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 U.S.
There is an often-overlooked concern that threatens the lives of Latino people in this country, and that is the problem of alcohol and drug abuse. Here, we’ll discuss the risk factors for substance abuse and addiction in Hispanic Americans as well as options for treatment.
Hispanics in America
In September 2019, the Pew Research Center estimated that the United States was home to around 60 million people of Hispanic descent. The Hispanic population is expected to grow significantly, up to 111 million by 2060.1 This increase in growth makes it even more imperative to provide recovery services and treatment programs geared toward Hispanic individuals in need of substance use disorder treatment.
People from Mexico have represented the largest non-native population in the United States since 1980, accounting for 25% of the 44 million foreign-born individuals in the country in 201.2 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 figures from the Pew Research Center released in 2019, the largest 10 Latino groups in the US include:4
- Mexicans: More than 36.6 million people or 62 percent of Latinos in the US
- Puerto Ricans: Over 5.6 million people
- Salvadorans: About 2.3 million people
- Cubans: Almost 2.3 million people
- Dominicans: Over 2 million people in the US
- Guatemalans: More than 1.4 million people
- Colombians: About 1.2 million people
- Hondurans: Around 940,000 people in the US
- Spaniards: Over 800,000 people
- Ecuadorians: Nearly 740.000 people
Latino groups from South America are growing more rapidly in the United States. For example, Salvadorans in the U.S. recently outranked Cubans as the third largest Hispanic-origin group in the U.S., and Hondurans recently outranked Spaniards for the eighth spot.4 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 commonly represented in the U.S. population include Argentina, Nicaragua, Venezuela, Peru, and others. This diversity makes it challenging to generalize about the reasons for substance abuse and the most effective methods for treating the addiction in people of 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.
Immigration and Risk Factors for Addiction
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 documented and undocumented) 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 when Hispanics emigrate to the United States, they 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
Depending on the individual’s experience, immigration itself can be a traumatic, multilayered experience that can have a lifelong negative impact on a person. Individuals have to leave their homes and cultures, sometimes by force; endure a journey that may be long, expensive, and dangerous to their 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 may contribute to the risk of substance abuse:9
- Religious or ethnic persecution.
- Lack of job opportunities or travel freedom because of an immigrant’s status as documented or undocumented.
- Lack of legal protection because of their status as citizens.
- 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.).
Acculturation and Addiction
Another more subtle risk factor for substance abuse in Latinos is acculturation, which refers to the cultural and psychological changes that arise from exposure to a new culture.
The American Psychological Association (APA) notes that acculturation only truly takes place as a result of contact with “culturally dissimilar” groups of people.10 For example, in some Hispanic cultures, averting one’s eyes shows respect for an elderly person or a person in authority, while 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 may be 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 people 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 Latinos 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.12
Addiction Differences within Hispanic Communities
Even the culturally variable roles of alcohol itself 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. This norm, however, does not generally apply to Hispanic men, who are often free to drink casually outside the home.14 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, or those who remain in their country of origin.
One reason for this may be that American women are drinking alcohol at unprecedented rates15 and do not have the same gender roles and customs that their Latina counterparts do. Hispanic women see this inherently American freedom and may find it more appealing than the alternative; thus, they may prefer to engage with their American friends in drinking. Highly acculturated Latina women tend to not only be more likely to drink alcohol than their less acculturated counterparts but to drink more when they do.16
Acculturation involves changing one’s attitudes and behaviors to match the new norm, and this includes attitudes and behaviors around alcohol and drug use.16 A 2007 study of nearly 6,700 adults (1,690 of them from Hispanic descent) in the state of Washington discovered that Hispanic people who were more acculturated were 13x more likely to use illegal drugs compared to those who adhered more closely to their culture’s values.17
The study’s author theorized that Hispanic people who recently emigrated 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, Hispanic people who moved to the United States long ago have had more time to acculturate, earn more money, and achieve greater job stability, all of which can distance them from the customs and values of the native country.17
The Better Acculturated, the Greater Addicted?
Acculturation is not objectively good nor bad, nor is it the only risk factor for addiction. As with most of the roads that lead to a substance use issue, there are dozens of potential risk factors at play that, in the right balance and combination, can determine why one acculturated immigrant may develop a substance abuse problem and why another may not.
There are benefits to acculturation, of course. For example, acculturation has been associated with the learning of a second language.18,19 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 immigrants from Asia and Spanish-speaking countries 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 English-speaking proficiency and preference among Latinos and higher rates of alcohol or drug abuse.21 Being born in the U.S. or living in it for 15 years or more, was also associated with greater alcohol use for Latinos, further suggesting that a greater comfort level with the American culture may lead to higher risk.21
For Latino Americans, visiting one’s country of birth regularly, staying in frequent touch with extended family, or maintaining Latino values in some other way was associated with a decreased risk of heavy drinking.21
Perhaps as a result of the unfamiliarity that migrant Latinos have with American culture and the ubiquitous presence of alcohol,22 the National Institute on Alcohol Abuse and Alcoholism (NIAAA) says while Hispanic people are less likely to drink alcohol than white people, they tend to drink more when they do choose to drink.23 The NIAAA lists acculturation, gender, and attitudes towards alcohol as factors that predict alcoholic behavior in the Hispanic community.23
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 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 The terms “Latinos” or “Latinas” may be preferred by some people hailing from Spanish-speaking counties in the Americas.
These unique characteristics are seen in how migrants from respective countries have different rates of substance consumption and addiction. Studying Hispanic subgroups in the United States, the Alcohol and Alcoholism journal discovered that people from Puerto Rico tend to be the heaviest drinkers among Latinos (3x more likely to develop alcohol problems than white Americans). This is partly because Puerto Rico has a much more open attitude towards drinking than other parts of 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).25,26 Mexican-Americans also suffer a higher risk of alcohol abuse, about 2x that of white Americans.26
The journal found that Cuban American have the lowest risk of alcoholism and are half as likely to become alcoholics as non-Hispanic white Americans. This rate may be because Cuban Americans often come to the Unites States as political refugees and face less adversity than other Hispanic immigrants, such as those who came to the country illegally and face hardship and prejudice.26
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.27
In the face of such widespread bias, some Hispanic Americans may feel compelled to use substances such as alcohol to alleviate the stress of working against such falsehoods, or to ingratiate themselves into what they perceive to be a hostile American culture.
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.26
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 they are less likely to receive treatment at a specialized rehab facility.28 In 2018, of the 3.3 million Latinos who had a substance use disorder, nearly 90% did not receive treatment. Additionally, over the 6.9 million Latinos with a mental illness, more than 67 percent received no treatment.
Research studies have shown that Latinos compared with the general U.S. population have poorer outcomes in substance abuse treatment, reduced access to rehab services, lower levels of participation in recovery activities, and higher dropout rates.29 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:30
- 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.
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.30 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.
Addiction Resources for the Hispanic Community
- Alcoholics Anonymous/Alcoholicos Anonimos: The original 12-step group’s website is available in Spanish, with links to AA literature, membership information, and an international resource locator.
- National Helpline: Substance Abuse and Mental Health Services Administration (SAMHSA): This telephone helpline service offers referrals and support in Spanish and English on issues regarding substance abuse and mental health. Call (800) 662-4357 for free, confidential information.
- Pan American Health Organization (PAHO): Alcohol and Substance Abuse Program: An international public health agency, PAHO is dedicated to improving the health and quality of life of individuals living in the Americas. Its Alcohol and Substance Abuse Program disseminates information and educational resources on addiction, promotes policies, and launches initiatives to increase public awareness of substance abuse in North, South, and Central America.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Hispanic/Latino: Resources on the SAMHSA website include Spanish-language resources, information on behavioral health and substance abuse in the Hispanic community, national survey reports, and agency and federal initiatives.
- U.S. Census Bureau. (2018). Hispanic Population to Reach 111 Million by 2060.
- Pew Research Center. (2019). Facts on US Immigrants, 2017.
- Lopez, M.H., Gonzalez-Barrera, A., & Cuddington, D. (2013). Diverse Origins: The Nation’s 14 Largest Hispanic-Origin Groups. Pew Research Center.
- Noe-Bustaminte, Luis. (September 16, 2019). Key Facts About U.S. Hispanics and their Diverse Heritage. Pew Research Center.
- Substance Abuse and Mental Health Services Administration. (2019). 2018 National Survey on Drug Use and Health: Hispanics, Latino or Spanish Origin or Descent.
- Lopez, M.H. & Barrera-Gonzalez, A. (2013). Salvadorans May Soon Replace Cubans as Third-Largest Hispanic-Origin Group. The Pew Research Center: FactTank.
- The Counseling Psychologist. (1995). Acculturative Stress: The Experience of the Hispanic Immigrant.
- Substance Use Disorders.
- Anxiety and Depression Association of America. (n.d.). Substance Abuse.
- American Psychologist. (2013). Rethinking the Concept of Acculturation.
- LinkedIn. (2014). Some Cultural Differences Between American Culture and Hispanic/Latino Culture Compared.
- Semuels, A. (2015). A Lonely Life for Immigrants in America’s Rust Belt. The Atlantic.
- Swanson, J. (2014). Addiction on the Rise in the Hispanic Community. The Fix.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Hispanic Community.
- Ghosh, P. (2011). The Alcoholism Gender Gap: Why Are More U.S. Women Becoming Problem Drinkers? International Business Times.
- Addiction Technology Transfer Center Network. (n.d.). Adapting to Life in the U.S. Can Increase Alcohol Consumption Among Latinas.
- HealthDay. (2007). U.S. Culture Boosts Hispanic Immigrants’ Substance Abuse Risk.
- Governing. (2012). How Language Fits into the Immigration Issue.
- Unger JB, Cruz TB, Rohrbach LA, et al. English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms. Health Psychol, 2000;19(5), 403-410.
- Alvarez, J., Jason, L. A., Olson, B. D., Ferrari, J. R., & Davis, M. I. (2007). Substance abuse prevalence and treatment among Latinos and Latinas. Journal of ethnicity in substance abuse, 6(2), 115–141.
- Cheever, S. (2011). How Alcohol Has Steered American History. The Fix.
- National Institute on Alcohol Abuse and Alcoholism. (2019). Alcohol and the Hispanic Community.
- U.S. Census Bureau. (2011). The Hispanic Population: 2010.
- Planas, R. (2013). One of America’s Last Holdouts May Raise Drinking Age to 21. The Huffington Post.
- ScienceDaily. (2014). Not All Hispanics Are the Same When It Comes To Drinking.
- Torregrosa, L. (2012). Media Feed Bias Against Latinos. New York Times.
- National Survey on Drug Use and Health. (2012). Need for and Receipt of Substance Use Treatment Among Hispanics.
- 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).
- Swanson, J. (2014). Addiction on the Rise in the Hispanic Community. The Fix.