Individuals of Hispanic origin represent the largest minority group in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the rate of abstinence from alcohol in Hispanic females is higher than the rate of abstinence from alcohol in Hispanic men. In addition, Hispanic females who report that they drink alcohol consume significantly less than Hispanic men do. For instance, in one survey SAMHSA reports the following:
- Among Hispanic women, 12% reported frequent use of alcohol.
- Among Hispanic men, 33% reported frequent use of alcohol.
- Among Hispanic women, 57% reported abstinence from alcohol.
- Among Hispanic men, 35% reported abstinence from alcohol.
Research indicates that many Hispanic individuals maintain the cultural norms associated with their particular area of origin regarding their use of alcohol (e.g., Mexican, Cuban, etc.). Differences between Hispanic individuals from particular areas regarding use of alcohol or other substances is primarily dependent on their country of origin, their age, and the level of acculturation they have attained with regard to accepting mainstream American norms and values. This complicates overall findings when researchers and organizations attempt to report statistics associated with alcohol use and abuse in individuals of Hispanic origin. However, many of the sources that do generalize report that alcohol use and abuse is higher in the Hispanic community than it is in other groups, such as Caucasians, Asians, and individuals of Middle Eastern background.
According to 2003-2011 data from the National Survey on Drug Use and Health published by SAMHSA, the following was true for individuals over the age of 12:
- It was estimated that 9.9% of Hispanic individuals needed treatment, whereas 9.2% of non-Hispanic needed treatment for any substance use disorder.
- Approximately 9% of Hispanic individuals receive treatment for a substance use disorder, whereas approximately 10.5% of non-Hispanic individuals received treatment.
- Approximately 3.6% of Hispanic individuals felt they needed treatment for substance abuse and did not receive treatment, whereas approximately 3.5% of non-Hispanic individuals felt they needed treatment and did not receive it.
- Approximately 2% of Hispanic individuals felt the need for treatment for substance abuse and sought treatment, whereas approximately 1.7% of non-Hispanic individuals felt that they needed treatment and sought treatment.
Self-reported past-month use of alcohol in Hispanic adolescents (15.8%) was generally consistent with the national average of past-month alcohol use for individuals between the ages of 12 and 17 (16%).
Thus, the data indicates that there are only slight differences in the percentages of individuals of Hispanic origin and non-Hispanic origin who need treatment for substance use disorders, get treatment for substance use disorders, and do not get treatment for substance use disorders. These differences would most likely not approach statistical significance (except perhaps for the overall percentages of individuals who received treatment for any substance use disorder). However, the issue of substance abuse, particularly abuse of alcohol, in individuals of Hispanic origin living in the United States is very complicated, is most likely not fully addressed, and deserves special considerations.
Special Areas of Concern
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has identified areas of concern that apply to Hispanic individuals and that can complicate both the collection of data regarding alcohol abuse and use prevalence, identifying alcohol use disorders in individuals, and treating alcohol use disorders in these individuals. Some of these areas of concern include:
- Cultural barriers, language barriers, and other barriers to communication
- Issues with discrimination and even perceived discrimination
- Fears of being singled out or persecuted
- The level of acculturation achieved by the particular individual
- Barriers to access to medical care
- Cultural views of treatment for addiction
- Family responsibilities that may result in some individuals not seeking treatment
- Stigma or shame associated with being diagnosed with an addiction or alcohol use disorder or being in treatment for one
- Obvious issues with undocumented immigrants, such as the fear of deportation, fears of persecution, lack of resources, etc.
For example, research has produced findings that indicate that Hispanic immigrants who rejected major American values and norms in favor of retaining their own cultural values were over 10 times less likely to report using high amounts of alcohol or other drugs, whereas Hispanic immigrants who chose to adopt the American lifestyle were more likely to report the abuse of alcohol and/or other drugs. Moreover, research, such as information presented in a research article in the Journal of Health and Social Behavior, has indicated that as a group, Hispanics in the United States are at a greater risk for developing issues with addictive behaviors than these individuals are in their home countries.
NIAAA also puts forth research that suggests that Hispanics who develop alcohol use disorders may have more chronic and recurring problems associated with their addictive behavior (33% in one report) than non-Hispanics (22.8% in the same report).
- Hispanics may have higher rates of complete abstinence from alcohol than other groups, but those Hispanics who do drink may consume alcohol in greater quantities and more often, especially in the form of binge drinking.
- Hispanics have an increased risk of developing alcohol-related liver disease.
- As a group, individuals of Hispanic origin are overrepresented in DUI-related fatalities.
- Individuals of Hispanic origin face significant barriers to getting treatment compared to individuals from other ethnic backgrounds.
Special Treatment Concerns
Cultural barriers that impede treatment for an alcohol use disorder in the Hispanic community should be addressed on both a macro (overall) level and micro (individual) level. Based on information provided in the book Ethnic and Multicultural Drug Abuse: Perspectives on Current Research, these concerns should include:
- The use of Spanish-speaking physicians, counselors, and addiction specialists
- Implementation of payment assistance programs to help low-income individuals get the treatment they need
- Consideration of the specific cultural and societal aspects of the Hispanic demographic to make these clients more comfortable in treatment and more likely to complete it
- The provision of educational and vocational services in the formal treatment program to learn skills that will help them become more self-sufficient and less likely to use alcohol or other drugs
The diagnostic criteria for an alcohol use disorder as presented by the American Psychiatric Association (APA) is used to identify an alcohol use disorder in a person of Hispanic origin, just as it is with any individual; however, trained clinicians always should consider cultural factors and how these can contribute to an individual’s presentation when making any type of diagnosis. The overall treatment program for an alcohol use disorder as specified by the National Institute on Drug Abuse (NIDA) and the American Society of Addiction Medicine (ASAM) would not vary substantially. According to a joint effort produced by SAMHSA and the Centers for Substance Abuse Treatment, it should include some specific considerations.
- The first step in the process is an overall evaluation of the individual. During this process, the clinician determines the need for treatment based on the severity of the alcohol use disorder and the presence of any other issues, such as a co-occurring mental health issue or specific conditions that can affect treatment.
- Considerations of an individual’s obligations to their family, career, education, etc., should also be made when creating an overall treatment plan.
- Clients in recovery need to be sober before they begin the hard work of recovery. For individuals with alcohol use disorders, this often requires placement in a physician-assisted withdrawal management program. Most often, for moderate to severe alcohol use disorders, this requires inpatient admission. The particular facility should include Spanish-speaking treatment providers and have clients in the program who are also of Hispanic origin, so clients can relate to others in the program and benefit from treatment.
- The use of medications and the need for medication adherence should be explained very specifically to all individuals.
- Substance use disorder therapy is the main component of any recovery program. Because individuals of Hispanic origin are often very family-oriented, it is suggested that family therapy and involvement should be an integral component of behavioral therapies, medically assisted treatments, and other interventions.
- The use of social support groups, such as Alcoholics Anonymous (AA), is strongly suggested. Data from SAMHSA suggests that even though there are many Spanish-speaking AA groups, many Hispanic individuals in recovery from alcohol use disorders do not attend them.
- The stigma regarding being labeled as an “alcoholic” should be addressed in treatment, and individuals should understand that addiction is not a form of weakness.
- Long-term aftercare programs should include activities that are consistent with a person’s cultural values, that offer religious and spiritual components to recovery, and that aid adjustment back to life in the outside world in order to prevent relapse.
The outcome for treatment for an alcohol use disorder should not vary substantially according to an individual’s ethnic background when all of these considerations are taken into account. Moreover, NIDA specifically states that successful treatment for any substance use disorder follows an overall blueprint that has been shown to be effective by research studies, but that has the flexibility to be personalized for the specific needs of the individual. This will include consideration of cultural issues.