Drug Abuse: Etiology and Cultural Considerations

Fred Beauvais & Eugene Oetting. Handbook of Racial & Ethnic Minority Psychology. Editor: Guillermo Bernai & Joseph E. Trimble. Sage Publications. 2003.

The use and abuse of psychoactive chemicals has been one of the more weighty social issues of the past half century. Drug use has permeated many segments of society and, in addition to inherent deleterious effects, has become intertwined with a large number of other social problems, including street gangs, organized crime, the spread of AIDS, school dropout, and violence. Drug abuse clearly affects all segments of society, and ethnic minority populations have not escaped involvement with drugs and the consequences of drug use.

Drug use is circumscribed by a variety of cultural, social, economic, and other demographic factors, which must be taken into account for a full understanding of the complexity of the problem. For instance, some use of crack cocaine occurs throughout the United States, but heavy use of crack cocaine, addiction to crack cocaine, and the violence and promiscuous sex associated with its use occur predominantly in inner cities and among ethnic minorities, particularly African Americans. The social isolation, prejudice, and the socioeconomic conditions in the ghetto and barrio environments where crack cocaine is most heavily used undoubtedly play a large part in that pattern of use. By contrast, the most recent surge in “club drugs,” such as ecstasy and ketamine, and their use at raves is occurring primarily among White American middle-class and suburban youth and reflects the changing lifestyles and values of those more affluent youth.

In each of these examples, ethnicity is a component in the use of the drug, but ethnicity is only one element in the overall social, economic, and cultural environment that is actually determining drug use. This complex pattern is typical of the kinds of links we expect to find between ethnicity and drug use. Ethnicity and ethnic identification are related to drug use, but the relationships are not simple; they are complex interactions that involve the entire social/cultural environment.

The purpose of this chapter is to examine some of the more global issues that are currently of interest in the cross-cultural study of substance abuse. Space certainly limits the level of detail that can be presented, but it is hoped that what is covered will provide some insight into the major topics of concern. A description of the differential rates of drug use by ethnic groups will set the stage for a discussion of etiological factors. Subsequent sections will focus on the current, high level of interest in the role of acculturation and cultural identification in substance use. The final sections will provide some guidance on developing culturally sensitive interventions, with a special emphasis on spirituality and the need to intimately involve ethnic communities in the development of interventions.

Ethnicity and Drug Use


Rates of Drug Use in Ethnic Minority Populations


Although public stereotypes about ethnicity and drug use have not actually been studied, it is likely that those stereotypes include the belief that ethnic minorities use drugs more than nonminorities. Actually, general population studies, using broadly defined ethnic glosses, reveal that with the exception of American Indians, drug use among U.S. ethnic minority adolescents is equal to or lower than that of nonminority youth (see, e.g., Johnston, O'Malley, & Bachman, 2000; U.S. Department of Health and Human Services [DHHS], 2000).

The lowest drug use rates are found among Asian Americans, followed by African Americans and Hispanics, with higher rates among White American youth. American Indians are the only broadly defined ethnic group that consistently shows higher rates of drug use than White American youth; Beauvais and coworkers (Beauvais, 1992, 1996; Beauvais & LaBoueff, 1985; Beauvais, Oetting, & Edwards, 1985) have tracked drug use of American Indian youth who live on reservations for the past 25 years. Consistently, over that time, rates of drug use have been much higher than those of other American youth. A number of surveys have found that youth of mixed ethnic origin have the highest rates of drug use of all adolescents (DHHS, 2000).

Among young people, gender differences in drug use are small for most ethnic groups; adolescent males and females are likely to use drugs at about the same rates. The exception has been Hispanic youth, where males typically have had higher rates of use than females. In a very recent study, however, Swaim (personal communication, October 15, 2000) has found that those gender differences may be disappearing among Mexican American youth.

Differences in drug use rates among minority populations seem to hold up across the life span with one exception. During adolescence, African Americans have lower drug use rates than the national average. However, there is a crossover as African Americans move into young adulthood and beyond; drug use among African Americans appears to increase until it is higher than that found for other ethnic groups (Biafora & Zimmerman, 1998; DHHS, 2000). There are no data-based explanations for this postadolescent increase in proportional use among African Americans. There is some speculation that the lower rates of drug use among African American youth occur because African American families exert more effective control over the behavior of their children (Griesler & Kandel, 1998; Peterson, Hawkins, Abbot, & Catalano, 1994). It is possible that as African Americans move into adulthood, some of them lose that extra family-based protection. It is also possible that African American youth suffer greater social and economic problems as they move from adolescence into young adulthood than other youth. If these young adults are subject to particularly high economic stress and discrimination and if, because of financial and social limitations, they are still living in disadvantaged neighborhoods where there is high exposure to peers who are using drugs, it may explain the higher relative levels of drug use (Biafora & Zimmerman, 1998). It would be useful to have a better understanding of what the early protective factors are among African Americans and how they operate and how those factors change with the move to young adult status. It would be valuable to both enhance these protective influences among other youth and to reduce whatever risk factors are appearing among older African American youth.

As might be suspected, ethnicity and socioeconomic status are often confounded. The issue has been characterized as follows:

Drug problems of minorities in disadvantaged environments probably do not generalize to minority youth in other environments. In ghettos, barrios or Indian reservations, prejudice is compounded by social isolation, poverty, unemployment, deviant role models and sometimes by gang influence. The result includes heavy drug involvement, but these pockets of high minority drug use probably are not well represented in general population surveys and are not typical of other American minority youth. (Oetting & Beauvais, 1990, p. 391)

American Indian youth offer a good example of how rates of drug use can vary under differing socioeconomic conditions. Beauvais (1992) reported that the rates of use for Indian adolescents who live on reservations, where economic stress can be severe, are quite a bit higher than for Indian youth living in nonreservation environments. Indian youth, living on reservations, experience the same social isolation, prejudice, poverty, and lack of opportunity found in the ghettos and barrios of America's inner cities and share the same high levels of drug use. Indian youth living off reservations also have high rates of drug use, but not as high as those found among reservation youth. This is not surprising because many of those nonreservation Indian youth actually live, part of the time, on reservations, and many other Indian youth suffer from the same kinds of social and economic problems as their reservation counterparts. The failure to partial out socioeconomic effects leaves the impression that high rates of substance abuse are a function of minority status rather than of economic and social disadvantage.

Consequences of Drug Use


Even though many ethnic minority groups have lower rates of drug use, it has been consistently found that ethnic minority populations endure much more severe consequences from their use (Rebach, 1992). These findings suggest that drug consequences are not produced merely by the use of drugs but are produced by a combination of drug use and psychosocial conditions. For instance, the generally lower socioeconomic status of ethnic minorities may make the consequences of drug use worse for minorities. Other social and psychological factors may also interact with drug use to produce more severe consequences. Resources for treatment of drug-produced health problems are likely to be more difficult to obtain in impoverished ethnic minority neighborhoods, and there may, in addition, be cultural barriers that make treatment for substance use and its medical consequences less available.

There are definitely more legal consequences for drug use among minority populations (Rebach, 1992). A major factor that has produced more severe legal consequences for minorities is the difference in penalties for possessing crack cocaine and for possessing powder cocaine. Although both are cocaine, the legal penalties for possession of crack are often far more severe than those for powder cocaine, and African Americans are more likely to use crack, whereas White Americans are more likely to use powder cocaine. Another factor has been police profiling. Police in many areas have stopped and searched the cars of ethnic minorities far more often than those of nonminorities, leading to more arrests of minorities. There is also speculation that there may be differential application of statutes by ethnic status; for the same evidence of a crime, minorities are more likely to be arrested and, once arrested, are likely to be charged with a more serious offense (Wallace, Bachman, O'Malley, & Johnston, 1995).

Ethnic Glosses and Drug Use


A major limitation of most studies of ethnic minority substance abuse is the use of broad glosses to define ethnic minorities, terms such as Hispanic, African American, or Asian (Trimble, 1990-1991). The use of these broad classifications provides some useful information about general trends in minority drug use but has obscured important differences among subgroups of ethnic populations. For instance, reporting the drug use of Hispanics or Latinos covers up very large cultural differences. Those broad ethnic glosses include major subgroups that have very different levels and styles of drug involvement. Cuban Americans, Puerto Rican Americans, Mexican Americans, and Americans with roots in South and Central America have different cultural, socioeconomic, and political backgrounds and are located in different geographic areas of the country. For example, Cuban Americans live primarily in the Southeast, with their highest density in Florida. They tend to be urban dwellers. They are, on average, better off socioeconomically and have different medical/cultural beliefs than Mexican Americans. Mexican Americans live primarily in the Southwest. Many live in rural communities, and their average income level is much below that of Cuban Americans. Even within these groups, there will be major economic and social differences that produce different types of drug use. The Mexican Americans living in large city barrios will certainly grow up with a different cultural experience and different types of drug involvement than those living in rural migrant worker communities.

Similarly, because it negates a stereotype, it is useful to know that, overall, African American adolescents have somewhat lower rates of drug use, but it does not tell us much about the actual drug use of very different African American populations. The cultural surround and the drug use of African Americans in an inner city, for instance, are vastly different from that of rural African Americans in small southern towns.

Another example involves the general perception that Asians have one of the lowest levels of drug use in the United States. There are many different Asian groups, with different languages, different socioeconomic levels, and different cultural beliefs. Although the data on many Asian subpopulations are sparse, there is evidence of extremely variable rates of use, with some Asian groups showing very high rates of use (Nagasawa, Qian, &Wong, 1999).

It should be clear that the proper interpretation of comparative drug use rates must include a thorough knowledge of the populations that are being studied. This is often not the case, and the resulting publications can lead to inappropriate generalizations. It is incumbent on researchers to make clear the nature and limitations of the groups that are being described. For example, a sample description might state, “The study population consisted of largely Mexican American youth living in a small, rural, southwestern community where the majority population was Mexican American.” Further descriptors should then include the predominant immigration history, socioeconomic conditions, and educational and employment opportunity. Without this type of detailed information, it is easy to form stereotypes about meaningless aggregations of minority populations.

Causative Factors in Ethnic Minority Drug Use


Drug use behavior emerges during adolescence and, in some instances, even earlier. Kandel (1999) found that it is rare for an individual to begin use of drugs after the age of 19 or 20. To understand the origins of drug abuse, then, we must examine the many factors that come together during this formative time. The main question is the degree to which the differing cultural backgrounds of some ethnic minorities may influence their decision to begin using drugs, thus setting them apart from the general population. If the basic causes of drug use are similar across cultures, the underlying principles for prevention and treatment may be generalizable across cultures. If the causes differ greatly for particular cultures, then preventive interventions would have to be focused specifically on the causes that are related to drug use within those individual cultures.

Genetics and Ethnicity


Some myths about the causes of ethnic minority drug use should be discarded. For example, discussion of drug and alcohol use among ethnic minorities often brings up the issue of genetic influences. There has been an assumption, for instance, that American Indians have a genetic predisposition to alcoholism. Despite a substantial amount of genetic research, no such link for a population-based characteristic has been found for American Indians (Long & Lorenz, 2000).

There are genetic differences in response to alcohol and drugs and in the potential for becoming addicted to drugs. These do run in families. But these genetic influences are factors that produce familial transmission in all ethnic groups. For example, the rate of familial transmission of alcoholism among American Indians resembles that found in the general population. High rates of alcoholism among some American Indian groups cannot be blamed on a genetic propensity. Without direct evidence demonstrating clear genetic differences between ethnic groups, it is best to assume that there is as much genetic variation within minority populations as there is between minority and nonminority populations. Genetic differences do not explain drug use among ethnic minorities.

Cultural/Ceremonial Use of Drugs


Another myth that should be eliminated is the idea that drug use among ethnic minority adolescents is related to what are perceived as exotic, unusual, or distinctive elements in ethnic minority cultures. For example, American Indian alcohol abuse and other types of intoxication have been postulated by some as being a substitute for the American Indian vision quest, a cultural practice among some tribes (Mail & McDonald, 1980). Similarly, the use of peyote in religious ceremonies by some Indian people has been invoked to account for the high use of mind-altering drugs by Indian adolescents. Another simplistic explanation for drug use behavior among Mexican American males is that boisterous and aggressive use of drugs and alcohol is just another expression of culturally accepted “machismo” or stereotyped dominating male behavior.

The popular appeal of these types of cultural explanations is that they provide simple answers to a difficult and complex problem. A deeper analysis shows that they just do not work. One limitation is that they involve inappropriate generalizations across the minority ethnic group. For instance, vision quests occur among some Indian tribes and not among others, but the rates of adolescent drug use are similar across all reservation tribes (Beauvais, 1992). A more serious limitation is that these explanations stereotype and distort the meaning and cultural significance of the traditional behavior. For example, the highly ritualized and controlled use of peyote by members of the Native American church bears no resemblance to out-of-control group drinking or to Indian adolescent use of drugs for recreational purposes. Likewise, instead of being a primary source of alcohol abuse, machismo is a very complex cultural expectation for male behavior that includes a great deal of family responsibility and respect for women, factors that strongly mitigate against certain forms of drunken behavior (Gilbert, 1989).

Secular and Temporal Causes of Drug Use


So what are the actual forces that determine drug use among ethnic minority youth? Do they differ from those for other American youth? If so, the trends over time in drug use for minority and nonminority youth might differ as well. Johnston et al. (2000) have been following the trends in drug use rates among American adolescents since 1974 and have found a quite orderly pattern. Drug use rose through the early 1980s and then began a 10-year decline. In 1992, use began to rise again, with indications that it may be leveling off again beginning in 1997. Importantly, although the levels of use among ethnic minorities may differ from that of youth in general, their pattern of increases and decreases in rates of use over time parallels that for other American youth. Johnston et al. found that the changes in drug use rates over time for Hispanic and Black students followed essentially the same trends as that for nonminority youth, whereas Beauvais (1996) found that trends across time for American Indian students paralleled those for other American youth. In essence, a general American “adolescent drug culture” appears to be driving the drug use behavior of all American youth, including ethnic minorities.

Johnston (1990) described a number of societal forces that may impinge on the lives of young people and that could be influencing drug use changes over time. He speculated that these forces may include drug availability, attitudes toward the law, perception of drug harmfulness, and historical forces such as the aftermath of foreign wars. The parallel trends in drug use of ethnic minority and nonminority youth argue that these temporal and secular forces influence drug use in essentially the same way for all American youth, ethnic minorities and nonminorities. Prevention programs that target these factors are, therefore, likely to be useful for both minority and nonminority youth.

Ethnicity and Individual Risk and Protective Factors


Those general societal forces alter trends in drug use over time, but at any one point in time, within any ethnic group, some young people get involved with drugs and others do not. There are personal and social characteristics that are risk and protective factors for drug use and that determine whether a youth will use drugs. Conceptually, it is important to recognize that risk factors are not simply the absence of protective factors; that is, they are not the opposite ends of a continuum. For instance, although poverty may be a risk factor for some youth, the lack of poverty is not necessarily a protective factor. In fact, youth with more available income are slightly more likely to use drugs. Likewise, high levels of chronic anger may predispose a youth to drug use, but the lack of an angry disposition may not be predictive of nonuse.

Do ethnic minority youth have different personal and social risk factors for drug use than nonminority youth? Unfortunately, the literature does not provide a clear answer to that question. One problem in trying to answer this question is that risk factors do not operate alone and cannot be studied individually. A consistent research finding is that it is the total number of risk factors that predicts substance use. For instance, Newcomb, Maddahian, and Bentler (1986) found that adolescents with seven or more risk factors, regardless of the type of risk factor, were nine times more likely to be heavy users of hard drugs compared with their overall study sample. This general finding holds true for both minority and nonminority youth: Moncher, Holden, and Trimble (1990) found this same result for American Indian youth and Newcomb (1995) for Latino adolescents.

The need to study the multiple interactions of risk factors produces problems in comparing findings across studies of ethnic groups. Newcomb (1995) reviewed a number of studies looking at ethnic differences in risk factors for drug use and found highly variable and, in some instances, contradictory findings. He concluded that this was the result of using different study groups within ethnic populations (e.g., rural vs. urban Hispanics). But other problems in comparison are produced because measures of risk and protective factors differ greatly across studies. One study may use only one or two items to assess a particular risk factor, whereas another study uses several items or even several short scales to assess a latent variable. The relatively high correlations among risk factors can also produce analysis problems when examining multiple predictors. If the measures of peer influence, for example, are weak, they may not add significantly to the variance predicted by family influence because of the correlations between family and peer influence.

Overall, it is likely that ethnic minority and nonminority youth share the same major risk and protective factors for drug use, although they are probably weighted differently for different ethnic groups and, possibly, even for subgroups within ethnic groups that live under different sociodemographic conditions. Newcomb (1995) categorized risk factors under four headings: culture and society (e.g., economic deprivation), interpersonal (e.g., family conflict), psychobehavioral (e.g., academic failure), and biogenetic (e.g., inherited susceptibility). Additional factors include age and emotional problems. These four areas are likely to influence drug use in all ethnic groups.

If there is one protective factor that appears to stand out for ethnic minority populations, it is the influence of the family. Although primary socialization theory proposes that the family is a strong risk and protective factor for all ethnic groups (Oetting & Donnermeyer, 1998), the family appears to have a somewhat greater influence on ethnic minority youth throughout the life span. Minority youth routinely express a greater closeness to the family and are more likely to turn to family in times of crisis. The existence of large, extended families in many minority populations increases the power of the family.

The drug use of both minority and nonminority adolescents is influenced by both peers and the family, but the relative strength of family influence may be greater for some ethnic minority youth. For instance, in developing a model for the relative impact of family and peers on the use of drugs, Swaim, Oetting, Jumper-Thurman, Beauvais, and Edwards (1993) found a somewhat attenuated path between peers and drug use for American Indians compared to White adolescents, whereas family assumed greater influence. The same proportionally greater family influence has been observed for other ethnic populations (Catalano et al., 1992; Vega, Gil, & Kolody, 1998). These findings have strong implications for the prevention of drug abuse. Capitalizing on the influence of the inherent strength of the family system could strengthen prevention programs for ethnic minority groups, especially those for adolescents. Such programs need to include elements that specifically incorporate the family into the prevention activities. Szapocznik et al. (1988) have had considerable success with treatment programs for drug-using Cuban American youth by using not only the family but the extended family as well.

For some ethnic minority youth, there are also differences in the relative effects of school success as a protective factor and of school failure as a risk factor. For example, it is likely that in every ethnic group, school dropouts have higher rates of drug use (Chavez, Oetting, & Swaim, 1994), but dropout has a very different meaning in different ethnic groups. In a fairly typical southwestern urban area, for example, there were, proportionally, very few White American female dropouts, and those few dropouts were highly deviant. Among Mexican American females, a much larger proportion had dropped out of school, but the general level of deviance among these girls was much lower. Dropout had a very different cultural and social meaning for White American and Mexican American females in this community (Chavez et al., 1994). As another example, gang members are often school dropouts, but in a Southern California community, an Asian gang that is involved in drug use and other deviant behaviors prides itself on success in school (Austin, personal communication, July 1995).

In general, youth who do well in school are also socialized normatively in other aspects of their lives and are less likely to have deviant friends and engage in other deviant acts. However, for a variety of historical reasons, some groups of minority youth have less of an investment in the educational system. For them, school success is not as available as a protective factor, and if the school environment is hostile, the school may even become a risk factor.

Although the risk and protective factors for drug use are likely to be essentially the same for ethnic minorities and nonminorities, the relative weights of various factors may differ. Prevention and treatment for ethnic minorities can be improved by taking these differences into account.

Cultural Identification, Acculturation, and Drug Use


A third area of difference for minority youth is the very fact that they are culturally different from the mainstream society. Ethnic minority youth typically have to reconcile those cultural differences. This is simply not an issue for nonminority youth. Acculturation and cultural identification have important implications for whether or not young people begin drug use, but this is a very complicated area. Depending on a host of other variables, being culturally different can be a risk factor or a protective factor, or it may have little bearing on drug use.

Acculturation Stress and Drug Use


Many writers have attributed drug use among minority youth to acculturation stress, the stress that is produced by trying to adapt to two cultures or trying to move toward the majority culture (for a review, see Rodriguez, 1995). This theory has not held up well, in part because many youth do not experience stress from the acculturation process, primarily because stress is not a primary factor in producing adolescent drug use. Adolescent drug use is a social behavior; it is not the result of self-medication for stress.

There is, however, some evidence that drug addiction is linked to the use of drugs to deal with emotions. Individuals do not start using drugs for emotional reasons; they start drug use for social reasons because they are engaged in a lifestyle that involves drug use and because their friends are using drugs (Oetting, Deffenbacher, & Donnermeyer, 1998). Most of these adolescent social users do not become addicted to drugs, but some move on to become addicts. As heavy drug users move toward drug addiction, they learn to use drugs under all kinds of circumstances, including using drugs to relieve stress. Although it has not been studied, it is possible that the experience of acculturation stress plays a role in this process and that, therefore, acculturation stress is related to the movement from drug use as a social behavior to drug addiction. The addict may learn to use drugs to reduce stress related to cultural adaptations as well as learning to use drugs to deal with other emotional hassles and crises.

Acculturation and Drug Use


Short of addiction, most drug use is a social behavior, and cultural values, attitudes, and beliefs influence social behaviors. There has been a fair amount of research on the effects of acculturation on substance use (i.e., a minority person accommodating to the larger culture). In general, it appears that drug and alcohol use will tend to move toward the levels found in the mainstream culture over time. The most complete studies of acculturation have probably been on the use of alcohol by Mexican females immigrating to the United States. Women emigrating from Mexico have much lower drug use rates than Mexican American or Anglo-American women (Gilbert, 1989). This protective effect, however, tends to weaken with successive generations in this country. The more that Mexican American females are identified with Anglo culture, the more alcohol they use (Caetano, 1988; Gilbert, Mora, & Ferguson, 1994; Trotter, 1985). Men who emigrate from Mexico show a slightly different pattern. The norm in Mexico is for infrequent heavy drinking, whereas the norm in the United States is characterized by more frequent drinking but in smaller quantities. Unfortunately, with increasing time in the United States, these patterns tend to combine into frequent heavy drinking.

Increasing drug and alcohol use with successive generational status in the United States has been found in other ethnic populations, but the explanations for this finding are elusive. On one hand, it would appear that simple modeling or social learning theory might account for an increase in use that would match that currently existing in the United States. But Blane (1977) found that Italian American immigrants developed a drinking style that included elements of their old culture and of the new culture. In general, as acculturation progresses, immigrants seem to follow any of a number of patterns. They can maintain the use patterns of their original culture. They can assimilate the drinking and drug use behaviors of the majority group. They can develop a new style that incorporates elements of both their traditional culture and the majority group. Trimble (1996) argued that generational status alone is not sufficient to account for cultural variables among immigrants. He stated that there is likely a wide range of levels of identification with one's traditional culture among immigrants that needs to be factored in.

Cultural Identification and Drug Use


One attempt at disentangling the many factors has been the search for a connection between cultural identification and drug use, particularly among adolescents. The hypothesis driving this search has been that adolescents who more closely identify with a traditional culture, with its proscription against drug use, will use fewer drugs. Alternately, it is postulated that the loss of culture is a major cause of drug use. A number of studies have attempted to find such a direct link but have been unable to do so, although there is evidence for indirect links (Beauvais, 1998). For instance, Whitbeck (personal communication, June 10, 2000) has found that American Indian youth with high Indian cultural identification feel that they are discriminated against more than those with lower levels of Indian cultural identification. High perceived discrimination, in turn, is correlated with higher levels of drug use. However, high Indian cultural identification is also related to better success in school, which leads to lower drug use. Perceived discrimination and school success are both related to Indian identification but have opposite effects on drug use that cancel each other out when a direct link is sought between drug use and cultural identification. Vega, Gil, and Wagner (1998) found that a high level of cultural identification was a protective factor against drug use for foreign-born Hispanics in Florida, but it was a risk factor for U.S.-born Hispanics. There are likely a host of other factors that also mediate the relationship between cultural identification and drug use in both positive and negative directions.

Oetting and Donnermeyer (1998) have proposed some theoretical reasons why a direct link between cultural identification and drug use is unlikely to be found. They proposed that adolescents are socialized mainly from three primary sources: family, peers, and school. Different social behaviors may be influenced differentially by these socialization sources. For example, the family may be the primary source of culture and of its transmission to children. A child may be strongly attached to family, and if that family adheres to its traditional background, this will be passed on to the child. Drug-using values, however, are not socialized through the family; they are socialized through peers. Cultural identification and drug use norms, therefore, derive from different primary socialization sources. It is possible then, to have a youth who is “traditional” and at the same time uses drugs. This combination would lead to the lack of a correlation between cultural identification and drug use. It could also produce changes in the correlation between cultural identification and drug use over time. For instance, there may be a negative link between drug use and strong cultural identification in the younger years when a child is still bonded primarily with the family, but that link could disappear when, during adolescence, peers become the predominant source of influence on many different behaviors, including drug use.

The situation may be somewhat different with adults. It is frequently observed within ethnic minority populations that adult alcoholics who become sober will engage in a cultural transformation as a central part of their search for sobriety. They rediscover their cultural roots, and treatment is often marked by extensive and intensive engagement in cultural rituals. It should be recognized, however, that these adults are at a very different developmental stage than adolescents; for the most part, they have disengaged from adolescent peer influences and are influenced by family members, clan relatives, and other adult peer sources. Developmentally, they may also have grown to the point where they are less dependent on the influence of others and are much more able to make independent decisions about their life and behavior. If culture is to make a difference in the lives of young people, creative ways need to be developed to make it much more central to their lives and to lessen the dependence on deviant peer norms. One route to this would be the development of an adolescent culture that is broadly supportive of traditional values wherein there are a significant number of peers who would endorse those values. It is difficult to ask an adolescent to engage in behaviors or to espouse values that are not rewarded or accepted among a broad spectrum of friends.

Cultural Interventions


Despite the similarities with other youth in patterns of rates of use, a great deal of attention has been given to the question of whether cultural elements within minority communities may operate in specific ways to affect drug-using behavior. At the broadest level, it is generally agreed that most cultures eschew drug abuse and in one form or another will sanction both use and abuse. Given that adolescent drug use is present in these communities, however, it is clear that these sanctions are not always effective. Nonetheless, there is likely to be a prevailing belief in many minority communities that drug abuse can be prevented or treated by the invocation of traditional cultural beliefs, practices, and values. This turns out to be an incredibly complex issue.

There is a strong consensus in the drug prevention field that any type of intervention should be cast in terms that are congruent with the values, beliefs, and practices of minority cultures (Resincow, Soler, & Braithwaite, 2000). This includes such things as language, traditional stories, the use of elders as teachers, and traditional crafts. Although currently no research indicates that the inclusion of traditional culture produces more effective interventions (Dent, Sussman, Ellickson, & Brown, 1996), it does greatly increase the acceptance of such programs within the community. Without community acceptance, no program can be maintained, and so incorporation of these elements in prevention and treatment programs is recommended.

One of the more serious barriers in addressing substance abuse across cultures is the lack of understanding of how psychoactive substance are viewed within various cultures. This encompasses both the meaning of drug use and the value judgment of whether drug use is good or bad. Drug abuse researchers and practitioners generally proceed from the assumption that most drug and alcohol use is harmful, and all efforts should be put forward to eliminate or minimize its use. It is further assumed that those who use drugs hold the same perspective that use is bad and that they are simply choosing to act in deviant ways. Although this may be a general perception of all drug users, it is often a thinly veiled stereotype that attributes deviancy to all those not of the majority culture. There may, in fact, be culturally influenced attitudes toward drugs that help explain some of the patterns that are found. O'Nell and Mitchell (1996), for instance, studied attitudes toward heavy use of alcohol in one American Indian tribe and found that alcohol use was perceived as a problem only to the extent that it interfered with fulfilling traditional responsibilities such as taking care of elders. The amount of alcohol consumed was not the criterion for alcohol abuse, so two individuals could be consuming the same amount: One would be perceived as having a problem, but the other would not.

Inaccurate perceptions of cultural attitudes toward drug use are not unique to ethnic minority groups. Although substance use agencies view any adolescent alcohol use or drug use as deviant, that is not necessarily true for many residents of American communities. Adolescent alcohol use is not only tolerated by adults; it is often viewed as a rite of passage and is expected, if not directly encouraged. Adolescent tobacco use is tolerated in many tobacco-growing communities and in many subcultures in the rest of the United States. Marijuana use is more likely to be hidden, but many parents would not be particularly shocked to find that their children have tried marijuana. It is likely that many culturally determined attitudes affect perceptions of substance use, and it is important to understand these values and beliefs and how they differ in neighborhoods and communities, as well as how they differ in ethnic minority subgroups.

Spirituality


A central element of traditional ethnic cultures is that of spirituality and the effects of spirituality on behaviors such as substance use. At the community level, nearly every discussion of substance use prevention and treatment will involve discussion of the need for increased attention to spirituality. Among Indian tribes, traditional elders and medicine people are very clear that substance abuse and related problems cannot be understood without inclusion of spirituality. Religion, prayer, and the connection to God are important elements in many Hispanic cultures. Spiritual connections in Asian cultures often link closely to extended historical family. Churches in African American communities play a prominent role in the control of drug and alcohol abuse. Curiously, however, spirituality has received very little attention from the research community. Only recently have there been efforts at the national funding level to address this central issue. This is a very sensitive issue that is difficult to approach from the perspective of Western scientific methods. Nonetheless, given the exceedingly strong beliefs among those at the community level that spirituality is at the core of preventing and treating substance abuse problems, spirituality should be included in the agenda in all communities, particularly in ethnic minority communities.

Community Involvement


Although good drug abuse prevention programs can be as effective as many other public health activities, their effects have been, at best, modest (Botvin, 1995). A major reason may be that the potency of most interventions does not match the gravity of the problem. It is unreasonable to expect, for instance, that a once-a-week classroom intervention for 12 weeks will do much to influence a group of youth who bring 12 years of prior socialization to the classes and who spend 25 hours with their friends for every hour in a drug prevention class. Furthermore, most of the existing interventions also focus only on the individual and ignore the powerful influence of the social context within which the individual exists. There is growing consensus that effective interventions must be long lasting and involve multiple sources of influence in the individual lives (Botvin, 1995; May, 1992). They must involve many different parts of the community. Inclusion of the community in the design of intervention programs may help ensure that the interventions are relevant, are potent, and include a wide range of socialization sources.

Research on minority drug abuse problems has suffered from the same limitation of the failure to include the local “voice.” Research hypotheses, methods, and interpretations are typically generated from the “outside” and, as such, lack validity regarding the actual situation within minority communities (Baldwin, 1999; Beauvais & Trimble, 1992). Over the years, minority communities have witnessed a procession of research efforts that most often fail to address the existing and serious problems that community members live with on a day-to-day basis. Resistance to such research is growing. The more fruitful route appears to lie in collaborative research projects that begin with problem identification at the local level and involvement of community members in the research project. This approach not only ensures community acceptance of the research effort but also leads to better science through more accurate interpretation of research results.

Useful Topics for Inquiry


This general presentation of drug use issues among ethnic minority populations suggests that there are a number of questions, the answers to which would be helpful in addressing the topic of substance abuse. Quite clearly, these are not exhaustive, but it is hoped that they describe some of the more salient areas of research.

An overriding issue is the need for new models of how to conduct such research. Our current approaches have not been particularly effective in elucidating such overarching influences as spirituality and the impact of cultural traditions on substance use. Furthermore, the typical “top-down” model, wherein research at the community level is formulated and conducted by outside researchers, needs to be inverted to incorporate the cultural knowledge of ethnic minority communities.

There should be continued efforts to unravel the posited links between acculturation and cultural identification and drug use. Of particular interest would be the study of the influences that lead to increased drug use as ethnic immigrants spend more time in the majority culture. Also of interest would be the nature and mechanism for the putative buffering effects of traditional culture on substance use.

Although the data reveal distinct trends in adolescent drug use over time, there is little understanding of which larger social forces influence these trends. This is of interest for all adolescent drug use because the trends are similar across ethnic populations. A fuller understanding of these phenomena would also help explain how culture moderates the rates of use between and within ethnic populations.

A final area of inquiry would be a more extensive study of the meaning of substance abuse within and between cultures. There is a common, value-laden assumption that drug use is something to be universally avoided and that the goal is to eradicate any use of mind-altering substances. It is not at all clear that this perception is shared by all populations and that there may be culturally bound drug-related behaviors that are acceptable.

Summary


Drug use is a serious problem among all American youth, including ethnic minority youth. Inner-city ghettos and barrios and Indian reservations may have high levels of drug use, suggesting that there is high drug use among minorities. It is true that when an ethnic minority group is socially isolated, impoverished, and uneducated and has little opportunity, that group is likely to have high rates of drug use. But the same principle holds true for nonminorities; when a group of White Americans is severely disadvantaged, drug use rates are also likely to be high. With the exception of American Indians, a large proportion of whom live under severe disadvantaged conditions, ethnic minority youth in general do not use drugs any more than other American youth.

Ethnic minority drug use is not produced by ethnic genetic differences or by traditional ethnic cultural practices that involve psychoactive drugs. Over time, the rates of adolescent drug use change. The changes are essentially the same among minority and nonminority youth, indicating that the secular and temporal factors that produce drug use are essentially the same for minority and nonminority youth. The major factors that produce temporal changes in drug use over time are the attitudes of American youth toward drugs, drug use, and drug users, and those changes influence both ethnic minority and nonminority youth.

The risk and protective factors that lead individuals toward drug use are also very similar for ethnic minority and nonminority youth, although their relative importance may differ. For example, family influence may be somewhat stronger and peer influence somewhat weaker in some ethnic groups, but both family and peer influence are present in all ethnic groups. Similarly, school success is a protective factor and school failure a risk factor for essentially all ethnic groups, but ethnic minorities may have different attitudes toward education that influence school adjustment and the links between school adjustment and drug use.

Although acculturation stress has been shown to produce emotional, social, and economic problems, it probably does not directly produce adolescent drug use because adolescents, for the most part, take drugs for social, not emotional, reasons. On the other hand, acculturation stress may influence drug addiction because addicts do learn to use drugs to deal with emotional problems.

Because drug use is a social behavior, cultural values and attitudes and the process of acculturation do influence drug use. As an ethnic group becomes acculturated to the majority culture, it generally tends to move toward the drug use behaviors of the majority culture. Specific patterns of cultural adaptation, however, may appear that include retention of some ethnic minority cultural norms or adaptation of those norms, blending them with norms of the majority culture.

The level of cultural identification with either the minority culture or the nonminority culture is related to drug use but not in any simple manner. Among adolescents, cultural identification is primarily derived from the family, whereas drug use norms are more likely to be derived from a different source—peers—so cultural identification may be only loosely related to drug use. A high level of cultural identification can also influence different processes, some of which produce a risk of drug use and others that protect against drug use.

Culture does play an important role in prevention and treatment. Prevention and treatment programs must be culturally congruent, or they will not be acceptable to ethnic minority communities and will not be supported and maintained. They must be in tune with cultural values and beliefs, or they will not influence their intended targets. Prevention, treatment, and research on drug use in ethnic minority communities should be a collaborative effort with heavy community involvement.