Transcript Drug Abuse in African american and hispanic adolescents

October 13, 2008
Consequences of Drug Use

Health risks
 74.5% of deaths among 15-to 24-year-olds
including accidents, assaults, suicide/homicide,
HIV/AIDS are all linked to drug use

Legal risks
 Criminal activity

Psychological risks
 Increased rates of SUDs/SADs, affective
disorders, anxiety disorders and anti-social
disorders
Consequences of Drug Use in a
Racial Context

All previous risks in addition to social
risks
 Increased rates of dropping out of school
 Increased rates of delinquency
 Increased rates of risky sexual behavior

Why are these points particularly salient
for minority adolescents?
 Because roughly 1/3 of these minority
groups are adolescents
Culture’s Role in Development
Culture- “knowledge skills, attitudes and
behaviors that are shared by a group of
people and may be transmitted from one
generation to another.
 Cultural awareness enriches the
understanding of:

 These groups minority groups
 The context in which their symptoms emerge
 Responses to prevention and treatment
Prevalence
African American adolescents report the
lowest rates of substance abuse followed
by non-Hispanic whites and then Hispanics
 Recent studies have show slight increases
in drug use across all groups
 Hispanic eighth and tenth graders have
shown the highest drug use rates, including
prescription pills use, over lifetime, annual,
and monthly time periods.

 This trend is reversed by the 12th grade,
however.
Possible Explanations

Explanation #1:
 Hispanics have higher drop out rates, so
drug using adolescents have possibly
dropped out of school by the 12th grade

Explanation #2:
 Higher rates of drug use among younger
children might represent an increase in drug
use among Hispanics, foreshadowing a rise
in the future as the children age
Culturally Specific Risk and
Protective Factors

Risk and Protective Factors Paradigm
 Framework which outlines the factors which
increase and decrease risk of offending
behavior
 Interventions using the RPFP are focused
on “reducing risk factors and strengthening
protective factors.” (Holtom & Lloyd-Jones)

http://www.peopleandworkunit.org.uk/docs/R
isk%20Protective%20Factors%20and%20H
ealth.pdf
Risk and Protection for African
Americans

Racial Identity
 Strong racial identity has been associated
with more favorable outcomes in
adolescence
○ Increased antidrug attitudes
○ Decreased substance abuse
 Parental racial socialization has also been
associated with more favorable outcomes in
adolescents
 How do people of different races promote
racial socialization in their clients?
Risk and Protection for Hispanics

Culture plays a significant role in the
development
 Youths with higher levels of acculturation
show higher rates of delinquency and
substance abuse
Risk and Protection for Hispanics
 What is the Immigrant Paradox and why is it
a paradox?
○ Foreign born Hispanics report better health
and lower stress levels; newer immigrants
offer better reports than those who’ve been in
the country for longer
○ Paradoxical due to the assumption that birth
and life in the United States are more
beneficial, but are not
 Why is this?
Role of the Family and
Differential Acculturation



Studies show deterioration of Hispanic family
values are associated with an increase in
alcohol use
Difficulties with acculturation are shown to
exacerbate the familial processes which are
associated with drug use
Differential acculturation- when adolescents
from immigrant families become more
acculturated than their parents
 How does this promote risk for substance abuse?
○ Creates additional conflict by undermining the family
bond and reducing parental authority
Martinez (2006) Mediation Effect

The study showed
that the relationship
between
discrepancies in
acculturation and
risk are mediated by
family stress and
parenting practices.
Family Stress and
Parenting Practices
Discrepancies in
Acculturation (i.e.,
differential
acculturation)
Risk for Substance
Abuse
Prevention and Treatment
Interventions

Family Inclusion
 Family has been shown to be the most
important factor in human development
 9 of 12 Interventions include the family in at
least one phase of the intervention
○ 2 include family but not the target youth in the
intervention
○ Familism is increased with African Americans
and Hispanics
Prevention and Treatment
Interventions

Cultural Context
 What is the importance of culturally specific
intervention programs?
○ Differences in exposure to risk and protective
factors between ethnic groups
○ Different groups respond better to
interventions specific to their particular cultural
values
Interventions: From Generic to
Culturally Specific

Strategy #1:
 Surface Modifications
○ Changing the name and/or other surface
characteristics to match them more closely to
the target group’s cultural values

Strategy #2:
 Deep Structure
○ Changing the actual content and process of
the intervention to incorporate cultural norms
and values of the target group

Which method would you prefer?
Context in Minority Interventions

It is sometimes necessary to tackle multiple
issues to treat just one.
 Deviant adolescent trajectories are
characterized by a variety of problems in
addition to substance abuse
○ Issues with social adjustment, conduct and
delinquency, and risk-taking sexual behaviors

“Sometimes” is the key word
 Why?
○ Santisteban et al. (2003) maladaptive family
functioning may precede, be concurrent with or
even proceed adolescent substance abuse.
Mediation and Moderation
It is important to understand not only why
interventions have an effect but also on
whom they have that effect (mediation)
 Also, females, who appear less frequently
in these intervention programs, tend to
have more severe psychopathology and
family conflict (moderation)

 African American and Hispanic females as
double minorities
Inequalities in Treatment and
Provider Issues

Fewer minorities are in treatment despite
increased levels of use and
disproportionate severity of consequences
 Possible reasons?

Blaming the client
 “They don’t come because they are
unmotivated.”
 Other potential reasons?
○ Difficulties associated with getting the entire family
involved in the intervention process
Increasing Engagement and
Retention in Treatment
Participant leadership
 Positive relationships between parents of
adolescent participants and facilitator

 Enhanced by Interventionist’s skills at initial
contact

Identifying skills during intervention that
effect retention and correct or encouraging
them
 Standardized through the use of a manual
 Flexible enough to fit a variety of family
situations and personalities