hispanic and substance abuse

Immigrants, particularly those of Hispanic descent, occupy a central place in public and political conversation today. In the United States, the Hispanic community encompasses a rich and diverse blend of ethnicities and cultures from Mexico, Central America, Puerto Rico, Cuba, and other Spanish-speaking regions of the world. Together, these ethnic groups have made significant contributions to the culture and economy of the US.

There is an often overlooked concern that threatens Hispanic lives in this country, and that is the problem of alcohol and drug abuse. As the Latino population in America grows by leaps and bounds, addiction rates in this community are also increasing.

Hispanics in America

In July 2013, the Centers for Disease Control and Prevention estimated that the United States was home to around 54 million people of Hispanic descent. Accounting for 17 percent of the country’s population, Latinos are the largest ethnic minority in America. In fact, the U.S. Census Bureau projects that Hispanics will make up 28.6 percent of the overall American population by the year 2060.[1] This increase in growth makes it even more imperative to provide recovery services and treatment programs that appeal to Hispanic individuals with substance use disorders.

People from Mexico have represented the largest non-native population in the United States since 1980, accounting for 28 percent of the 41 million foreign-born individuals in the country in 2013.[2] However, the American public may not be aware that members of the Hispanic community come from over 20 different Spanish-speaking nations across the globe.[3] According to 2011 figures from the Pew Research Center, the largest 10 Latino groups in the US include:

hispanic population
  • 1. Mexican: 64.6 percent of US Hispanics (33,539 people)
  • 2. Puerto Rican: 9.5 percent (4,916 people)
  • 3. Salvadoran: 3.8 percent (1,952 people)
  • 4. Cuban: 3.6 percent (1,889 people)
  • 5. Dominican: 2.9 percent (1,528 people)
  • 6. Guatemalan: 2.3 percent (1,216 people)
  • 7. Colombian: 1.9 percent (989 people)
  • 8. Spaniard: 1.4 percent (707 people)
  • 9. Honduran: 1.4 percent (702 people)
  • 10. Ecuadorian: 1.2 percent (645 people)[4]

Latino groups from South America are growing more rapidly in the United States. Recent data indicates that Salvadorans may soon outrank Cubans as the third largest Hispanic-origin group in the US.[5] Population growth among people from El Salvador has outranked growth among Cubans since 2007, and the Dominican population is also increasing.[6]

Other Spanish-speaking countries represented in the US population include Argentina, Nicaragua, Venezuela, Peru, and many more. This diversity makes it challenging to generalize about the reasons for substance abuse and the most effective methods for treating addiction in the Hispanic community. However, common threads can be identified in the lives of Latinos that may contribute to the risk of drug or alcohol abuse.

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Immigration and Risk Factors for Addiction

immigration and risks

Notwithstanding the meteoric rise of the Hispanic population, as well as the representation Hispanics receive in government and public life, their status as immigrants (both legal and illegal) and their minority ethnic demographic position present a combination of factors that contribute to powerful and life-changing sources of stress.

The Counseling Psychiatrist warns that Hispanics who emigrate to the United States can face triggers of anxiety and depression that can last for their entire lives.[7] The Anxiety and Depression Association of America explains that substance abuse, trauma, and stress disorders often coincide.[8]

Immigration itself can be a traumatic, multilayered experience that can have a lifelong negative impact on a person. Individual have to leave their homes and cultures, sometimes by force, endure a long (and/or expensive or dangerous) journey to their port of destination, be evaluated for entry upon arrival, and settle down in a foreign land where the language, customs, and culture are very different. Certain ethnic groups encounter racism and discrimination from the locals, adding to the stress they can face. The Anxiety and Depression Association of America lists some other challenges that immigrants may have to endure, challenges that create the potential for substance abuse:

  • Religious or ethnic persecution
  • Lack of job opportunities or travel freedom because of an immigrant’s legal status
  • Lack of legal protection because they are not citizens of the country
  • Fear of deportation
  • Difficulty (or inability) to see friends and family in their home country
  • Trauma in the case of involuntary emigration (as a result of fleeing violence, being a victim of human trafficking, etc.)[9]

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Acculturation and Addiction

Latinos can face the risk of substance addiction from a far more insidious source. That source is acculturation, which refers to the cultural and psychological changes that arise from exposure to a new culture. The official journal of the American Psychological Association notes that acculturation only truly takes place as a result of contact with “culturally dissimilar” groups of people.[10] For example, Hispanic culture mandates that averting one’s eyes shows respect for an elderly person or a person in authority; in the United States, not maintaining eye contact suggests dishonesty or untrustworthiness. American culture places great importance on deadlines, and not maintaining deadlines can be seen as unprofessional; however, time management in Hispanic cultures is a lot more fluid, with more emphasis placed on the individual’s availability than the idea of completing work on schedule. Conversely, American culture famously prizes individual fulfillment and independence, while Hispanic cultures focus on family and group cohesion, and happiness.[11]

Such stark differences in the concepts of identity, family, work expectations, and interpersonal communications can be significant triggers of stress for Hispanic immigrants who are trying to adapt to America and its well-established way of life. Feelings of loneliness, frustration, and isolation may arise; a lawyer from Venezuela tells The Atlantic that after moving to Cincinnati from immigrant-dense South California, she became so despondent that she stopped talking.[12] The director of the Center for Multicultural Mental Health Research at Harvard Medical School tells The Fix that Hispanics who live in areas where no one understands them, and they have no one to talk to, may resort to substance abuse to alleviate the inevitable depression they experience.[13]

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Addiction Differences within Hispanic Communities

customs and drugs

Even the differing roles of alcohol itself in American and Hispanic cultures play a part in the rate of addiction in Hispanic communities. For example, traditional Hispanic societies do not permit women to drink socially or casually. Hispanic men, however, are free to drink outside the home, with friends.[14] However, according to Alcoholism: Clinical & Experimental Research, Hispanic women who move to the United States and have a high level of acculturation (i.e., where they engage with their new surroundings more openly and successfully, with minimal psychological distress) tend to drink more than their counterparts who do not acculturate well, or those who remain in their country of origin. One reason for this may be that American women are drinking alcohol at unprecedented rates and do not have the same gender roles and customs that their Hispanic counterparts do. Hispanic women see this inherently American freedom and find it infinitely more appealing than the alternative; thus, they engage with their American friends in drinking. However, lacking a proper context and perspective with which to drink, Hispanic women endanger themselves by consuming more alcohol than is healthy.[15]

Conversely, Hispanic women who would rather maintain their cultural attitudes towards drinking will have low levels of acculturation and resultant low risk of developing addictive drinking habits.[16] A 2007 study of upwards of 6,700 adults (1,690 of them people of Hispanic descent) in the state of Washington discovered that Hispanics who did not followed their cultural and traditional customs were 13 times more likely to report using illegal drugs, compared to acculturated Hispanics.

The study’s author theorized that recent Hispanic immigrants are more connected to their families and customs, making them less likely to leave their familiar surroundings and go out drinking with American students, friends, and coworkers in the name of assimilating. On the other hand, Hispanics who moved to the United States a long time prior have had more time to acculturate, earn more money, and achieve greater job stability, all of which can distance themselves from their homeland’s customs.[17]

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The Better Acculturated, the Greater Addicted?

Acculturation should not be thought of as objectively good or bad. There are positives to acculturation, such as adopting the food, clothing, and language of the new culture. However, there are also negatives, such as picking up potentially dangerous and self-destructive habits. Both positive and negative acculturation influences mental health wellbeing, in ways that are beneficial and harmful. As with most of the roads that lead to an addiction problem, there are dozens of potential risk factors at play that, in the right balances and combination, can determine why one acculturated immigrant may develop a substance abuse problem and why another may not.

For example, acculturation has been associated with the learning of a second language.[19] In the case of immigrants moving to the United States, learning English is akin to receiving the “keys to the kingdom,” unlocking educational and economic opportunities that a non-English speaker cannot grasp.[15] But Health Psychology specifically identified a connection between Hispanic and Asian immigrants using English, and “psychological variables” that might lead to them becoming lifelong smokers.[20]

Likewise, the Journal of Ethnicity in Substance Abuse mentions studies that “consistently find a positive relationship” between Hispanics using English and higher rates of alcohol or drug abuse. Studies on the subject that involved interviews with Hispanics discovered that those who responded to questions in English were more likely to use dangerous substances, and abuse them, than those who responded in Spanish (or their specific first language). Similarly, Hispanics who visited their country of birth regularly, stayed in frequent touch with extended family, or maintained their cultural values in some other way, had lower rates of addiction and substance abuse than their Hispanic counterparts who did none of those things.[21]

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drinking rates

Hispanics and Non-Hispanics

Perhaps as a result of the unfamiliarity that migrant Hispanics have with American culture and the ubiquitous presence of alcohol (The Fix looks in great detail at the long and sometimes contentious history between the United States and alcohol), the National Institute on Alcohol Abuse and Alcoholism says that Hispanics who drink have higher rates of alcohol consumption than non-Hispanic white people (even though Hispanics are less likely to drink than non-Hispanic white people; when Hispanics do drink, they drink more).[22]

For instance, 70.3 percent of non-Hispanic white people had at least one drink in the previous year; for Hispanic people, that percentage was only 54.5 percent. The difference in the figures is even starker when it came to teetotalers, people who always abstain from alcohol. Of this group, 15.5 percent of non-Hispanic white people reported that they never touch alcohol; for Hispanics, the rate shot up to 31.8 percent.

But if we look at the numbers of drinkers who consumed four or more drinks on one single occasion in the past year (which is the criteria for binge drinking), the story is very different. While only 36.8 percent of non-Hispanic white people engaged in binge drinking at least once in the previous 12 months, 41.9 percent of Hispanics reported having four or more drinks in a sitting. For people who had more than four drinks at a time more than 12 times in the past year, the breakdown was 21.3 percent for non-Hispanic white people, and 26 percent for Hispanic people.

The Institute lists acculturation, gender, and attitudes towards alcohol as factors that predict alcoholic behavior in the Hispanic community.[23]

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Addiction Across Hispanic Communities

It is very important to note that the ethnonym “Hispanic” doesn’t merely refer to people hailing from Mexico, but any country or culture that was colonized by the Spanish Empire of the 16th, 17th, and 18th century. The empire was one of the largest in world history, and one of the earliest to attempt global conquest. The acquisition of Latin American territories has resulted in a number of Central and South American countries being considered “Hispanic,” each with their own individual cultures, customs, and histories.[24]

These unique characteristics are seen in how migrants from respective Hispanic countries have different rates of substance consumption and addiction. Studying Hispanic subgroups in the United States, the Alcohol and Alcoholism journal discovered that immigrants from Puerto Rico tend to be the heaviest Hispanic drinkers (three times more likely to develop addiction problems than white Americans). This is partly because Puerto Rico has a much more open attitude towards drinking than the United States does; the drinking age is 18, and there is no law against consuming alcoholic beverages in public spaces (as there is in many jurisdictions across the US).[25]

To that point, Science Daily explains that Mexican-Americans abuse alcohol at a rate that is twice that of Caucasian Americans, and Puerto Ricans do so three times as much because alcohol is a large part of Puerto Rican culture.[26] The Alcohol and Alcoholism journal also found that beer was the most common drink of choice among Hispanics, favored by men; wine, preferred by women, came in second.

puerto ricans and drinking

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The ‘Cuban Success’

large families uneducated

Similarly, the journal found that Cuban men drink the least among Hispanic men, giving them a less than 1 percent chance of becoming addicted to dangerous substances. This may be because Cubans are thought of as political exiles in the United States, facing less legal and cultural resistance to their acculturation (when compared to Hispanics of other origins). As a result, Cubans are often thought to be the most successful Hispanic immigrant group to America, enjoying access to education and the economy on par with the overall American population.[27] Such factors may be why so few Cubans drink in relation to other Hispanic immigrants.[28]

Conversely, Hispanics of other origins (especially Mexicans) have to battle prejudicial assumptions that they migrated to the United States illegally, or that there are already too many people of Mexican descent in the country. A 2012 survey carried out by the National Hispanic Media Coalition revealed that 33 percent of non-Hispanic Americans (consisting of various ethnicities) believed that more than 50 percent of the Hispanics in the US were uneducated with large families, a belief that The New York Times called a mistake.[29]

In the face of such widespread bias, Mexicans may feel compelled to use substances to alleviate the stress of working against such falsehoods, or to ingratiate themselves into what they perceive to be a hostile American culture. The Journal of Nervous Mental Disease notes that Mexican Americans face a number of factors that put them at risk for a substance abuse problem, including depression.[30]

As Science Daily points out, “not all Hispanics are the same when it comes to drinking.” Accepting this, and working with its implications, can change a lot about treating alcoholism and drug addiction across the tens of millions of people across various Hispanic cultures in the United States.

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Substance Abuse Treatment in the Hispanic Community

According to statistics from the National Survey on Drug Use and Health, Hispanic Americans are more likely to need substance abuse treatment than non-Hispanics, yet Hispanics are less likely to receive treatment at a specialized rehab facility.[31] Between 2003 and 2011, nearly 10 percent (9.9) of Hispanics surveyed met the criteria for a substance use disorder, compared with 9.2 percent of non-Hispanics. Yet out of the Hispanics who needed treatment, 9 percent actually received help, compared with 10.5 percent of non-Hispanics. The majority of the Hispanic individuals surveyed (94.4 percent) reported that they did not get help because they did not feel they needed treatment. This percentage was slightly lower than the number of non-Hispanics who did not feel they needed help (94.8 percent).[32]

Research studies have shown that Latinos have poorer outcomes in substance abuse treatment, showing reduced access to rehab services, lower levels of participation in recovery activities, and higher dropout rates.[33] Culturally sensitive treatment programs can help resolve some of the disparities in treatment that occur in the Hispanic community. Some of the key factors in developing a treatment program tailored for Latinos include:

  • Offering bilingual recovery activities, including individual and group therapy sessions, support groups, and 12-Step meetings for Spanish speakers
  • Acknowledging Hispanic cultural values, such as family, spirituality, an emphasis on personal relationships, and a desire for conflict resolution
  • Understanding family structures and gender roles in traditional Hispanic cultures[34]

Traditionally, substance abuse has been viewed as a private problem in Hispanic cultures – an issue that should be resolved within the family rather than in a rehab program.[35] However, as rates of substance rise among second- and third-generation Hispanic Americans, the need for structured recovery programs that meet the needs of Latinos and Latinas is becoming more apparent. As America’s Hispanic community grows larger and more diverse, meeting these needs will contribute significantly to the country’s overall health and wellbeing.

getting treatment

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Addiction Resources for the Hispanic Community

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Citations

[1]2014 National Population Projections: Summary Table.” (n.d.) U.S. Census Bureau. Accessed September 24, 2015.

[2]Hispanic or Latino Populations.” (September 2014). Centers for Disease Control and Prevention. Accessed September 24, 2015.

[3] Lopez, M.H., Gonzalez-Barrera, A., & Cuddington, D. (June 19, 2013). “Diverse Origins: The Nation’s 14 Largest Hispanic-Origin Groups.” Pew Research Center: Hispanic Trends. Accessed December 13, 2015.

[4] Ibid.

[5] Lopez, M.H. & Barrera-Gonzalez, A. (June 19, 2013). “Salvadorans May Soon Replace Cubans as Third-Largest Hispanic-Origin Group.” The Pew Research Center: FactTank. Accessed December 13, 2015.

[6] Ibid.

[7]Acculturative Stress: The Experience of the Hispanic Immigrant.” (January 1995). The Counseling Psychologist. Accessed September 24, 2015.

[8]Substance Use Disorders.

[9]Substance Abuse.” (n.d.) Anxiety and Depression Association of America. Accessed September 24, 2015.

[10]Rethinking the Concept of Acculturation.” (July 2013). American Psychologist. Accessed September 24, 2015.

[11]Some Cultural Differences Between American Culture and Hispanic/Latino Culture Compared.” (August 2014). LinkedIn. Accessed September 24, 2015.

[12]A Lonely Life for Immigrants in America’s Rust Belt.” (May 2015). The Atlantic. Accessed September 24, 2015.

[13]Addiction on the Rise in the Hispanic Community.” (November 2014). The Fix. Accessed September 24, 2015.

[14]Alcohol and the Hispanic Community.” (July 2013). National Institute on Alcohol Abuse and Alcoholism. Accessed September 24, 2015.

[15]The Alcoholism Gender Gap: Why Are More U.S. Women Becoming Problem Drinkers?” (September 2011). International Business Times. Accessed September 24, 2015.

[16]Adapting to Life in the U.S. Can Increase Alcohol Consumption Among Latinas.” (n.d.) Addiction Technology Transfer Center Network. Accessed September 24, 2015.

[17]U.S. Culture Boosts Hispanic Immigrants’ Substance Abuse Risk.” (August 2007). HealthDay. Accessed September 25, 2015.

[18]Acculturation in Relation to the Acquisition of a Second Language.” (2009). Journal of Multilingual and Multicultural Development. Accessed September 25, 2015.

[19]How Language Fits into the Immigration Issue.” (January 2012). Governing. Accessed September 25, 2015.

[20]English Language Use as a Risk Factor for Smoking Initiation Among Hispanic and Asian-American Adolescents: Evidence for Medication by Tobacco-Related Beliefs and Social Norms.” (September 2000). Health Psychology. Accessed September 25, 2015.

[21]Substance Abuse Prevalence and Treatment Among Latinos and Latinas.” (March 2011). Journal of Ethnicity in Substance Abuse. Accessed September 25, 2015.

[22]How Alcohol Has Steered American History.” (May 2011). The Fix. Accessed September 25, 2015.

[23]Alcohol and the Hispanic Community.” (n.d.) National Institute on Alcohol Abuse and Alcoholism. Accessed September 25, 2015..

[24]The Hispanic Population: 2010.” (May 2011). U.S. Census Bureau. Accessed September 25, 2015.

[25]One of America’s Last Holdouts May Raise Drinking Age to 21.” (November 2013). The Huffington Post. Accessed September 25, 2015.

[26]Not All Hispanics Are the Same When It Comes To Drinking.” (September 2014). Science Daily. Accessed September 25, 2015.

[27]Cuban Immigration.” (n.d.) Immigration to America. Accessed September 25, 2015.

[28]Incidence of Alcohol Use Disorders Among Hispanic Subgroups in the USA.” (June 2014). Alcohol and Alcoholism. Accessed September 25, 2015.

[29]Media Feed Bias Against Latinos.” (September 2012). New York Times. Accessed September 25, 2015.

[30]Risk Factors for Secondary Depression Among Mexican Americans and Non-Hispanic Whites. Alcohol Use, Alcohol Dependence, and Reasons for Drinking.” (March 1993). The Journal of Nervous Mental Disease. Accessed February 4, 2015.

[31] National Survey on Drug Use and Health. (October 25, 2012). “Need for and Receipt of Substance Use Treatment Among Hispanics.” The NSDUH Report. Accessed December 13, 2015.

[32] Ibid.

[33] Alvarez, J., Jason, L.A., Olson, B.D. et al. (2007). “Substance Abuse Prevalence and Treatment Among Latinos and Latinas.” Journal of Ethnicity in Substance Abuse 6(2). Accessed December 13, 2015.

[34] Swanson, J. (Nov. 2, 2014). “Addiction on the Rise in the Hispanic Community.” The Fix. Accessed December 13, 2015.

[35] Ibid.