more prevalent among blacks, with white IDU prevalence in 2002 at approximately 90 per 10,000 adults and black IDU prevalence at 156 per 10,000 adults [2,3] . On average, rates of IDU are similar in Hispanic and non- Hispanic white populations, but disparities in IDU are present in some metropolitan areas [2], and the collection of data on Hispanics as a whole may obscure the significant variability between Hispanic subgroups [4,5]. U.S.-born Hispanics report higher rates of substance use than immigrants [6], and among Hispanics diagnosed with AIDS, those born in the U.S.A. or Puerto Rico were more likely to have contracted HIV through IDU than those born in Central or South America, Mexico, or Cuba [7]. ...
... Metropolitan areas with greater white-Latino differences in IDU tend to be located in the Northeast, an area where the majority of Latinos are of Puerto Rican origin [2]. In the Northeast, Latino-white disparities in IDU may be due to the relatively high rates of heroin use and high levels of residential segregation, which has been linked to increased IDU, found among Puerto Ricans living in mainland US [2,5,8]. Among injection drug users (IDUs), average HIV prevalence in the 96 largest U.S. metropolitan areas has been estimated to be 6.2% [9], far greater than the prevalence in the general population [10]. ...
... Compared to local demographics, Puerto Ricans are overrepresented in the study population. However, anecdotal information from outreach workers suggests that Puerto Ricans are over-represented in the Providence IDU population, which is consistent with national findings about substance use among Latino sub- populations[5,7]. It is possible that social desirability bias also affected survey responses. ...
Article
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Injection drug use (IDU) continues to be a significant public health issue in the U.S. and internationally, and there is evidence to suggest that the burden of injection drug use and associated morbidity and mortality falls disproportionately on minority communities. IDU is responsible for a significant portion of new and existing HIV/AIDS cases in many parts of the world. In the U.S., the prevalence of HIV and hepatitis C virus is higher among populations of African-American and Latino injection drug users (IDUs) than among white IDUs. Methadone maintenance therapy (MMT) has been demonstrated to effectively reduce opiate use, HIV risk behaviors and transmission, general mortality and criminal behavior, but opiate-dependent minorities are less likely to access MMT than whites. A better understanding of the obstacles minority IDUs face accessing treatment is needed to engage racial and ethnic disparities in IDU as well as drug-related morbidity and mortality. In this study, we explore knowledge, attitudes and beliefs about methadone among 53 out-of-treatment Latino and African-American IDUs in Providence, RI. Our findings suggest that negative perceptions of methadone persist among racial and ethnic minority IDUs in Providence, including beliefs that methadone is detrimental to health and that people should attempt to discontinue methadone treatment. Additional potential obstacles to entering methadone therapy include cost and the difficulty of regularly attending a methadone clinic as well as the belief that an individual on MMT is not abstinent from drugs. Substance use researchers and treatment professionals should engage minority communities, particularly Latino communities, in order to better understand the treatment needs of a diverse population, develop culturally appropriate MMT programs, and raise awareness of the benefits of MMT.
... Despite the effectiveness of Oxford Houses as a recovery option, a study that examined 170 Oxford Houses throughout the country found that Latinos represented only 3% of residents (Jason et al., 2007). Findings from qualitative research suggest that the underutilization of Oxford Houses by Latinos may be due to several factors, including lack of knowledge about this program as well as language and cultural barriers (Alvarez, Olson, Jason, Davis, & Ferrari, 2004). In order to address a lack of culturally appropriate substance abuse recovery options for Latinos, male bilingual-bicultural houses were opened to create a culturally-comfortable environment. ...
... Efforts are presently underway to open a female bilingualbicultural house. Although research indicates that Latinas are less likely to use substances than Latinos and other women in the U.S., the women who do use substances may experience similar problems to Latinos and, in some cases, their need for treatment may be more severe (Alvarez et al., 2004). As attempts are being made to recruit Latinas for a potential bilingual-bicultural Oxford House, it is likely that there may be many of the similar barriers that have prevented Latinos from becoming Oxford House residents. ...
... As attempts are being made to recruit Latinas for a potential bilingual-bicultural Oxford House, it is likely that there may be many of the similar barriers that have prevented Latinos from becoming Oxford House residents. Language, cultural, and gender specific barriers compound treatment disparities for Latinas (Alvarez et al., 2004). Another factor related to cultural values is the difficulty of ending relationships that might perpetuate an unhealthy lifestyle and low self-esteem (Wong & Longshore, 2008). ...
Article
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Latinos often do not seek substance abuse services, and this might be correlated to the lack of culturally-modified substance abuse treatment approaches. Oxford House is the largest self-help residential recovery program in the U.S., yet few Latinos are among their current residents. In an effort to change this, bilingual-bicultural recovery homes were recently developed for Latinos. This article describes the process in opening these bilingual-bicultural houses and how sociocultural factors such as the family, simpatía, and gender roles impacted the living environment of these houses. In addition, language is highlighted as a key factor to the comfort and success of Latinos living in Oxford Houses. Based on these experiences, the article addresses several obstacles/barriers that impacted this process and possible feasible solutions to these challenges. One challenge is the Latino family system. While this may provide a supportive, cost-effective option for some; it can also perpetuate a cycle of codependence and substance abuse.
... Therefore, the extent to which findings on acculturation and drinking behaviour extend to more at-risk samples, remains less known. There have been a handful of studies on Hispanics seeking substance use treatment (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;Rojas, Hallford, Brand, & Tivis, 2012), and of them, one (Arciniega, Arroyo, Miller, & Tonigan, 1996) Disorders to Treatments), to investigate whether different behavioural treatments (Cognitive-Behavioural Therapy, Twelve-Step Facilitation or Motivational Enhancement Therapy) were suited to patients with different characteristics, including: severity of alcohol involvement, gender, motivation and psychiatric severity (Project MATCH Research Group, 1997). A secondary analysis of Project MATCH did not find any associations between acculturation level and drinking behaviour, including number of heavy drinking days (Arciniega et al., 1996). ...
... Understanding the prevalence, co-morbidity and aetiology of substance abuse and depression among a Hispanic at-risk sample is needed given the poorer response to substance abuse treatment (Alvarez et al., 2004;Brecht, von Mayrhauser, & Anglin, 2000), including higher premature termination rates (Alvarez et al., 2004, for a review;White, Winn, & Young, 1998). Hispanics report greater co-occurrence of elevated depressive symptoms and hazardous drinking than non-Hispanics (Mendelson et al., 2008;Sleath & Williams, 2004). ...
... In fact, women reported an average level of depressive symptoms that exceeded the clinical cut point for probable clinical depression, suggesting that heavy drinking Hispanic women express elevated depressive symptoms regardless of acculturation level. This pattern is consistent with studies reporting that (Hispanic and non-Hispanic) women who abuse substances in general report more serious levels of psychological and social problems than men (Alvarez et al., 2004;Hesselbrock et al., 2003;Rojas et al., 2012). ...
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Background: Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms. Methods: Participants (N = 100) completed measures at baseline. Results: Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men. Discussion: Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.
... Substance use rates among Hispanic women do not differ significantly from rates among other ethnicities, but Hispanic women may have greater difficulty accessing treatment and other health services, including substance abuse treatment, and thus may experience more severe consequences of their substance use: drug-related deaths, intentional and unintentional injuries, exposure to violence, increased health care costs, school drop-out rates, and crime (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;SAMHSA, 2002;Zemore et al., 2009). Hispanic women substance users report fewer job-related skills, lower educational attainment, and fewer social resources than white women, further making Hispanic women vulnerable to the negative effects of substance use Ramirez & de la Cruz, 2003). ...
... Hispanic women substance users report fewer job-related skills, lower educational attainment, and fewer social resources than white women, further making Hispanic women vulnerable to the negative effects of substance use Ramirez & de la Cruz, 2003). Hispanic women report similar lifetime and recent (past 30 days) substance use rates as other ethnicities, but Hispanic women account for a disproportionately smaller percentage of women entering treatment (Alvarez et al., 2004;Amaro, Nieves, Johannes, & Cabeza, 1999;SAMHSA, 2002;SAMHSA, 2007;Wu et al., 2010). ...
... Compared to other ethnicities, Hispanic women are more likely to be involved with the criminal justice system and to attend substance abuse treatment under court-order . Hispanic women often report familial concerns, especially the fear of losing custody of their children, as a deterrent to seeking substance abuse treatment (Alvarez et al., 2004;Kline, 1996). Treatment entry for Hispanic women may also be influenced by cultural values and norms, specifically values placed on the strength of the family unit. ...
Article
The present study examined Hispanic substance-using parenting women treated in women-only (WO; n=126) versus mixed-gender (MG; n=853) programs and associated outcomes assessed 10 years after admission. Relative to other races/ethnicities of women admitted to the set of 40 California treatment programs in 2000-2002, Hispanic women were underrepresented in WO programs. Compared to those in MG programs, Hispanic women in WO programs demonstrated more severe treatment needs, indicated by their greater severity in drug and alcohol use, health and mental health problems, and criminal justice involvement at admission. They also had fewer economic resources (15% WO vs. 23% MG were employed, p<.05; 48% vs. 37% on public assistance, p<.05). Data based on administrative records covering 3 years pre-admission and 8 years post-admission showed that Hispanic women treated in WO programs had higher mental health service utilization over 8 years post-treatment admission, though no differences were found in trajectories of arrests and incarceration. In sum, long-term outcomes (in terms of criminal justice involvement) among Hispanic women in WO treatment were comparable to those in the MG treatment, despite greater service needs at admission. WO programs were able to engage more Hispanic women in use of mental health services. Future research should focus on factors limiting Hispanic women's participation in WO programs, which could suggest ways for improvement so as to benefit all Hispanic women in need of these special services.
... Based on a multidimensional approach, acculturation is defined as "the confluence among heritagecultural and receiving-cultural practices, values, and identities" [20]. The cultural clash signified by the differences in values and social norms that prevent Latinos from adapting successfully to the U.S. mainstream culture, within a specific environment, may lead to different behavioral consequences including substance use relapse [21]. However, most studies measuring acculturation on Latinos used data from nonclinical samples [12] and employed unidimensional markers including country of origin [22], length of stay in the U.S. [15] and language [23,24]. ...
... Taken together, the inclusion of cultural orientation in substance use models is needed to further our understanding on specific acculturation aspects that may be linked with substance abuse. More important, research in this area is critical to inform and develop sustainable and effective substance abuse aftercare for Latinos [21]. ...
... The proposed multidimensional acculturation framework is hypothesized to render more exploratory power than using simplistic uni-dimensional acculturation models [20,33]. Having a better understanding of the association between multiple acculturation dimensions and substance use would help design and implement effective substance use relapse interventions for Latinos working on their recovery [21]. ...
Article
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Disparities in substance abuse treatment (SAT) utilization and completion suggest that traditional substance abuse models may fall short of addressing the complex needs of Latinos, increasing the odds of relapsing. The need for substance use models that integrate multiple acculturation domains in relation to substance abuse is warranted. The goal of the present study is twofold: a) test a multidimensional acculturation model on Latinos who completed SAT; and b) examine the association between the proposed multidimensional acculturation and days consuming alcohol and illicit drugs in the past six months. A total of 131 participants (Mage=36.15, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) were interviewed upon completion of SAT. Results from the SEM indicated adequate model fit to the population under study, supporting the use of a multidimensional acculturation approach for this population. Subsequent results from the structured regression analysis suggest that multidimensional acculturation is negatively associated with days using alcohol in the past 6 months. The implications of these findings are discussed.
... Although a few studies indicate that Latinos access SAT at the same rate than European Americans and African Americans, most studies found that Latinos have poorer SAT outcomes than their European American counterparts [10][11][12][13][14]. Specifically, Latinos encounter more barriers to access SAT, receive fewer services, are less satisfied with treatment, report higher likelihood of unmet need, and are more likely to drop out of SAT than European Americans [6,9,13,[15][16][17][18][19][20][21]. Taken together, the above literature illustrates the need for research to understand key individual and contextual factors that inform substance use prevention and services for Latinos [9,22,23]. ...
... On one of the few studies comparing European American and Latinos receiving SAT found that Latinos were likely to be court-referred, from low socioeconomic status (SES), had higher drug than alcohol problem, and high level of criminal activity [51]. A study using national data to examine ethnic and gender differences among individuals seeking SAT found differences in substance use rates, not only based on gender and ethnicity, but also between those seeking services and those found in community samples [22]. Given the heterogeneity (i.e., generational status, acculturation) and dynamic growth of this population, there is the need for research that shed light on the factors that increase the likelihood of relapse in immigrants and U.S. born Latinos who have completed SAT [15,22,48]. ...
... A study using national data to examine ethnic and gender differences among individuals seeking SAT found differences in substance use rates, not only based on gender and ethnicity, but also between those seeking services and those found in community samples [22]. Given the heterogeneity (i.e., generational status, acculturation) and dynamic growth of this population, there is the need for research that shed light on the factors that increase the likelihood of relapse in immigrants and U.S. born Latinos who have completed SAT [15,22,48]. ...
Article
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Latinos are exposed to adverse psychosocial factors that impact their health outcomes. Given the heterogeneity and rapid growth of this population, there is an urgent need to understand the mechanisms through which psychosocial factors impact substance abuse and anxiety between immigrant and U.S. born Latino adults. The present study employs a multi-group path analysis using Mplus 7.2 to examine generational differences in the paths between affiliation culture, years of formal education, contact with important people, and length of full-time employment to substance abuse and anxiety in immigrant and U.S. born Latino adults who completed substance abuse treatment. A total of 131 participants (Mage= 36.3, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) in recovery from substance abuse completed self-report measures. Results from the multi-group path analysis suggest that being more affiliated to the U.S. culture is associated with substance abuse, whereas years of formal education and longer full-time employment is associated with reduced anxiety in the immigrant group. Conversely, frequent contact with important people and affiliation to the U.S. culture are associated with fewer years of substance abuse, whereas longer full-time employment is associated with substance abuse in the U.S. born group. Anxiety and substance abuse was correlated only in the U.S. born group. The implications of these findings are discussed.
... When exploring differences in the prevalence of substance use among Latino subgroups, it is also important to consider variations based on gender, cultural values, birthplace, and other sociodemographic characteristics (Amaro et al., 1999). Possible factors contributing to the increased risk of illicit drug use and abuse among Mexican Americans and Puerto Ricans include specific demographics such as younger age, fewer years of formal education, and higher rates of unemployment and concentrated poverty in comparison to other Latinos living in the United States (Alvarez et al., 2004;Vega and Sribney, 2005). ...
... These disparities have a particularly detrimental effect on Latinas born in the United States. Studies have suggested that foreign-born Latinas are more likely than their male counterparts to abstain from substances and illicit drugs and less likely to participate in heavy drinking (Alvarez et al., 2004;Amaro et al., 1999;Vega et al., 1998). Cultural norms are associated with the discouragement of substance and alcohol use among foreign-born Latinas (Alvarez et al., 2004;Amaro et al., 1999). ...
... Studies have suggested that foreign-born Latinas are more likely than their male counterparts to abstain from substances and illicit drugs and less likely to participate in heavy drinking (Alvarez et al., 2004;Amaro et al., 1999;Vega et al., 1998). Cultural norms are associated with the discouragement of substance and alcohol use among foreign-born Latinas (Alvarez et al., 2004;Amaro et al., 1999). Nonetheless, when compared to any other female racial group in the United States, some studies have suggested that Latinas report higher rates of lifetime use of alcohol and illicit drugs (Alvarez et al., 2004). ...
... When exploring differences in the prevalence of substance use among Latino subgroups, it is also important to consider variations based on gender, cultural values, birthplace, and other sociodemographic characteristics (Amaro et al., 1999). Possible factors contributing to the increased risk of illicit drug use and abuse among Mexican Americans and Puerto Ricans include specific demographics such as younger age, fewer years of formal education , and higher rates of unemployment and concentrated poverty in comparison to other Latinos living in the United States (Alvarez et al., 2004; Vega and Sribney, 2005). Other characteristics that shape Latino substance use includes the historically observed acculturation and gender gaps in substance use rates, which seem to be higher among Latinos with greater acculturation, broadly defined by place of birth and language spoken. ...
... These disparities have a particularly detrimental effect on Latinas born in the United States. Studies have suggested that foreign-born Latinas are more likely than their male counterparts to abstain from substances and illicit drugs and less likely to participate in heavy drinking (Alvarez et al., 2004; Amaro et al., 1999; Vega et al., 1998). Cultural norms are associated with the discouragement of substance and alcohol use among foreign-born Latinas (Alvarez et al., 2004; Amaro et al., 1999). ...
... Studies have suggested that foreign-born Latinas are more likely than their male counterparts to abstain from substances and illicit drugs and less likely to participate in heavy drinking (Alvarez et al., 2004; Amaro et al., 1999; Vega et al., 1998). Cultural norms are associated with the discouragement of substance and alcohol use among foreign-born Latinas (Alvarez et al., 2004; Amaro et al., 1999). Nonetheless, when compared to any other female racial group in the United States, some studies have suggested that Latinas report higher rates of lifetime use of alcohol and illicit drugs (Alvarez et al., 2004). ...
... Of those who utilized and completed SAT, Latinxs reported their needs were not met in treatment (Mulvaney-Day et al., 2012). Taken together, traditional substance abuse models may fall short of addressing the complex needs of Latinxs, increasing the odds of relapsing (Alvarez et al., 2004). ...
... U.S. mainland-born Latinx) and substance use in the past six months, and attitudinal acculturation (i.e., identify more with Latinx culture vs U.S. mainstream culture) moderating frequency of substance use. The use of a theory-driven acculturation model may further our understanding of the role of multiple acculturation dimensions implicated in recovery and inform and develop sustainable and effective substance abuse aftercare for Latinxs (Alvarez et al., 2004;Jason et al., 2013;Lopez-Tamayo et al., 2016b). ...
Article
Full-text available
Disparities in access and utilization of substance abuse treatment (SAT) among Latinxs, accentuated by this population's rapid growth, create a public health issue. Although substance abuse literature has given more consideration to environmental factors and social support concerning treatment outcomes, current substance abuse models fail to address important contextual and cultural aspects for Latinxs in recovery, including acculturation. The proposed study aims to test out a multidimensional acculturation model on a sample of 131 Latinxs (Mage= 36.3; SD±10.4, 117 males, 49% immigrants) who recently completed SAT. Specifically, the proposed study employed a conditional process model using the PROCESS Macro for SPSS to examine the association between behavioral acculturation and substance use behavior in the past six months on nativity status at different levels of attitudinal acculturation. Results yielded that, after controlling for age and substance use, higher endorsement of U.S. mainstream cultural practices was associated with a higher frequency of days using alcohol among Latinx immigrants, specifically those reporting high and very high affiliation to the U.S. mainstream culture. Also, a negative association between U.S. mainland-born Latinx and frequency of days using illicit drugs in the past six months was observed, but only among those who endorse very high affiliation of U.S. mainstream culture.
... Research that treats highly heterogeneous samples as a homogeneous unit of analysis runs the risk of overlooking triggers for disease as well as protective factors specific to the nations in these groupings (Guilamo-Ramos et al. 2020;Orozco-Hershey 2019). These works may also overlook differences in their histories of political violence, mass-trauma, marginalization, and health practices (Alvarez et al. 2004;Comas-Diaz 2001;García 2020;Gimenez 1989;Griner and Smith 2006;Guilamo-Ramos et al. 2020;Hunt et al. 2004). Moreover, these works have frequently used Anglocentric and Eurocentric theories to examine the health issues of these multi-ethnic categories (Gimenez 1989;Griner and Smith 2006;Guilamo-Ramos et al. 2020;Hunt et al. 2004). ...
... The conceptual framework was informed by prior research on populations with similar social histories (Brave Heart 1998;Evans-Campbell 2008;Kirmayer et al. 2011;Mohatt et al. 2014;Ortega-Williams et al. 2021;Prussing 2014;Walters and Simoni 2002;Yehuda et al. 1998). Selected articles were used to inform the prevalence and distribution of mental health and substance use patterns among IMA-US (Alegría et al. 2007;Alvarez et al. 2004;Catalano et al. 2000;Grant et al. 2004;Kessler et al. 2006;Mines et al. 2010;Zúñiga et al. 2014). ...
Article
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Recently, Black, Indigenous, and other People of Color (BIPOC) have encountered an escalation in adverse social conditions and trauma events in the United States. For individuals of Mexican ancestry in the United States (IMA-US), these recent events represent the latest chapter in their history of adversity: a history that can help us understand their social and health disparities. This paper utilized a scoping review to provide a historical and interdisciplinary perspective on discussions of mental health and substance use disorders relevant to IMA-US. The scoping review process yielded 16 peer reviewed sources from various disciplines, published from 1998 through 2018. Major themes included historically traumatic events, inter-generational responses to historical trauma, and vehicles of transmission of trauma narratives. Recommendations for healing from historical and contemporary oppression are discussed. This review expands the clinical baseline knowledge relevant to the diagnosis, treatment, and prevention of contemporary traumatic exposures for IMA-US.
... In addition, Hispanics who hold strong & Michael A. Mancini mancinim@slu.edu 1 preferences for the Spanish language have lower rates of DUD's than Hispanics who do not have such preferences [22]. Prevalence rates of drug use and drug use disorders within the US Hispanic population are impacted by an array of other risk and protective mechanisms including experiencing family conflict and discrimination, being poor, unemployed, younger, male and less educated [12,21,24]. Hispanics are less likely to use illicit drugs and/or develop DUDs if they maintain a strong ethnic identity and Spanish language preference, have close family cohesion and live in relatively safe neighborhoods [22][23][24][25]. ...
... We found the estimated prevalence of drug use for all drug types was greater for US-born Hispanics than Hispanic immigrants across all 5 subgroups. This supports other studies that have found strong protective effects of foreign nativity for drug use and drug use disorders [1,6,11,16,17,19,21]. Drug use prevalence varied by the type of drug, ethnic subgroup and nativity. ...
Article
Purpose: To examine illicit drug use and service utilization patterns of US-born and foreign-born Hispanics in the United States. Methods: Hispanic respondents 18 years and older in the NESARC were categorized as being of Mexican (n = 3,556), Puerto Rican (n = 785), Cuban (n = 346), Central American (n = 513), or South American (n = 381) origin. We examined lifetime prevalence of drug use and substance abuse treatment utilization patterns for US-born and Hispanic immigrants across subgroups. Results: Lifetime prevalence of drug use was greater among US-born Hispanics than Hispanic immigrants after controlling for age, gender, income, education, urbanicity, parental history of drug use problems and lifetime DSM-IV mood/anxiety disorders. Both US-born and immigrant Hispanic drug users were less likely than non-Hispanic white drug users to have utilized any form of substance abuse treatment (US-born AOR = 0.89, immigrant AOR = 0.64) and more likely to have utilized family or social services (US-born AOR = 1.17, immigrant AOR = 1.19). Compared to US-born Hispanic drug users, Hispanic immigrant drug users were less likely to have used any form of substance abuse treatment (AOR = 0.81) and were more likely to have utilized family or social services (AOR = 1.22). Conclusion: Strategies to increase engagement and retention of Hispanic drug users in substance abuse treatment include increasing access to linguistically and culturally competent programs that address unmet family and social needs. Further studies examining differences in drug use and service utilization patterns within Hispanic subgroups are needed.
... Department of Justice, 2005). Although there is no specific information on regional substance use rates by Hispanic subgroup, geographically Cuban Americans tend to live in the Miami area, Puerto Ricans primarily in urban areas along the east coast, and Mexican Americans primarily in the west but also dispersed throughout urban and rural parts of the U.S. (Alvarez, Olson, Jason, Davis, & Ferrari, 2004). ...
... English language preference at home is also associated with increased risk for substance use disorders (Ortega, Rosenheck, Alegría, & Desai, 2000), and Hispanics born in the U.S. are more likely to experience substance use disorders than their foreign-born peers (Alegria et al., 2006;Alegria, Mulvaney-Day, et al., 2007). These three factors are thought to reflect a lower retention of traditional family values and more exposure to a U.S. culture that has a greater availability of drugs and more relaxed norms regarding alcohol and drug use (Alvarez et al., 2004;Borges et al., 2011;Gil, Wagner, & Vega, 2000). ...
... Women with a substance use disorder are more likely to also have a co-morbid psychiatric diagnosis, as compared to the general population (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;Beckwith & Espinaosa, 1994;Brady et al., 1998;Chander & McCaul, 2003;Gentillo et al., 2000;Mann, Hintz, & Jung, 2004;Phillips, Carpenter, & Nunes, 2004;Randall et al., 1999). Psychological diagnoses that were the most likely to be associated with substance abuse or dependence by females included depression, anxiety, and posttraumatic stress disorder (PTSD) (Brady, Dansky, Sonne, & Saladin, 1998;Merikangas & Stevens, 1998;Sax & Wolfe, 1999). ...
... The majority (76.8%) of women in this study were dually diagnosed, with an Axis I mental health diagnosis and a substance abuse diagnosis. This information was consistent with finding from other studies reporting that women with substance abuse disorders are more likely to have a comorbid psychiatric diagnosis, as compared to the general population (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;Beckwith & Espinosa, 1994;Brady et al., 1998;Chandler & McCaul, 2003;Gentillo et al., 2000;Mann, Hintz, & Jung, 2004;Phillips, Carpenter, & Nunes, 2004;& Randall et al., 1999). ...
... Hispanic populations in the United States are not homogenous and as their acculturation process is not uniform, their substance use treatment service needs may vary depending on their cultural heritage and the region of the country where they have settled (Alvarez et al., 2004;Caetano, Ramisetty-Mikler & Rodriguez, 2008). Given these factors, caution must be used when interpreting results from substance use studies reporting no differences across ethnic groups when Hispanic ethnicity is considered homogenous (Alvarez et al., 2004;Burlew et al., 2009). ...
... Hispanic populations in the United States are not homogenous and as their acculturation process is not uniform, their substance use treatment service needs may vary depending on their cultural heritage and the region of the country where they have settled (Alvarez et al., 2004;Caetano, Ramisetty-Mikler & Rodriguez, 2008). Given these factors, caution must be used when interpreting results from substance use studies reporting no differences across ethnic groups when Hispanic ethnicity is considered homogenous (Alvarez et al., 2004;Burlew et al., 2009). ...
Article
Factors associated with retention and outcomes for Hispanic offenders mandated to treatment for substance use disorders have been overlooked in the literature resulting in an impediment to providing evidence-based, culturally relevant treatment services. This project examined the roles of motivational factors, the therapeutic relationship, and acculturation in predicting treatment retention and recidivism among Hispanic male probationers mandated to residential treatment. By following a treatment cohort over one hundred and twenty days, this research identifies factors that may be targeted to improve interventions and policies. The following conclusions are supported: among Hispanic offenders, the number of days in treatment is positively related to motivation to change and level of acculturation.
... 13 Existing SAT programs may overlook unique needs that are important for Latinos in recovery from substance use. 3,14,15 Despite calls for the incorporation of cultural aspects at all different stages of substance use prevention and treatment, 7 research on cultural constructs in relation to substance use behavior remains neglected. ...
... The 5 th Edition of the ASI has been used with Latino participants in several large studies and yielded strong psychometric properties. 14,45,46 The Spanish translation was back translated and pilot tested prior to undergoing a validation study. 47 Correla-tions for the test-retest reliability of the English and Spanish versions of the ASI range from .80 to .90. ...
Article
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The significant research gap on Latino adults who completed substance abuse treatment (SAT) impacts the provision of substance use prevention and treatment for this population. Given the need for culturally-appropriate SAT for Latinos, research that examines the role of cultural constructs and acculturation in relation to substance use behavior is warranted. The purpose of the present study is to test, based on the social control theory, a multiple moderation model using the PROCESS macro(1) to examine the moderating effect of Familismo on the association between history of family conflict and years of substance abuse on Latino males who completed SAT at different levels of acculturation (i.e., cultural orientation). Generational status (i.e., immigrant, U. S. born) and age are used as covariates. A total of 117 Latino male participants (Mage= 37, 54% non-U.S. born with a mean length of stay of 19 years in the U.S.) who completed SAT from facilities located in the metropolitan area of Chicago completed self-report measures. Results from the multiple moderation analysis showa significant three-way interaction (family conflict × Familismo × acculturation), indicating that participants with Latino and bicultural orientation who endorse average to high levels of Familismo have fewer years of substance abuse compared to those with U.S. mainstream culture orientation and low Familismo. Findings illustrate the need for SAT that assesses for family conflict and integrates cultural aspects to reduce substance use behavior on Latino males.
... Although investigators have recommended the use of qualitative methods in increasing our understanding of culturally specific behaviors and phenomena among racial and ethnic minorities (Gonzalez, 2007;Lugo Steidel, Ikhlas, Lopez, Rahman & Teichman, 2002), substance abuse, violence and HIV research targeting Hispanics have been dominated by quantitative studies. Most of the research specifically addressing substance abuse, IPV and HIV risk behaviors among Hispanic females has been quantitative in nature, estimating the prevalence, describing the consequences, identifying the risk factors (e.g., Alvarez, Olson, Jason, Davis, & Ferrari, J.R., 2004;Caetano, Field, Ramisetty & McGrtath, 2005;Field & Caetano, 2003;Peragallo, 1996) and to a much lesser degree describing the effects of interventions targeting behavioral change (Coyle et al., 2004;Flaskerud et al, 1997;Harvey et al., 2004;Peragallo et al., 2005;Raj, 2001). ...
... Most of the research specifically addressing substance abuse, IPV and HIV risk behaviors among Hispanic females has been quantitative in nature, estimating the prevalence, describing the consequences, identifying the risk factors (e.g., Alvarez, Olson, Jason, Davis, & Ferrari, J.R., 2004;Caetano, Field, Ramisetty & McGrtath, 2005;Field & Caetano, 2003;Peragallo, 1996) and to a lesser degree describing the effects of interventions targeting behavioral change (Coyle et al., 2004;Flaskerud et al, 1997;Harvey et al., 2004;Peragallo et al., 2005;Raj, 2001). Fewer studies have described Hispanic women's actual experiences with these from the "emic" or insider's perspective (Belknap & Sayeed, 2003;Ortiz, 2005;Peragallo, DeForge, Khoury, Rivero & Talashek, 2002;Talasheck, Peragallo, Norr & Dancy, 2004). ...
Article
Among the health disparities affecting the U.S. Hispanic population today are those relating to risky behaviors such as substance abuse, intimate partner violence (IPV) and HIV/AIDS. However, few studies have examined how these conditions may impact this population. The purpose of this dissertation was to explore the experiences that Hispanic women in South Florida have with regard to substance abuse, IPV and risks for HIV/AIDS, to describe how these conditions may be related, and to develop a model that can be used to guide research and interventions targeting this population. This dissertation uses data collected in Project DYVA (Drogas y Violencia en las Americas- Drugs and Violence in the Americas), a pilot research study that utilized both qualitative (Phase I) and quantitative (Phase II) research methods to describe the experiences of Hispanic women in South Florida between the ages of 18 and 60 with regard to substance abuse, violence and risky sexual behaviors. Three studies were conducted as part of this dissertation. The first study utilizes data collected during the qualitative phase of Project DYVA. During this phase eight focus groups were conducted and analyzed using qualitative content analysis (N = 81). The second and third studies utilize data collected during the second phase of Project DYVA. In this phase cross-sectional questionnaires collecting information regarding demographics, acculturation, self-esteem, depression, substance abuse, IPV and risks for HIV, were administered to 82 Hispanic women. Univariate and multivariate statistics were used to explore the relationships between substance abuse, IPV and risk for HIV (study 2) and between resource availability, IPV and depression (study 3). The findings from this dissertation suggest that substance abuse, IPV and risk for HIV are closely related intersecting health issues. IPV, the condition that emerged as the most salient of the three, also appears to be closely associated with resource availability (i.e., self-esteem and income) and depression. Additional individual, cultural, relationship and socio-environmental factors that may play a significant role in shaping the experiences that Hispanic women have with regards to these intersecting conditions were also identified and organized into a model.
... From this sample, Alvarez, Jason, Davis, Ferrari, and Olson (2004) interviewed nine Latino men and three Latina women living in OH. Most of the study's participants were in their 20s or early 30s, U.S.-born and English-dominant. ...
Article
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The current study compared traditional recovery homes for individuals with substance use disorders with homes that had been modified to feature culturally congruent communication styles. Findings indicated significant increases in employment income, with the size of the change significantly greater in the culturally modified houses. Significant decreases in alcohol use over time were also found, with larger decreases over time in the traditional recovery homes. Use of prescribed medications and days using drugs significantly decreased over time, but not differentially for those in the two types of recovery homes. The implications of these findings are discussed.
... It is especially necessary to increase effectiveness in service delivery and reduce variation in care for vulnerable populations (Institute of Medicine 2006; National Council for Community Behavioral Healthcare 2012). In particular, delivery of evidence-based care in racial and ethnic minority communities is an important element in reducing health disparities (Alvarez et al. 2004;Amaro et al. 2006;Delva et al., 2005). However, substance abuse treatment (SAT) programs in these communities generally suffer from unstable funding, passive leadership, high staff turnover, and limited technical resources to conduct clinical operations and support fidelity in the implementation process (D'Aunno 2006; Office of Applied Studies 2007; Roman et al. 2006). ...
Article
Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.
... The Hispanic group may include individuals that differ in terms of genetic, social, historical and cultural characteristics. 47,48 The individuals assigned to "other" race/ethnicity group were composed of participants who reported mixed racial/ ethnic identities. As a result, there may be important subgroups that potentially respond differently to the treatment that were masked by combining these groups in our analyses. ...
Article
The study goal was to determine whether client attributes were associated with outcomes from group cognitive behavioral therapy for depression (GCBT-D) as delivered in community-based addiction treatment settings. Data from 299 depressed residential clients assigned to receive either usual care (N = 159) or usual care plus GCBT-D (N = 140) were examined. Potential moderators included gender, race/ethnicity, education, referral status, and problem substance use. Study outcomes at 6 months post-baseline included changes in depressive symptoms, mental health functioning, negative consequences from substance use, and percentage of days abstinent. Initial examination indicated that non-Hispanic Whites had significantly better outcomes than other racial/ethnic groups on two of the four outcomes. After correcting for multiple testing, none of the examined client attributes moderated the treatment effect. GCBT-D appears effective; however, the magnitude and consistency of treatment effects indicate that it may be less helpful among members of racial/ethnic minority groups and is worthy of future study.
... As suggested by the psychotherapy literature on cultural matching (Karlsson, 2005), we examined, in particular, whether similarity in client-therapist birthplace and level of acculturation in a Spanish-speaking sample had any bearing on client outcomes in substance abuse treatment. From the findings, we can conclude that beyond matching clients and therapists on ethnicity and language, as the design of the study established and as previous literature would suggest (Alegria, et al.,, 2006; Alvarez et al., 2004; Diaz et al., 2001; Malgady & Zayas, 2001), there may not be any additional benefit in Hispanic populations of matching on cultural characteristics, such as birthplace (U.S. born vs. foreign born) and level of acculturation. Because this study is the first to examine the cultural match question in a substance abusing treatment population, further research should explore this question in clinical populations with other presenting problems (e.g., depression; anxiety) and using other psychotherapy modalities to determine if the findings are consistent across areas and treatments in Spanish-speaking populations. ...
Article
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This secondary data analysis of the Clinical Trials Network's Motivational Enhancement Therapy effectiveness trial with Spanish-speaking substance users examined whether the degree of birthplace and acculturation similarities between clients and therapists, as well as the therapists' own level of acculturation and birthplace were related to the clients' participation in treatment and level of substance use during outpatient substance use treatment. Sixteen therapists and their 235 clients from the larger effectiveness trial were included in the analyses for this study. Results of the multilevel regression models for client participation in substance use treatment and client days of substance use, taking into account within and between therapist cultural characteristics, revealed that birthplace match and acculturation similarity between each therapist and his or her clients did not predict client outcomes. Instead, therapists' birthplace and level of acculturation independently predicted days of substance use, but not treatment participation for monolingual Spanish-speaking clients. These findings are discussed in the context of the results of the main effectiveness trial and of psychotherapy research with ethnic minority populations, in particular Hispanic minorities.
... Previous studies have found considerable heterogeneity among Hispanic groups (e.g. Mexicans, Puerto Ricans, Cubans, and individuals from Spain, the Dominican Republic, or Spanish-speaking Central and South American countries; Alvarez et al., 2004). It is important to recognize the potential heterogeneity both across and within Hispanic American samples as these differences may relate to prevalence of VRFs and mental health outcomes. ...
Article
Although vascular depression has received considerable research attention, relatively little research in this area has focused on minority samples. This study investigated the association between baseline vascular risk factors (VRFs) and risk for elevated depressive symptoms at 2-year follow-up in a sample of 964 individuals without significant depressive symptomotology (CES-D < 12) or cognitive impairment (MMSE>or= 24) at baseline from the Hispanic Established Population for the Epidemiologic Study of the Elderly. We examined the associations between self-reported baseline vascular risk factors (chest pain, heart attack, stroke, hypertension, diabetes, and smoking) and a composite of these risk factors with elevated depressive symptoms (CES-D >or= 16) at 2-year follow-up. Seventy-four (7.7%) of the 964 participants without evidence of depression at baseline demonstrated elevated depressive symptoms (CESD >or= 16) 2 years later. There was an overall pattern of higher rates of elevated depressive symptoms at 2-year follow-up with increasing number of vascular risk factors (0 VRFs = 6.4%, 1 VRF = 5.5%, 2 VRFs = 7.7%, and 3 or more VRFs = 14.7%). After controlling for demographic variables, physical functioning, and other medical conditions, the cumulative vascular risk index was significantly associated with elevated depressive symptoms at 2-year follow-up (p < 0.05). Our results suggest vascular conditions may contribute to risk for depression over time among Mexican American elders, and this is relatively independent of other medical conditions. These findings suggest that depression is an additional long-term complication of these common cardiovascular disorders.
... The Hispanic group may include individuals that differ in terms of genetic, social, historical and cultural characteristics. 47,48 The individuals assigned to "other" race/ethnicity group were composed of participants who reported mixed racial/ ethnic identities. As a result, there may be important subgroups that potentially respond differently to the treatment that were masked by combining these groups in our analyses. ...
Article
Little is known about the effect of group therapy treatment modules on symptom change during treatment and on outcomes post-treatment. Secondary analyses of depressive symptoms collected from two group therapy studies conducted in substance use treatment settings were examined (n = 132 and n = 44). Change in PHQ-9 scores was modeled using longitudinal growth modeling combined with random effects modeling of session effects, with time-in-treatment interacted with module theme to test moderation. In both studies, depressive symptoms significantly decreased during the active treatment phase. Symptom reductions were not significantly moderated by module theme in the larger study. However, the smaller pilot study’s results suggest future examination of module effects is warranted, given the data are compatible with differential reductions in reported symptoms being associated with attending People-themed module sessions versus Thoughts-themed sessions.
... Gender played a significant role in perceived barriers to accessing treatment, but only when considering migration status. Although women reported more barriers than men to entering treatment in other research on Latinos in the United States [17,32], findings suggested that among adults who have used illicit drugs, nonmigrant Mexican men reported an average of 1.3 more barriers to accessing substance abuse treatment compared to Mexican women who had traveled to the United States. This preliminary finding contributes to an initial understanding of differences in perceived access to care when considering groups categorized by migration status. ...
Article
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Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.
... Alegria et al. (2006) note that this results in significant knowledge gaps in relation to the impact of services for racial/ethnic groups. Finally, when racial/ethnic groups are sampled in services research, it is clear that substantial heterogeneity -genetic, social, historical and cultural -exists within groups (Alvarez, Olsen, Jason, Davis, & Ferrari, 2004;Buka, 2002). Thus, while it is increasingly documented that remaining in treatment and receiving services tailored to specific needs is related to improved outcomes, it is not known whether these relations hold for specific racial/ethnic groups. ...
Article
This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.
... Selain itu, wanita yang terlibat dengan aktiviti penyalahgunaan dadah juga dianggap oleh masyarakat sebagai kumpulan yang kurang berfungsi (Chatham, Hiller, Rowan-Szal, Joe & Simpson, 1999) untuk memainkan peranan dalam penjagaan anak-anak dan pembentukan keluarga sejahtera (Davis, 1990;Sheridan, 1995). Menurut beberapa kajian yang telah dijalankan oleh sarjana barat mendapati bahawa wanita yang terlibat dengan masalah penyalahgunaan dadah berkecenderungan tinggi mengalami masalah yang berkaitan dengan psikologi (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;Chander & McCaul, 2003;Gentilello et al., 2000;Mann, Hintz, & Jung, 2004;Phillips, Carpenter & Nunes, 2004;Zimmermann, Pin, Krenz, Bouchat, Favrat, Besson & Zullino, 2004), seperti kemurungan, kebimbangan, gangguan bipolar afektif, fobia, gangguan psikoseksual dan gangguan akibat masalah yang berkaitan dengan tekanan selepas trauma (Brady, Dansky, Sonne & Salahuddin, 1998;Denier;Fornari, Kent, Kabo & Goodman, 1991;Najavits, Weiss & Shaw, 1997;Saxe & Wolfe, 1999). Manakala kajian yang dijalankan oleh Fauziah, Mohamad, Chong & Azmi (2012a) mendapati individu yang terlibat dengan dadah khasnya yang menggunakan dadah jenis heroin dan morfin berkecenderungan tinggi menunjukkan tingkah laku yang agresif. ...
Article
Women involvement in drug abuse has adverse impacts not only to the nation but also impose great challenges to achieve stable family structures. Therefore, this article aims to explore the experiences of women drug user in Malaysia with reference to their drug abuse activity and identify the level of family relationship they possess. This research used quantitative method and cross-sectional survey. A total of 120 women at the Center of Drugs Recovery and Narcotic Rehabilitation (PUSPEN), Bachok, Kelantan were chosen using stratified random sampling. Data were analyzed using descriptive analysis. The results of the study showed that 39.5 percent of women inmates started getting involved in drug activities at the age of 15-20 years, 79 percent had been arrested for the first time to undergo a rehabilitation process, majority of them (54.6 percent) reported to use drugs on regular basis and more than half of the respondents (63 percent) admitted that they obtained drugs supplies from drug dealers. Analysis of drug using pattern reveals that syabu (75.6 percent) and heroin (61.3 percent) are the most popular drugs used by the inmates. Finding also showed that majority (60.5 percent) of drug inmates engaged in moderate level of family relationship. Findings from this research yielded wide implications to improve drug abuse treatment and rehabilitation programs in an institution, particularly among women drug users in Malaysia.
... Nuestro descubrimiento de que los individuos que reportaron dependencia a las drogas perciben más barreras para acceder al tratamiento es consistente con estudios nacionales e internacionales [17,33]. Este hallazgo subraya oportunidades para futuras investigaciones centradas en identificar diferencias en el acceso al cuidado para adultos dependientes a distintos tipos de drogas ilícitas. ...
Research
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Resumen Antecedentes: Hemos examinado las barreras que perciben los migrantes mexicanos para acceder al tratamiento por abuso de sustancias, y las posibles diferencias según el género. Métodos: Este estudio analiza un subconjunto de datos de hogares que fueron recopilados en México en 2011 a través de la Encuesta Nacional de Adicciones (National Survey of Addictions). Una muestra de 1,143 individuos que reportaron consumir drogas ilícitas fue analizada usando modelos binomiales negativos multivariados para determinar relaciones directas y moderadas del género, la condición migratoria y la dependencia de las drogas con respecto a las barreras percibidas para tener acceso al tratamiento. Resultados: Hallazgos significativos incluyeron disparidades en la dependencia de las drogas según el estatus migratorio. En comparación con los hombres no migrantes, las mujeres que han viajado a los Estados Unidos estuvieron asociadas con un menor número de barreras (1.3) para acceder al tratamiento. Una menor cantidad de barreras para tener acceso a la atención se asoció con personas que residen en otras regiones del país, en comparación con los que viven en la Ciudad de México. Conclusiones: La dependencia a las drogas, el género, el estatus migratorio y la ubicación regional son factores asociados con el acceso al tratamiento necesario. Las implicaciones tanto en las políticas de la asistencia sanitaria para el desarrollo de las infraestructuras de los servicios de tratamiento, como en las investigaciones futuras, se discuten en el contexto de la reforma actual de la política de drogas en México. [publicacion traducida al Espanol].
... Nuestro descubrimiento de que los individuos que reportaron dependencia a las drogas perciben más barreras para acceder al tratamiento es consistente con estudios nacionales e internacionales [17,33]. Este hallazgo subraya oportunidades para futuras investigaciones centradas en identificar diferencias en el acceso al cuidado para adultos dependientes a distintos tipos de drogas ilícitas. ...
Research
Full-text available
Resumen Antecedentes: Hemos examinado las barreras que perciben los migrantes mexicanos para acceder al tratamiento por abuso de sustancias, y las posibles diferencias según el género. Métodos: Este estudio analiza un subconjunto de datos de hogares que fueron recopilados en México en 2011 a través de la Encuesta Nacional de Adicciones (National Survey of Addictions). Una muestra de 1,143 individuos que reportaron consumir drogas ilícitas fue analizada usando modelos binomiales negativos multivariados para determinar relaciones directas y moderadas del género, la condición migratoria y la dependencia de las drogas con respecto a las barreras percibidas para tener acceso al tratamiento. Resultados: Hallazgos significativos incluyeron disparidades en la dependencia de las drogas según el estatus migratorio. En comparación con los hombres no migrantes, las mujeres que han viajado a los Estados Unidos estuvieron asociadas con un menor número de barreras (1.3) para acceder al tratamiento. Una menor cantidad de barreras para tener acceso a la atención se asoció con personas que residen en otras regiones del país, en comparación con los que viven en la Ciudad de México. Conclusiones: La dependencia a las drogas, el género, el estatus migratorio y la ubicación regional son factores asociados con el acceso al tratamiento necesario. Las implicaciones tanto en las políticas de la asistencia sanitaria para el desarrollo de las infraestructuras de los servicios de tratamiento, como en las investigaciones futuras, se discuten en el contexto de la reforma actual de la política de drogas en México. [publicacion traducida al Espanol].
... Although gender is a robust indicator of likelihood and amount of alcohol use, with Latino men showing a higher propensity to drink alcohol across subgroups based on country of origin [17][18][19], there is limited understanding of the interacting roles of gender and indigenous background (e.g., Mayan) and gender and SES (income and education) regarding alcohol use. There is evidence of traditional sex roles among indigenous populations in Mexico. ...
Article
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Background Despite increasing concern about the quality of life of older adults, little is known about characteristics associated with health risk behaviors among older adults in middle-income countries. This study relied on unique longitudinal data to examine the relationship between sociodemographic characteristics and alcohol use among low-income older adults, one of the fastest-growing populations worldwide. Methods This multilevel longitudinal analysis involved three waves of data (2008–2010) from 2,351 adults aged 70 or older in Yucatán, Mexico. Multilevel regressions models were used to test interactions among gender, speaking Mayan (indigenous language), and socioeconomic status to understand conditions associated with the odds of current alcohol use and the frequency and amount of alcohol use. ResultsHalf of the participants in this study report consuming alcohol in their lifetime, 21.58 % of whom were current alcohol users. Older adults reported consuming alcohol 1.15 days a week and 1.60 drinks per day. Speaking Mayan was associated with lower odds of current alcohol use. However, men who spoke Mayan reported higher odds of drinking alcohol compared to women and non-Mayan (Spanish) speakers. The positive relationship between socioeconomic status and alcohol use was also moderated by gender (male). Conclusions Findings show that older and Mayan populations had lower odds of drinking in Yucatán, Mexico, whereas men were at highest risk of drinking alcohol, after adjusting for ethnic culture and socioeconomic status. Implications for health policy and epidemiological studies on substance use among older adults residing in low-income settings are discussed.
... Latinos rank at the bottom of rates of racial/ethnic groups seeking and accessing substance use and depression treatment [63]. Even when substance use treatment is accessible, utilization rates are low [64] and Latinos are likely to terminate early, report treatment to be of low quality, and have poorer outcomes [65]. However, the need for treatment of psychological distress near El Paso-Ciudad Juàrez appears to be high. ...
Article
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We present results from a cross-sectional, clinic-based survey of border-region Latino men who have sex with men (MSM) and who also are living with HIV in the El Paso-Ciudad Juárez area. Among the 66 participants who reported serodiscordant anal or vaginal intercourse, we examined levels of psychological distress and substance use and the association of these variables with condomless sex. Bivariate analyses indicated that MSM who reported condomless sex with a serodiscordant partner were more likely to report higher scores on measures of anxiety, depression, and trauma. These men were also more likely to report more days of alcohol use to the point of intoxication. In multivariate logistic regression, no variables were independently associated with sexual risk behavior, but symptoms of anxiety trended toward statistical significance. Our study is one of few reports aimed at understanding the HIV epidemic among Latino MSM living with HIV in the El Paso-Ciudad Juárez border region. Although we found no evidence of a relation between our measures of psychological distress and substance use and sexual risk behavior in multivariate analyses, psychological distress and problematic alcohol use were common in the sample and are important targets for intervention in their own right.
... Because Latino/as receiving SUD treatment have higher rates of substance use than nonclinical samples, it is important to examine how acculturation is related to treatment outcomes (Alvarez, Olson, Jason, Davis, & Ferrari, 2004). Very few studies have examined the impact of acculturation on substance use treatment. ...
Article
Full-text available
The purpose of this study was to examine the association of acculturation with substance use treatment outcomes in a sample of treatment-seeking Latino/as (N = 405). The study used data from a multisite randomized controlled trial of a culturally adapted version of Motivational Enhancement Therapy delivered in Spanish. Berry, Kim, Minde, and Mok’s (1987) acculturation model was used to divide the sample into 4 types (integrated, assimilated, separated, marginalized), based on Bicultural Involvement Questionnaire scores. One-way analyses of variance, chi-squared tests, and repeated-measures regression were used to examine baseline acculturation, posttreatment outcomes, and follow-up outcomes. All participants were of Latino/a background, and 88.4% of the sample was male. Participants with greater acculturation to American culture (i.e., integrated and assimilated acculturation types) reported more substance use and associated problems at baseline, χ2(3) = 20.5, p
... The remaining four studies found in the search explored national data sets of women in treatment but they did not provide treatment outcomes data specific to the Hispanic women samples (Clark, 2001;Grella, 1999;Grella et al., 2000;Alvarez et al., 2004). ...
Article
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The results of a focused search of the literature on empirical studies of substance abuse treatment outcomes with Hispanic adults are reviewed. Also provided are key research opportunities and recommendations on substance abuse treatment for Hispanics. The paper is divided into two major sections: the first focuses on behavioral drug treatment studies on Hispanic adults, and the second identifies published original articles in pharmacotherapy, namely that more empirical research is needed to determine which treatments are efficacious with Hispanic populations. For treatment modalities not associated with promising effect sizes with Hispanic samples, cultural modifications may be needed to improve the compatibility of the treatment with Hispanic culture. For those treatments found to have promising effect sizes with various Hispanic subgroups, with Hispanics at different levels of acculturation, and with Hispanics from various socioeconomic backgrounds. The authors stress the need for theory-driven interventions to be developed specifically for well-characterized Hispanic subgroups (e.g., suburban middle-income Puerto Ricans living in the Northeast).
... Latinx youth's cultural processes appear to be important predictors of alcohol use behaviors (Guerrero et al, 2013, Szapocznik et al, 2007. Subgroup differences in their rates of alcohol use are often associated with national origin, place of residence, acculturation and acculturation stress, gender, and SES (Alvarez et al, 2004). For example, Mexican American men in the Southwest report heavier and more consistent alcohol consumption and are more likely to engage in binge-drinking behaviors than other Latinxs such as Cubans, Central Americans, and South Americans (Alvarez et al., 2007). ...
Article
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The present study describes results of a randomized three-group repeated measures study that examined whether augmenting a culturally-based parent education program (Familias) can strengthen the effects of a youth intervention (kiR) in reducing rates of alcohol consumption among Latinx adolescents. A stratified random sample of 462 Latinx early adolescents from a Southwestern city participated in this study. Ordinary Least Squares regression results show that receiving the parental and youth curricula components and two other family practices were significantly associated with lower rates of alcohol consumption at Wave 2. Findings support the notion that prevention efforts that include a culturally grounded parent component could be a more effective strategy to help Latinx youth refrain from alcohol use than youth-only programs.
... 8,17 There is ample evidence that Hispanics of different national origins have widely divergent drug use patterns and differ also in the consequences of their drug use. [18][19][20] A study conducted by Selik 21 on mortality due to HIV infection among U.S. Hispanics found large disparities in death rates by national origin. Hispanics of Puerto Rican origin had a significantly higher rate of death due to HIV diseases than those of Cuban, Central/South American or Mexican origin. ...
Article
Drug users have been found to be at high risk of mortality but the mortality experience of Hispanic drug users remains understudied. This study assessed mortality among Puerto Rican injection drug users (IDUs) in New York City (NY), and in Puerto Rico (PR). Study subjects were 637 IDUs from NY and 319 IDUs from PR. Mortality was ascertained using data from the National Death Index. Annual mortality rate of the NY cohort was 1.3 per 100 person years compared to the PR cohort with a rate of 4.8. Compared to the Hispanic population of New York City, the standardized mortality ratio (SMR) of the NY cohort was 4.4. Compared to the population of Puerto Rico, the SMR of the PR cohort was 16.2. The four principal causes of death were: NY-HIV/AIDS (50.0%), drug overdoses (13.3%), cardiovascular conditions (13.3%), and pulmonary conditions (10.0%); PR-HIV/AIDS (37.0%), drug overdoses (24.1%), sepsis (13.0%), and homicide (11.1%). Modeling time to death using Cox proportional hazards regression, the relative risk of mortality of the PR cohort as compared to the NY cohort was 9.2. The other covariates found to be significantly associated with time to death were age, gender, education, social isolation, intoxication with alcohol, and HIV seropositivity. The large disparity in mortality rates found in this study suggests that health disparities research should be expanded to identify intra-group disparities. Furthermore, these results point to an urgent need to reduce excess mortality among IDUs in Puerto Rico.
... They are also more likely to drop out during early stages of treatment and report not having their service needs met (Wells, Klap, Koike, & Sherbourne, 2001). Considering the current population growth of Latinos in the United States and their documented health disparities, especially related to alcohol and drug abuse (Alvarez, Olson, Jason, Davis, & Ferrari, 2004;Amaro et al., 2006;Delva et al., 2005), this study seeks to identify individual and service factors that may enable first-time treatment participants from different Latino subgroups to successfully complete treatment. ...
Article
A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear. This study analyzed a subset of multicross-sectional data (2006-2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA (N=12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients. Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members. These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.
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Alcohol use disorders are highly prevalent conditions that generate a large fraction of the total public health burden. These disorders are concentrated in mentally ill populations, in which reliability of self-reporting of alcohol consumption may be especially compromised. The application of objective biomarkers for alcohol use may therefore play an important role in these patients. This article provides a description and comparative overview of traditional versus novel biomarkers of alcohol consumption. Greater professional familiarity with and use of novel biomarkers as diagnostic and treatment management tools may enhance clinical standards and research on alcohol use in patients with a dual diagnosis.
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The present study used archival data to examine the differential growth among self-governed substance abuse recovery homes for men (N = 443) and women (N = 125). The number of these homes increased dramatically across the U.S. from 1988-1999 when state loan funds were made available to states and technical assistance was utilized by organizations developing the houses. State loan programs and the utilization of technical assistance, however, had the strongest impact on the expansion of women's houses compared to men's houses. The implications of these findings in relation to the scarcity of recovery options for women are discussed.
Book
Despite evidence showing Latinos to be among the fastest growing populations in the US, very little attention has been given to practice with Latino individuals, families, and communities. Beginning with a comprehensive definition and demographic map of Latinos, Latino culture, and a cultural asset paradigm, this book identifies strategies for designing culturally relevant programs and services. Chapters highlight health and social concerns including issues surrounding gender, religion, language, immigration, substance abuse, and health conditions. More importantly, the chapters also outline a practice framework that places cultural assets at the center. The book provides a rich paradigm for understanding perspectives on culture, access, assets, and how they intersect to inform best practices. The step-by-step framework guides through six stages: pre-contact assessment, initial contact and asset identification, resource mapping, relationship building, intervention, and evaluation. Each stage is heavily grounded in theoretical and socio-political considerations with particular attention to thinking critically about selecting best practices and how to sustain an evidence-based practice.
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Acknowledgments This report was prepared by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA), RTI International (a trade nameof Research Triangle Institute) of Research Triangle Park, North Carolina, and Synectics for Management Decisions, Inc., of Arlington, Virginia, under Contract No. 283-99-9018. At SAMHSA, Thomas M. Brady co-edited the report, and Theodora Fine, Sharon Amatetti, Peter Delany, and Al Woodward provided review comments. At RTI, Olivia Silber Ashley was co-editor, and Mary Ellen Marsden was senior advisor. B. Kathleen Jordan, Kara Riehman, and Wendee M. Wechsberg provided review comments. Also at RTI, Molly Aldridge, Catherine Aspden, Kyung-Hee Bae, Michael Bradshaw, Jessica Cance, Larry Crum, Jennie L. Harris, Mindy Herman-Stahl, Amy Hernandez, Jennifer J. Kasten, Kellie M. Loomis, Alex Orr, Barry Weaver, Nathan West, and Megan Williams provided research or writing assistance; Diane G. Caudill produced the graphics; Catherine A. Boykin and Loraine G.Monroe assisted with the tables; Joyce Clay-Brooks, Linda Fonville, and Judith Cannada provided document preparation support; Teresa F. Gurley and Pamela Couch Prevatt readied files for the SAMHSA printer and Web site; and D.J. Bost, Richard S. Straw, K. Scott Chestnut, Jason Guder, and Jeff Novey copyedited and proofread the report. At Synectics, Sameena Salvucci, Leigh A. Henderson, Alisa Male, Albert Parker, and Lev S. Sverdlov provided statistical, research, and writing support. Final report production was provided by Beatrice Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA. Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. However, this publication may notbe reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services (DHHS). Citation of the source is appreciated. Suggested citation: Brady, T. M., & Ashley, O. S. (Eds.). (2005). Women in substance abuse treatment: Results from the Alcohol and Drug Services Study (ADSS)(DHHS Publication No. SMA 04-3968, Analytic Series A-26). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Disclaimer
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With the growing number of Hispanics in the U. S. and the accompanying growing number of Hispanic clients in the specialty substance abuse treatment system, it is increasingly pertinent to ensure that they receive appropriate and relevant treatment for substance use disorders. We use nationally representative data to determine the sociodemographic, substance use, mental health, and treatment characteristics of Hispanic clients in specialty substance abuse treatment, as compared to non-Hispanic White clients. Hispanic clients are in treatment more often for heroin use and are referred to treatment more often by the criminal justice system. More White clients receive individual counseling than Hispanic clients. Hispanic clients have fewer co-occurring mental disorders than White clients, but a similar history of mental health treatment. These findings set the stage for refining the agenda to develop the most effective treatments for Hispanics with substance use disorders.
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Although the risks and protective processes influencing substance use behaviors of adult Latinos have been increasingly examined in the literature, substance abuse among adult Latinas remains a relatively understudied area. This study examined associations between mother-daughter attachment and substance abuse among 158 Latina mothers and their adult daughters (N = 316). Dyads of mothers and daughters were categorized into four groups: (a) mother/daughter both drug or alcohol abusers (Dyad 1), (b) mother abuser and daughter non-abuser (Dyad 2), (c) mother non-abuser and daughter abuser (Dyad 3), and (d) mother/daughter both non-abusers (Dyad 4). Dyad 1 participants reported lower levels of attachment to each other than all other types of dyads. Participants born in the U.S. reported more substance abuse than their non-U.S. born counterparts. Future longitudinal research is recommended to determine the presence of a mother-daughter attachment threshold that, if established early and maintained, may act as a protective mechanism against the intergenerational co-occurrence of substance abuse among adult Latinas.
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We evaluated organizational factors associated with the implementation of contingency management treatment (CMT) and medication-assisted treatment (MAT) in substance abuse treatment (SAT) programs serving racial and ethnic minority communities. Analysis of cross-sectional data collected in 2010-2011 from a random sample of 148 publicly funded SAT programs showed that accepting private insurance was positively associated with CMT and MAT implementation, whereas larger programs were associated with greater implementation of MAT. Supervisorial openness to and expectations about implementing evidence-based practices (EBPs) and attributes for change were strongly associated with CMT, whereas the interactions between openness to EBPs and programs that accept private insurance and that are governed by parent organizations were positively associated with MAT. These external expectations and managerial attitudes supported the implementation of psychosocial and pharmacotherapy treatments in SAT. Implications for improving standards of care in minority communities are discussed.
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Objective The primary aim in this study was to use a joint analysis approach to examine the association between longitudinal depressive symptoms and survival in Mexican Americans. Methods: The separate Cox regression and joint modeling were applied to data from the Hispanic Established Population for Epidemiological Study of the Elderly (HEPESE). Depressive symptoms were measured by the Center of Epidemiological Studies Depression Scale (CES-D). The trajectories of CES-D, modeled by random effect, were used as independent variables to fit the mortality curve adjusted by other variables including demographics and physical functioning. Results: The separate Cox regression couldn’t identify association between depressive symptoms and survival. The joint analysis indicated that the slope of CES-D score was not associated with mortality in older Mexican-Americans, however the intercept had negative effects on mortality. Conclusion: There was significant association between baseline depression symptoms and mortality, while no association with slope in older Mexican Americans
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Hispanic women in the United States are disproportionately affected by intimate partner violence (IPV). One correlate of IPV among Hispanic women with important public health implications is substance misuse. However, limited research has identified culturally relevant factors that may impact the strength of the IPV-substance misuse association in this population. The present study examined the moderating role of acculturation in the relation between IPV types (i.e., physical, psychological, and sexual) and substance (i.e., alcohol and drug) misuse. Participants were 150 IPV-exposed Hispanic women in the community ( M age = 35.13). IPV types, substance misuse outcomes, and acculturation were significantly and positively correlated with each other at zero-order. Moderation analyses indicated that the relations between IPV and substance misuse were stronger among Hispanic women with higher (vs. lower) levels of acculturation. These findings suggest the potential utility of considering acculturation when assessing and treating substance misuse among IPV-exposed Hispanic women.
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Substance abuse prevalence rates for Latinos/as generally mirror those of the general U.S. population; however, a number of indicators of assimilation to U.S. culture as well as sociodemographic variables predict substance use and abuse among this group. Latinos/as have poorer outcomes in substance abuse treatment programs. Yet there is little empirical evidence that explains the problems these individuals experience in treatment, and there are few studies on the use and effectiveness of mutual help groups among this population. New developments in the conceptualization and measurement of acculturation will lead to a greater understanding of the role of culture in the prevalence and treatment of substance-related problems.
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Research on Latinos receiving substance abuse care lacks detail in terms of client characteristics, treatment services, and the effectiveness of treatment. This study uses data from a large, recent, nationally representative sample of outpatient substance abuse treatment units to examine differences in client characteristics, treatment services, and outcomes. The study examines differences between units with 20% or more Latino clients and treatment units with 90% or more White clients. Results show that units with high concentrations of Latinos treat clients who are significantly poorer, more prone to abuse drugs than alcohol, more prone to turn to crime to support their habit, more likely to be ordered to treatment by the courts, and at a higher risk for HIV/AIDS; these clients have poorer treatment outcomes. Treatment and policy implications for units treating high concentrations of Latino clients and culturally sensitive substance abuse treatment are discussed.
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This article presents data on the profile and history of childhood abuse from a study of 66 Latinas enrolled in a residential substance abuse treatment program. Data were gathered through interviews conducted at program entry. A significant majority reported a childhood history of abuse (80%) and past year diagnosis of mental health problems (76%) and health (68%) problems. Compared to those with no reported history of childhood abuse, women with a history of abuse were more likely to be predominantly Spanish speakers (p = .01), report significantly higher levels of health problems (p = .01), have had children removed from their custody (p = .008), and drop out in the early stages of treatment (p = .01). These findings have important implications for the course of treatment, how history of abuse is handled in residential treatment, and support services needed by clients. The authors discuss challenges and approaches to providing needed services.
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Previous work has shown length of time in drug abuse treatment is associated with better outcomes, but the role of therapeutic engagement and process needs further examination. In this study, the total number of counseling sessions attended by 557 clients in their first 90 days of community-based outpatient treatment was examined in relation to indicators of treatment delivery and progress. Significant client improvements were found on behavioral criteria and psychosocial functioning during the first 3 months of treatment, and session attendance was positively related to favorable behavioral changes as well as to positive perceptions by clients and counselors of their therapeutic interactions. Client background, treatment motivation, and therapeutic focus of counseling in Month 1 were significant predictors of session attendance in the first 3 months following admission to methadone treatment.
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The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programming for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readiness and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.
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Data from the Hispanic Health and Nutrition Examination Survey were used to examine the influence of acculturation on alcohol consumption among Puerto Rican, Cuban-American, and Mexican-American women in the United States. Acculturation was found to be positively related to frequency of consumption and probability of being a drinker among all three groups. A positive relationship was also evident for total drinks consumed among Cuban-American women, and volume (drinks per occasion) and total drinks consumed among Mexican-American women.
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Ethnic differences in alcohol consumption patterns are often reported in general population surveys, but less is known about variation among ethnic groups presenting for treatment. Within a larger clinical trial, patterns of drinking, drug use and related problems were compared for Hispanic (n = 102) and non-Hispanic white (n = 104) male (n = 154) and female (n = 52) clients presenting at a public clinic for outpatient treatment of alcohol problems. Relatively few reliable ethnic differences were observed in alcohol /drug use patterns. Non-Hispanic white men reported significantly more pretreatment tobacco use than did Hispanic men (84.7% vs 61.3% of past 90 days). Hispanic women reported significantly fewer legal problems (28.6% vs 83.9%), symptoms of dependence and negative consequences of drinking relative to non-Hispanic white women. Measures of acculturation and acculturative stress failed to differentiate drinking patterns among Hispanic clients. Within a treatment-seeking sample, Hispanics and non-Hispanics may be more similar with regard to drinking practices than is the case in the general population. High consumption, adverse consequences and dependence symptoms were characteristic of men presenting for alcohol treatment regardless of ethnic identification. In contrast, Hispanic treatment-seeking women had the lowest consumption, adverse consequences and dependence symptoms of all the groups described, and they reported significantly fewer alcohol-related problems and symptoms than did non-Hispanic women.
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We examined the relation between acculturation and illicit drug use among Hispanics in the United States employing data from the 1982-84 Hispanic Health and Nutrition Evaluation Survey (HHANES). Across all Hispanic groups, acculturation into US society, as reflected in English language use, was associated with higher rates of illicit drug use even after sociodemographic variables such as gender, age, income, and education were considered. Significant interactions between language and education indicated that the predominant use of English was more strongly associated with marijuana and cocaine use among Mexican Americans and Puerto Ricans of lower educational attainment than among those of higher educational attainment. Significant interactions between language use and other factors such as sex, marital status, and place of birth were also associated with marijuana and cocaine use. These results suggest that the experience of acculturation, especially as it relates to drug use, is closely tied to the social and economic context in which an individual lives.
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Between 1981 and 1995, approximately 5 million people from either Mexico, Cuba, Central America, or South America immigrated to the United States. Some regional studies have suggested that as Hispanic immigrants become acculturated to American society, their risk of mental illness increases sharply. This study examined the lifetime risk of psychiatric and substance use disorders among U.S. Hispanic subgroups and the specific role of nativity, parental nativity, language preferences, and other sociodemographic characteristics as risk factors for these disorders. The study used the National Comorbidity Survey (NCS), a national probability sample of 8098 U.S. adults aged 15 to 54. Selected DSM-III-R psychiatric diagnoses were collapsed into eight categories. When compared with non-Hispanic whites, Mexican-Americans were less likely to have any psychiatric disorder. After multivariate adjustment, acculturation items predicted greater risk of having any DSM-III-R disorders for Mexican-Americans and "other" Hispanics and greater risk of having a substance abuse disorder for Puerto Ricans, among other significant relationships. The results suggest that there is likely to be an increasing prevalence of psychiatric and substance use disorders among Hispanics that may be attributable to increasing levels of acculturation among the more than 5 million recent immigrants from Latin America.
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Recent policy has focused on documenting and reducing ethnic disparities in availability and quality of health care. The authors examined differences by ethnic status in unmet need for alcoholism, drug abuse, and mental health treatment. Data were from a follow-up survey of adult respondents to a 1996-1997 national survey. Non-Hispanic whites, African Americans, and Hispanics were compared in access to alcoholism and drug abuse treatment and mental health care (primary or specialty), unmet need for care, satisfaction with care, and use of active treatment for alcoholism, drug abuse, and mental health problems in the prior 12 months. A total of 31.9% of whites, 28.1% of African Americans, and 30.1% of Hispanics had some alcoholism, drug abuse, and mental health care, mostly in primary care. Among those with perceived need, compared to whites, African Americans were more likely to have no access to alcoholism, drug abuse, or mental health care (25.4% versus 12.5%), and Hispanics were more likely to have less care than needed or delayed care (22.7% versus 10.7%). Among those with need, whites were more likely than Hispanics or African Americans to be receiving active alcoholism, drug abuse, or mental health treatment (37.6% versus 22.4%-25.0%). The authors document greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites. New policies are needed to improve access to and quality of alcoholism, drug abuse, and mental health treatment across diverse populations.
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This article examines a doubly oppressed group: mainland Puerto Rican women. Sociocultural and gender?related problems are analyzed within the context of cultural change. The crucial role played by the Puerto Rican woman in the transculturation of the mainland diaspora is pinpointed. Community paradigms relevant to psychological interventions with this group are discussed, and guidelines are suggested to the community psychologist working with Puerto Rican women.
Although drinking by black and Hispanic women in the United States differs from that of white women in terms of prevalence rates and incidence of alcohol-related problems, factors such as age and employment status have similar effects on drinking in each group. However, influences on drinking among minority women are complex and must be thought of as an interaction of cultural, personal, and historical factors. This interplay is beginning to emerge from ethnic studies.
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The purpose of this paper is to examine differences in patterns and consequences of narcotics use among Hispanic and white addicts over time. Data were gathered from admission records and from interviews conducted in 1974-75 and 1985-86 from 323 Hispanic and 212 white narcotics addicts admitted to the California Civil Addict Program in 1962 to 1964. Analyses compared the two groups on narcotics use, incarceration, mortality, and other characteristics at each follow-up point and in terms of drug-use status. Compared with white addicts, Hispanic addicts showed a progression of more persistent and severe narcotics addiction. At each interview point, Hispanics were more likely than whites to be using opiates or to be incarcerated. Comparisons of opiate use at the two interview points showed that Hispanics were less likely than whites to remain abstinent and were more likely to relapse to opiate use. Overall, Hispanics also had greater involvement in the criminal justice system, higher rates of cocaine use, and a higher proportion of deaths due to violence and accidents.
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In this study socioeconomic status and demographic differences in reported alcohol and drug use among Black, Hispanic, and White respondents to the 1988 National Household Survey on Drug Abuse (T. Virag, B. Cox, & J. V. Rachel, 1991) were examined. White respondents reported significantly higher levels of alcohol and drug use than Blacks and Hispanics did. Separate regression analyses of alcohol and drug use by race revealed that education, income, and employment status were significant determinants of alcohol use. Employment status and marital status significantly influenced drug use among all respondents.
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The Latina substance abusermay find her journey to treatment filled with potholes and blind alleys. This paper describes how gender and culture shape her experiences. We analyzed data from six focus groups and interviews with 37 women in a therapeutic community, focusing on the process through which they sought assistance. Themes that emerged from our qualitative analysis suggest both gender and culture shaped our Latina substance abusers' experiences in ways that isolated them and made it harder for them to recognize their drug abuse as problematic. Gender and culture created structural barriers which limited their awareness of available treatment and of treatment being a viable option. Finally, both culture and gender created structural barriers to negotiating the logistics of entering treatment. We also offer some modest suggestions for informal and formal referral sources which might facilitate this process.
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This article will provide a summary of existing information related to the evaluation of alcohol and other drug (AODA) treatment and prevention programs for Hispanics/Latinos. In addition, the authors provide an overview of recent survey data which examined actual evaluation practices in a national sample of federally funded substance abuse prevention projects targeting Hispanic/ Latino high risk youth and families.
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This analysis of the National Household Survey on Drug Abuse (NHSDA) focuses on correlates of substance use among Hispanic groups. Using 1994-B and 1996 NHSDA surveys (U.S. Department of Health and Human Services [USDHHS], 1996, 1998), these analyses use sampling areas to control for intracluster correlation and its subsequent effect on empirical conclusions. Models are specified for alcohol, cigarettes, marijuana, cocaine, and any illicit drug, controlling for national origin, gender, age, socioeconomic status, language, and family structure. Results indicate that models failing to account for intracluster correlation may lead to erroneous ethnic contrasts of substance use. Also, substance use varies widely by national origin—and Hispanic men and women have highly divergent patterns of use, more so than non-Hispanic White men and women. Finally, controlling for neighborhood does not wholly diminish ethnic contrasts in substance use.
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The prevalence ofpast-yearand lifetime substance use, problem indicators, and the most important reasons for abstaining (among nonusers) were compared between Texas Hispanics and non-Hispanics, as well as among three subgroups of Hispanics who represented different levels of acculturation: Mexican born (i.e., least acculturated), U.S. born but relatively unacculturated, and U.S. born/highly acculturated. In general, prevalence rates among Hispanics increased as a function of U.S. acculturation, with the most acculturated group's rates more closely resembling non-Hispanics than Mexicanborn Hispanics. There were also significant variations by level of acculturation in the reasons given for abstinence. Whereas health was the most commonly cited reason for abstinence regardless of ethnicity, other important reasons (e.g., moral reasons versus influence of family and friends) varied significantly by ethnicity and acculturation. Results are interpreted with special regard to prevention.
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Literature on gender differences among those entering substance abuse treatment is limited. Using data from intake interviews in a large multisite prospective clinical epidemiological study, this study provides the opportunity to explore gender differences with implications for treatment response. Comparisons are made not only between women and men but also between four different treatment modalities.Traditional gender differences were found with regard to age, education and employment. Although some drug use patterns were similar, men reported more alcohol use while women reported more daily use of cocaine. Women reported more problems related to health and mental health. In addition, women reported much greater proportions of past and current physical and sexual abuse. Women also reported greater concerns about issues related to children, although both women and men reported concern about drug treatment affecting custody of children.
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Analyzes the sociocultural and gender-related problems of mainland Puerto Rican women within the context of cultural change. The crucial role played by the Puerto Rican woman in the transculturation of the mainland diaspora is pinpointed. It is noted that in the face of male dominance, Puerto Rican women are often expected to fulfill conflicting passive and assertive roles. Community paradigms relevant to psychological interventions with this group are discussed, and guidelines are suggested to the community psychologist working with Puerto Rican women. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Discusses the role of ethnocultural factors in understanding and treating substance abuse disorders. Research and theory suggest that acculturation experiences, sources of stress, coping mechanisms, social support variations, and beliefs about substance use are key factors associated with differential patterns of substance abuse among some ethnic groups, particularly African Americans, Hispanics, and Native Americans. In recent years, models of substance abuse intervention specifically targeting these ethnic groups have been developed. The author examines the movement toward culturally sensitive psychosocial treatment models. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Estimated associations of subjective reasons for drinking with heavy drinking (HD), frequent drinking (FD), and alcohol abuse or dependence (AAOD). Respondents were 725 Mexican-American and 915 non-Hispanic White community residents who reported drinking at least once in the 6 mo before being interviewed. Each reason for drinking and number of reasons given for drinking were associated with HD, FD, or AAOD. However, multivariate models suggested that different reasons may be associated with different types of alcohol involvement. Cultural differences in alcohol involvement were typically not accounted for by cultural differences in reasons for drinking. Drinking to cheer up or to loosen up around people and drinking to induce sleep had different associations with HD and AAOD in different cultural groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This chapter attempts to describe and understand how various experiences of ethnicity may relate to the use and abuse of illicit drugs and to factors that influence cessation, treatment efficacy, and relapse. Topics addressed in the chapter include the minority experience: some common issues; epidemiological data on ethnic/racial minorities and substance abuse; cultural competence in drug abuse treatment; multicultural perspectives (common sociocultural features across ethnic/racial groups, unique sociocultural features of African Americans, Latinos/Hispanics, Asian-Americans, Native American Indians); practical considerations in treatment and service delivery (client–provider relationships, assessment, treatment, relapse prevention, agency operations). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The objective of this study was to report trends in alcohol problems among whites, blacks, and Hispanics between 1984 and 1995. Data were obtained from two nationwide probability samples of U.S. households, the first conducted in 1984 and the second in 1995. The 1984 sample consisted of 1777 whites, 1947 blacks, and 1453 Hispanics. The 1995 sample included 1636 whites, 1582 blacks, and 1585 Hispanics. On both occasions, interviews (average length, 1 hr) were conducted in respondents' homes by trained interviewers. The results indicate that between 1984 and 1995, alcohol problems were stable among white and black men and increased among Hispanic men. The rates of three or more alcohol problems for men of each ethnic group for 1984 and 1995 were: 12% and 11% for white men, 16% and 13% for black men, and 9% and 16% for Hispanic men, respectively. Problem prevalence was stable and relatively low among women in all three ethnic groups. Overall, the prevalence of alcohol problems continues to be high among men in the United States. Even though recent research has shown that rates of frequent heavy drinking among white men have declined, we found no corresponding decrease in problem prevalence. Rates of frequent heavy drinking and alcohol-related problems between 1984 and 1995 have remained especially high among black and Hispanic men, suggesting that men of these two ethnic groups should be specifically targeted for renewed prevention efforts.
Article
Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.
Article
The Addiction Severity Index (ASI) is 12 years old and has been revised to include a new section on family history of alcohol, drug, and psychiatric problems. New items were added in existing sections to assess route of drug administration; additional illegal activities; emotional, physical, and sexual abuse; quality of the recovery environment; and history of close personal relationships. No changes were made in the composite scoring to maintain comparability with previous editions. This article discusses the clinical and research uses of the ASI over the past 12 years, emphasizing some special circumstances that affect its administration. The article then describes the rationale for and description of the changes made in the ASI. The final section provides "normative data" on the composite scores and severity ratings for samples of opiate, alcohol, and cocaine abusers as well as drug abusing inmates, pregnant women, homeless men, and psychiatrically ill substance abusers.
Article
Surveys have generally shown that Hispanics in the United States have lower than the national average rates of drinking, along with average rates of heavy drinking and drug use. Acculturation has been shown to be related to drinking and drug use. This study reports results from a large general population telephone survey conducted in New York State. Hispanic New York State residents were lower than the national average in drinking and heavy drinking when demographic variables were held constant. Gender differences in substance use were greater for Hispanics than for non-Hispanics, with males higher than females. Among Hispanic groups, Puerto Ricans were high and Dominicans were low in drug use. Among Hispanics, more frequent use of English was associated with higher drinking and drug use rates. Traditional Hispanic attitudes and closeness to country or origin were not related to substance use.
Article
Epidemiologic data from three national surveys conducted in 1988, 1990, and 1991 were used to investigate the association between acculturation and use of crack cocaine among Hispanic Americans living in the United States. Poststratification and conditional logistic regression were used to hold constant shared aspects of neighborhood environment, age, sex, and education. The analyses showed a strong inverse relationship between degree of acculturation and crack smoking among Mexican Americans (relative odds = 0.12, 95% confidence interval = 0.04, 0.34) but not among other Hispanics in the study population. This observed variation within the US Hispanic American population deserves special attention in future research.
Article
Advances in alcohol and ethnicity epidemiology during the past decade include greater emphasis on intraethnic variation, factors influencing drinking behavior, and building conceptual models. Despite progress, most research continues to focus on ethnicity/race as a demographic variable and few studies investigate ethnic hypotheses. Although prevention and treatment of alcoholic disorders in ethnic groups have been dealt with extensively in the clinical and ethnographic literature, little rigorous research has been conducted. The key issue in this area involves the extent to which prevention and treatment programming needs to be ethnically responsive in order to be effective. The very little empirical literature that exists on this topic suggests that answers will not be simple and will vary according to aspects of acculturation status and ethnohistorical factors. The most important development during the past 10 years has undoubtedly been the federal regulatory encouragement of research on the major ethnic groups of the United States.
Article
The dropout rates among cocaine abusers in outpatient treatment programs have averaged 55%. We sought to find patient predictor variables associated with early attrition. Dropouts were more likely to be African-American or Hispanic-American, younger, with an earlier onset of substance abuse. Among minorities, those with more education were less likely to drop out. Patients who were less educated and smoked or injected cocaine were particularly prone to discontinue treatment prematurely. The implications of these findings, and promising interventions for reducing the dropout problem, are discussed.
Article
This article describes gender differences in alcohol and other drug (AOD) use and misuse in a representative sample of young women and men in the United States. Data were drawn from the National Longitudinal Survey of Youth (NLSY) and focus on gender differences in prevalence and patterns of AOD use in African American, Hispanic, and White young adults ages 19 to 24 years old. Findings are summarized and implications for prevention are presented.
Article
We examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (N = 269) and women (N = 294). Data were obtained from a 1991/1992 general population survey on alcohol that included questions on sexual behavior. Guided by a conceptual/theoretical framework, we focused on gender and acculturation differences as we examined the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior. Logistic regression analyses were performed separately for men and women to evaluate the predictive strength of acculturation, demographic factors, and alcohol consumption on risky sexual behavior. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. The data indicate the need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.
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Dietary intake and substance abuse are important predictors of pregnancy outcome yet little is known about these behaviors in Mexican Americans. Dietary, tobacco, and alcohol intake of Mexican-American and non-Hispanic white women were compared across the reproductive cycle. Four cross-sectional groups--interconceptional, pregnant, lactating, and postpartum non-lactating--were compared within and between ethnic groups. A stratified sample of 682 women, 16 to 44 years old, of Mexican birth or origin from the Hispanic HANES was contrasted with a similarly stratified sample of 1,396 white non-Hispanic women from the NHANES: Demographic, behavioral and health characteristics, food practices, and fluid intake were examined. Data on food servings were combined into five major food groups. Compared with white non-Hispanics, Mexican-American women had lower socioeconomic status and worse perceived health. However, Mexican Americans reported lower consumption of tobacco, alcohol, diet soda, and caffeine, particularly during pregnancy and lactation. Although portion sizes for the foods consumed were not assessed, frequency of consumption of fruits and vegetables and milk was lower and meat higher among Mexican Americans. Despite socioeconomic disadvantages, Mexican-American women have better health habits than white non-Hispanic women. From these data it is unclear how diet affects pregnancy outcomes in Mexican Americans.
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This study investigated whether the use of the Addiction Severity Index (ASI) in a network of inner-city alcohol and drug abuse clinics under nonideal conditions would yield internally consistent and valid data. A sample of 8,984 ASI scores was collected over a 34-month period. Construct validity was examined by computing the internal consistency of all subscales. Convergent and divergent validity of composite scores and of severity ratings were evaluated using correlation matrices. Findings demonstrated that ASI scores were internally consistent and valid, even though the recommended administration protocol may not always have been followed as faithfully as might be desirable. This robustness bodes well for the use of the ASI in on-line clinical environments. Results should be viewed with caution until the reliability of ASI administration is tested under similar nonideal conditions and until permissible deviations from standard protocol can be quantified.
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This study examines and compares the drinking patterns and problems of members of four Hispanic groups (Cubans, Mexican Americans, Puerto Ricans and other Hispanics) in the United States, with information presented by gender and age. The 1993 National Household Survey on Drug Abuse, a recent national probability sample of the household population aged 18 and over in the United States, is used. Data are obtained through in-person interviews. The sample includes 4,462 Hispanics of Cuban (n = 620), Mexican (n = 2,467), Puerto Rican (n = 619) and Central and South American (n = 756) origin. Analyses are conducted using SUDAAN. There are significant differences across the Hispanic groups in their drinking patterns and problems. Among men, Mexican Americans report the most frequent and heavy drinking, and the greatest prevalence of drunkenness and alcohol-related problems. Cubans report the lowest percentages of such respondents, and Puerto Ricans and other Hispanics are in between the other two groups. For women, fewer ethnic differences are evidenced than for men. In general, Puerto Ricans and Mexican Americans drink more often and heavily and experience more problems than the other groups. Even after controlling for predictors of adult alcohol use, some ethnic differences in drinking persist. The four Hispanic groups have different drinking patterns. More research is necessary to determine the factors associated with differences in drinking across Hispanic groups.