Many things factors into why some people struggle with substance abuse. Things like biology and genetics can play a role, as addiction is a heritable disease, and environmental aspects can also be significant. Culture, religion, race, social circles, socioeconomic status, and home environment can all be involved in the way a person thinks, acts, and feels. Race and culture can also be involved in how a person treats alcohol and drug abuse, and how individuals seek necessary addiction treatment, if they do at all.
Specialized programs are often most beneficial when they cater to specific demographics, be it gender, race, or both. These focused programs can relate to people on a different level while being understanding and empathetic of individuals’ cultural backgrounds.
The United States Census Bureau publishes that around one-third of the American population is comprised of an ethnic minority, with Hispanic, African American, and Asian making up the largest groups (other than Caucasian). The National Survey on Drug Use and Health (NSDUH) for 2013 publishes the following statistics on race demographics and addiction rates for adults within the United States:
- American Indian and Alaska Native: 14.9%
- Native Hawaiian and Other Pacific Islander: 11.3%
- Hispanic: 8.6%
- Caucasian: 8.4%
- African American: 7.4%
- Asian: 4.6%
In general, the 2016 NSDUH reports that the average past-year rate of addiction for Americans aged 12 and older was 5.6%. Ethnic minorities may face higher rates of addiction than national averages suggest due to poor living conditions; limited access to specialized care; and elevated social, economic, emotional, and environmental risk factors.
Hispanic or Latino
As one of the largest and fastest growing ethnic minorities in the United States, the Hispanic population continues to expand. In general, this population tends to have alcohol and addiction rates that are similar to national averages. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 24.7% of Hispanic individuals reported past-month binge alcohol drinking at the time of the 2014 NSDUH while national averages were 23%. Binge drinking is considered a potentially risky pattern of consuming alcohol that can lead to a wide range of possible hazards and issues, including increasing the odds for suffering from addiction.
While alcohol consumption and addiction rates for Hispanic individuals may be similar to those of the general population, the Journal of Ethnicity in Substance Abuse reports that this race demographic is less likely to perceive a need for treatment and seek treatment services than the general public. Some of this may be due to cultural norms, such as the propensity to turn to family for help instead of outsiders. There can also be a language barrier or lack of access to nearby treatment services. A large percentage of the Hispanic population does not have health insurance coverage, as the Centers for Disease Control and Prevention (CDC) publishes that more than 20 percent of Hispanics under the age of 65 are without health insurance coverage. Lack of health insurance can be an additional barrier to addiction treatment, as can poverty and financial strain, which can also contribute to higher rates of substance abuse.
The NSDUH Report publishes that for data collected between 2003 and 2011, Hispanic adults aged 12 and older were more likely to have needed, and not received, specialty substance abuse treatment than their non-Hispanic peers. Nearly 10% of Hispanic adults needed substance abuse treatment compared to closer to 9% of the general population. Only 9% of Hispanic adults needing treatment received it, as opposed to 10.5% of the general public.
Treatment services for the Hispanic and Latino population should be culturally sensitive, and include language translation when needed. Families should be included in treatment and recovery, as large families are often part of a person's home environment and daily social circle. Addiction treatment programs may be optimal when they are gender-specific and cater specifically to the Hispanic population. Admissions coordinators can help families navigate the process of using their insurance if they have it, or learn how to utilize public and community programs.
The African American population group is at a higher risk for behavioral health issues than many other race demographics due many social and economic factors. The American Psychological Association (APA) reports that nearly one-quarter, 22%, of the African American population lives in poverty, with many who are incarcerated, homeless, victims of violent crime, or have (or are) children in the foster care or child welfare system. All of these factors can limit a person's access to behavioral health care services, which includes addiction and mental health treatment programs.
This being said, the NSDUH Report publishes that between 2003 and 2011, African Americans needed treatment for alcohol abuse or addiction less than that other ethnic or racial groups: 6.8% versus 7.8%, respectively. African Americans were more likely to need treatment for illicit drug abuse and addiction, however. APA publishes that African American individuals are more likely to abuse more than one drug at a time (polydrug abuse) than other racial demographics. While they may abuse alcohol less frequently than other racial groups, they have an elevated risk for more significant drinking-related issues.
The CDC publishes that 13.6% of black non-Hispanics report themselves as being in fair or poor health – a significantly high number. SAMHSA publishes that African Americans may suffer from a slightly higher rate of co-occurring mental illness and addiction than the general public: 3.8% compared to 3.3%, respectively. Co-occurring mental health and substance use disorders require specialized integrated care programs that can manage both disorders at the same time.
African Americans suffer from higher rates of HIV infection and higher fatality rates due to major diseases than Caucasians, and therefore special medical considerations may need to be taken into account during an addiction treatment program.
Addiction treatment considerations for the African American population will need to be culturally sensitive; address maladaptive thoughts and behaviors; teach stress management techniques; and focus on co-occurring mental health and medical issues. The NAACP reports that African Americans make up a significant proportion of the prison and jail population, often due to drug-related arrests, economic isolation, and inner-city crime. African Americans receiving addiction treatment may come from referrals related to criminal justice proceedings, and these programs will need to work with drug courts to ensure compliance. Whether court-ordered or voluntary, addiction treatment can help individuals find the motivation to make positive life changes to sustain long-term recovery.
Asian American, Native Hawaiian, and Other Pacific Islander
The Asian American, Native Hawaiian, and Other Pacific Islanders (AANHPI) demographic is the fastest growing ethnic minority group in the United States, SAMHSA publishes. This is a very diverse racial group that includes minorities with heritages from over 50 different cultures.
The Asian population group is often thought of as "model" minority, as its members are often successful, well-educated, and seemingly healthy. Asian Americans tend to abuse substances and struggle with alcohol- and drug-related issues at very low rates, much lower than the national averages. SAMHSA publishes that only 4.5% struggled with addiction at the time of the 2014 NSDUH. American-born Asian Americans are much more prone to addiction and issues with alcohol and drug abuse than those who are foreign born, however.
Native Hawaiians and Other Pacific Islanders are often lumped into the same general racial demographic with other Asian Americans; however, this racial demographic tends to suffer from addiction and substance abuse at higher rates than the general public. SAMHSA reports an addiction rate of 10% for Native Hawaiians and Other Pacific Islanders at the time of the 2014 NSDUH.
In Asian cultures, individuals tend to be private and may face cultural barriers to behavioral health treatment. Addiction and substance abuse may be seen as a weakness, and something to be kept behind closed doors and not admitted to anyone outside the family. APA reports that AANPIs are more likely to turn to their personal social, religious, or family networks before seeking professional help for mental health or substance abuse concerns.
A lack of access and education about treatment services as well as potential language barriers can be additional reasons that this particular race demographic does not seek help when needed. Behavioral health concerns often manifest as physical symptoms in this group of people, and trained professionals will need to be able to recognize that headaches, stomach upset, and sleep difficulties may be signs of a behavioral health issue.
Treatment programs that are culturally sensitive, and work with personal family, religious, and cultural networks, can be highly beneficial for the AANPI population. The AANPI demographic may also prefer a treatment modality that focuses on achieving full emotional, physical, and spiritual balance, using both traditional and holistic measures to attain and sustain recovery.
American Indian and Alaska Native
American Indians and Alaska Natives (AI/AN) tend to abuse substances more than other racial demographics, and also suffer from more mental health concerns than the general American population. The CDC publishes that the highest percentage of people reporting fair or poor health were of the AI/AN race demographic. In 2015, over 16% of the AI/AN population in the United States thought they were in poor or just fair health compared to a national average of less than 10%.
SAMHSA reports that the rate of mental illness and the suicide rate for American Indians and Alaska Natives are much higher than national averages. The suicide rate is 2.5 times the national average for AI/AN adolescents and young adults between the ages of 15 and 34. Rates of co-occurring mental health disorders and addiction are high as well: 8.8% for AI/AN adults in the year leading up to the 2014 NSDUH compared to a national average of 3.3%. The AI/AN population has higher rates of addiction involving alcohol, marijuana, hallucinogens, and cocaine than other racial demographics as well, the Journal of Addictive Disorders publishes. Alcohol-related problems are also significant for the AI/AN population; they have a higher-than-average rate of association between suicide and alcohol use as well as an elevated history of sexual abuse, violence, and exposure to trauma.
The NSDUH Report indicates that AI/AN individuals are almost more than twice as likely than other racial demographics to need treatment for a drug and/or alcohol addiction problem: 17.5% versus 9.3% based on data obtained between 2003 and 2011. This group is also more likely to seek help for addiction and substance abuse concerns, however, and more willing to admit that they would benefit from a treatment program.
Over three-quarters of AI/AN individuals admitted into a specialized treatment program in 2012 reported alcohol abuse, compared to only around half of non-AI/AN individuals, SAMHSA publishes. Of those citing alcohol as their primary substance of abuse, more than 80% admitted to starting drinking before the age of 17 versus 72.8% of non-AI/AN individuals.
Drinking at a young age, exposure to trauma, suicidal behaviors, and co-occurring mental health disorders all can exacerbate alcohol-related issues and complicate treatment methods. A specialized, comprehensive, and integrated treatment program that can attend to these specific needs, and be cognizant of cultural and racial sensitivities, is optimal for recovery. American Indians and Native Alaskans may benefit highly from a structured residential treatment program that can attend to all behavioral health concerns in order to enhance recovery.
Caucasians have a higher rate of current alcohol use (at the time of the 2013 NSDUH) than any other race demographic, with 57.7% of individuals aged 12 and older reporting past-month alcohol consumption. White teenagers between the ages of 12 and 17 drink alcohol more often than other ethnic groups; the 2013 NSDUH reports that 12.9% drank alcohol. Almost one-quarter of the white population reports past-month binge drinking, and about 7% admit to heavy drinking in the past 30 days.
Caucasian males typically outnumber females when it comes to drinking and alcohol-related problems; however, in recent years, the rate of women drinkers has increased. Drinking has become more socially acceptable for women over the years, and the Washington Post reports that almost three-quarters of white women admit to drinking alcohol more often than women of other races. SAMHSA reports that women tend to have more behavioral health issues, which can exacerbate and contribute to more alcohol-related issues.
Caucasian males have a high risk for alcohol abuse and problems related to alcohol consumption, West Virginia University (WVU) publishes. Caucasians may have a family history of alcoholism as well as certain biological or genetic factors that make them potentially more vulnerable to suffer from alcohol abuse and addiction.
This racial demographic is considered a majority population, and addiction treatment is generally accessible and sensitive to the needs of Caucasians. Treatment services that cater to specific demographics within the Caucasian race can be helpful, however, such as those that are age- or gender specific. White women tend to have more medical and mental health concerns that may be related to alcohol abuse, and specialized treatment programs that address co-occurring disorders can be highly beneficial for this group.