Self-Reported Reasons for Abstinence from Illicit Drugs

OBJECTIVE

To provide a more balanced understanding of the initiation and restraint of substance use, educators, clinicians, and researchers would benefit from a review of research assessing the reasons nonusers report for having abstained from drugs.

METHOD

Based on searches of computerized databases and the reference sections of relevant articles, we identified 15 relevant studies that assessed and quantified participants' expressed reasons for having abstained from (a) one or more named substances or (b) drugs (or alcohol and drugs) with little or no further specification. We defined as more salient those 25% of reasons in each study that were endorsed most frequently, ranked highest, or rated most influential.

RESULTS

Five reasons - concerns about physical health, lack of interest, harmful psychological consequences, personal beliefs/morals, and peer/family disapproval - were most frequently identified as salient across studies and substances.

CONCLUSION

These salient reasons are consistent with outcome expectancy and social learning models that have been proposed to explain drug initiation. To enhance the value of future research, we recommend testing whether importance ratings differ across contexts; repeatedly assessing within-subject variability of reasons across time; evaluating the association of psychological characteristics with reasons for abstaining; and continuing to evaluate which reasons for abstaining vary by type of drug, gender, ethnicity, and religiosity. We also recommend additional research comparing which reasons predict continued abstinence and which predict initiation of use during follow-up.

Nation of Origin, Gender, and Neighborhood Differences in Past-Year Substance Use among Hispanics and Non-Hispanic Whites

This analysis of the National Household Survey on Drug Abuse (NHSDA) focuses on correlates of substance use among Hispanic groups. Using 1994-B and 1996 NHSDA surveys (U.S. Department of Health and Human Services [USDHHS], 1996, 1998), these analyses use sampling areas to control for intracluster correlation and its subsequent effect on empirical conclusions. Models are specified for alcohol, cigarettes, marijuana, cocaine, and any illicit drug, controlling for national origin, gender, age, socioeconomic status, language, and family structure. Results indicate that models failing to account for intracluster correlation may lead to erroneous ethnic contrasts of substance use. Also, substance use varies widely by national origin—and Hispanic men and women have highly divergent patterns of use, more so than non-Hispanic White men and women. Finally, controlling for neighborhood does not wholly diminish ethnic contrasts in substance use.

Hispanic Subgroups, Acculturation, and Substance Abuse Treatment Outcomes

This study explored Hispanic subgroup differences in substance use treatment outcomes, and the relationship of acculturation characteristics to these outcomes. Data were from a multisite randomized clinical trial of motivational enhancement therapy versus treatment as usual in a sample of Spanish-speaking substance abusers. Participants were Cuban American (n=34), Mexican American (n=209), Puerto Rican (n=78), and other Hispanic American (n=54). Results suggested that Cuban Americans and individuals with more connection to Hispanic culture had lower treatment retention. Hispanics born in the U.S and those who spoke English at home had a lower percentage of days abstinent during weeks 5-16, although Puerto Ricans born in the U.S. and Cuban Americans living more years in the U.S. had a higher percentage of days abstinent in weeks 1-4 and 5-16, respectively. Results may inform future hypothesis-driven studies in larger Hispanic treatment seeking samples of the relationship between acculturation and treatment outcome.

Working the Pony

We present a model of the drinking practices of Latina immigrants who work in bars or cantinas and are compensated for drinking 8 oz beer or ponies with customers, hence working the pony. A total of 358 women recruited from 61 randomly selected cantinas were interviewed as part of a community study conducted in a metropolitan area in the U.S. Southwest. Participants reported drinking an average of 21 beers on nights they worked for ponies. Multiple regression results indicate that drinking practices are related to sociodemographic, work history, drug use, and sexual risk characteristics. The drinking of cantineras is more than 4 times higher than the heavy episodic drinking of high risk Latino male drinkers and young male restaurant workers. The findings suggest that they may be at risk of multiple health problems and could benefit from alcohol risk-reduction interventions.

Gender differences in the effect of linguistic acculturation on substance use among Mexican-origin youth in the southwest United States

This study tested for gender differences in the impact of linguistic acculturation on pro-drug norms, substance use intentions, and actual substance use among youth of Mexican heritage in a large metropolitan area in the Southwest United States. The authors analyzed baseline survey data provided by 2,487 middle school students of Mexican heritage who were part of a larger, multiethnic randomized efficacy trial of a drug abuse prevention program. Using multi-group structural equation modeling, the authors found that linguistic acculturation was positively and directly related to adherence to pro-drug norms, substance use intentions, and recent alcohol use, controlling for age, poor grades, and socioeconomic status. In addition, linguistic acculturation had an indirect effect on substance use intentions and recent alcohol use through pro-drug norms. The direct effect of linguistic acculturation on pro-drug norms was stronger for girls than for boys, as was its indirect effect on substance use intentions.

Acculturation and substance use: social influence as a mediator among Hispanic alternative high school youth

Research suggests that acculturation increases the risk of substance use among Hispanic youth. However, this process is not well understood. This study examined associations between acculturation and several substance use indicators among a sample of 714 Hispanic youth attending alternative high schools in southern California. Peer social influence was assessed as a potential mediator. Acculturation, measured by language use, was associated with increased risk of lifetime alcohol, marijuana, and current alcohol, cigarettes, marijuana, and hard drug use, controlling for age, socioeconomic status, and gender. Results of mediation analyses indicate that peer social influence mediated the relationship between acculturation and lifetime alcohol and current alcohol, cigarettes, and hard drug use. Evidence for partial mediation was observed with lifetime and current marijuana use. These results provide evidence that peer social influence is an important mediating variable that should be considered when examining the relationship between acculturation and substance use.

Latino/a Culture and Substance Abuse

This article provides descriptions of issues related to Latino/as, alcoholism, and substance abuse. A review of the available literature is provided, including preliminary data analyses by the National Epidemiologic Survey on Alcoholism and Related Conditions conducted by the National Institute on Alcohol Abuse and Alcoholism and from the National Hispanic Science Network on Drug Abuse. There is some evidence that substance abuse among Hispanics may be increasing, especially among adolescents. Despite the dearth of knowledge regarding prevention and treatment interventions for Latino/a populations, the evolving evidence-based research provides additional information. Some clinical implications are provided and directions for research are suggested.

Acculturation and alcohol among Latino adults in the United States: a comprehensive review

BACKGROUND

In light of the inconsistent evidence associating acculturation with drinking outcomes among Latinos in the United States, the current paper comprehensively reviews the literature on this topic.

METHODS

Studies were eligible for review if they (1) were published in a refereed journal, (2) were published in English, (3) sampled Latino/Hispanic adults aged 18+, (4) examined self-reported drinking behavior, alcohol-related problems, and/or alcohol abuse/dependence, and (5) reported original results or unique analyses from a larger dataset. The review includes only studies using composite scales of acculturation. Studies were identified via electronic databases (i.e., PSYCHINFO, ETOH, and PUBMED) using search terms, and combinations thereof, including "acculturat*," "alcohol*," "Latino," and "Hispanic." This search was supplemented by recursive checking and author searches. Thirty-two articles were identified and coded on methodological characteristics; results from 24 disaggregating genders and using appropriate outcomes were summarized.

RESULTS

Higher acculturation was very consistently associated with higher odds of drinking among women, even controlling for demographic covariates. The evidence for women also suggested associations between higher acculturation and heavier drinking on other outcomes, including total volume, drinking frequency, typical quantity, heavy/problem drinking, drinking problems, and abuse/dependence, despite some null results. Relationships were weaker and ambiguous among men. Some evidence suggested that highly acculturated men are (compared with peers low on acculturation) more prone to drink, and perhaps as a result, can show higher consumption and problems. However, results also implied that, among male drinkers, higher acculturation may be associated with a lighter drinking pattern. Important study limitations were identified, including low power, aggregation of nondrinkers with drinkers, restrictive sampling, measurement issues, and analytical issues.

CONCLUSIONS

The pattern of results suggests important associations between acculturation and drinking outcomes-particularly for women-but conclusions are tempered by serious methodological limitations. The review urges further research, particularly large-scale, longitudinal studies, addressing these limitations.

Perceiving the Risk of Substance Use: The Roles of Nativity, Acculturation, and Family Support among Hispanic Children

The prevalence of substance use behavior and the personal characteristics and social and cultural factors that influence substance use among children have been studied extensively. However, much less attention has been directed at the attitudes towards, and particularly the perceived risks of, using substances, and even less research has focused on Hispanic youth, whose rates of substance use have been increasing. Understanding what factors are associated with perceived risk is important because there is evidence that perceived risk is associated with subsequent substance use. The current study uses longitudinal data collected from 553 children in the Cicero Youth Development (CYD) Project to identify individual and environmental factors associated with the perceived risk of substance use. We pay particular attention to dimensions of nativity and acculturation in an effort to determine whether there are differences in risk perception between U.S.-born Hispanic children and their foreign-born counterparts. Results indicate that a number of factors are associated with perceived risk, including family support, parent-child communication, peer substance use, and child temperament. Additionally, U.S.-born Hispanics perceive substances as less risky than immigrants, and among immigrants, length of time in the U. S. is negatively associated with perceiving great risk in substance use. Implications for policy and prevention strategies are discussed.

Hispanics' locus of control, acculturation, and wellness attitudes

There is reason to believe that various cultural attitudes and beliefs influence certain health behaviors, and additional research should identify the causes of such behaviors. This study explored the relationships among cultural identity, acculturation, locus of control, and health beliefs using a sample of 110 Hispanic individuals taking college classes in the southern or southwestern United States. Path analysis indicated that an external locus of control was positively related to health barrier perceptions and that acculturation was negatively related to health barrier perceptions. The findings suggest that Hispanics' perceived control over health outcomes and positive health beliefs could be enhanced with culturally perceptive counseling.

The Effect of Acculturation on Patterns of Hispanic Substance Use in Washington State

A growing body of research on Hispanic substance use in the United States has found acculturation to result in increased drug use. This study contributes to this research by analyzing the effect of acculturation on Hispanic substance use in Washington State, a state with a rural and dispersed Hispanic population. Findings reveal acculturation to have a strong positive effect on levels of illicit drug use, hard drug use, binge drinking and bender drinking among Hispanics.

The influence of acculturation on drug and alcohol use in a sample of adolescents

This article reports on the associations between acculturation and substance use among 198 ninth-grade Southern California adolescents (mean age=13.8 years). Substance use measures included 30-day (current) and lifetime use of alcohol and other drugs. Acculturation was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) acculturation scale, a multi-dimensional acculturation scale yielding four acculturation strategy scores. Linear regression analyses evaluated the association between acculturation on alcohol and drug use, adjusting for several covariates. Results revealed that the assimilation acculturation strategy was significantly, but negatively associated with current alcohol use, especially among males. The separation acculturation strategy was significantly and positively associated with current alcohol use, especially among females. Marginalization was associated with greater risk for lifetime alcohol and drug use, especially among males, and a greater risk of current drug use among females. The social influence covariates were predictive of both current and lifetime alcohol and drug use. Future studies should incorporate multidimensional acculturation scales in adolescent substance use to understand how different acculturation strategies impact different populations.

Substance abuse prevalence and treatment among Latinos and Latinas

Substance abuse prevalence rates for Latinos/as generally mirror those of the general U.S. population; however, a number of indicators of assimilation to U.S. culture as well as sociodemographic variables predict substance use and abuse among this group. Latinos/as have poorer outcomes in substance abuse treatment programs. Yet there is little empirical evidence that explains the problems these individuals experience in treatment, and there are few studies on the use and effectiveness of mutual help groups among this population. New developments in the conceptualization and measurement of acculturation will lead to a greater understanding of the role of culture in the prevalence and treatment of substance-related problems.

Preventing HIV, eliminating disparities among Hispanics in the United States

HIV/AIDS has disproportionately impacted Hispanics/Latinos in the United States. This literature review focuses on the disparities that exist in the impact of HIV/AIDS across Hispanic subgroups. Elimination of these disparities requires attention to underlying biological, behavioral and psychological, social and cultural, and economic and structural factors. Attention to factors within these domains has important implications for the reduction of other health-related disparities that exist across Hispanic/Latino subgroups in the United States.

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.

Heterogeneity among Latinas and Latinos entering substance abuse treatment: findings from a national database

The current study examined differences in 30-day and lifetime substance use for a sample of Mexican American, Puerto Rican, and Cuban American men and women from the Drug Evaluation Network System, a national database on individuals seeking substance abuse treatment. There were significant gender and ethnic differences in recent and lifetime substance use after controlling for age, years of education, employment, medical, and psychological problems. Lifetime and 30-day substance use rates found in this study do not coincide with prevalence rates found in community samples of Latinas/os, indicating that the patterns of substance use may be different among individuals who seek substance abuse treatment than among those in the general population. The results of this study highlight the heterogeneity of Latinas/os who abuse substances.

A mediational model of the relationship between linguistic acculturation and polydrug use among Hispanic adolescents

Hispanic seventh and eighth graders (N=1,038) in 22 New York City middle or junior high schools completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana use), linguistic acculturation (language use with parents), perceived peer smoking norms, perceived peer drinking norms, and psychological distress. Students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents. Bilingual students perceived that a higher proportion of their peers drink than those who spoke Spanish with their parents, and this higher perception of their peers' drinking was associated with greater polydrug use controlling for linguistic acculturation. In the final model, linguistic acculturation was no longer significant and peer drinking norms predicted polydrug use, peer drinking norms mediated the relationship between linguistic acculturation and polydrug use, but not peer smoking norms and psychological distress.

An Estimate of the Level and Determinants of Illicit Drug Use among Unauthorized Latino Immigrant Arrestees in California

Although justifications for a more restrictive U.S. immigration policy have increasingly relied on linking socially unacceptable behaviors such as welfare participation and illicit drug use with illegal entry, very few immigration impact studies separate respondents by foreign-born legal status. Applying a legal status prediction equation to 1994–1996 CALDUF data, this paper (1) estimates the relative level of illicit drug use (IU) among unauthorized Latino immigrant arrestees (ULIAs) in California and (2) investigates how individual-demographic and institutional-structural factors influence IU. ULIAs were underrepresented, with a smaller proportion testing positive for IU and having experienced or desired drug treatment. Regression results suggest (1) ULIA status had an independent negative effect on IU; and (2) higher earnings may have decreased, and public assistance recipiency and the percent of one's income obtained illegally may have increased, the likelihood of IU. We conclude by discussing implications for various policy instruments.

Linguistic acculturation associated with higher marijuana and polydrug use among Hispanic adolescents

Hispanic sixth and seventh graders in 22 New York City middle schools (mean age: 12.66 years) completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana) use and linguistic acculturation at two assessments (N = 1299 at baseline; N = 1038 at 1-year follow-up). Adolescents who spoke English with their parents smoked marijuana more frequently than those who spoke Spanish with their parents at both surveys. By the 1-year follow-up, students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents.

Traditionalism in the prevention of substance misuse among Puerto Ricans

Data are presented from a multicluster stratified sample of 1,084 Puerto Rican households in the New York City area. Researchers examined the impact of loss of traditional Hispanic family-oriented gender role values and degree of acculturation upon drug use. Sociodemographic variables are presented. Indices of "traditionalism" and "acculturation" were created, validated, and correlated with drug use. Traditionalism was found to covary negatively with drug use, but more so for women. The positive relationship between acculturation and drug use was found to be influenced by different levels of traditionalism. Implications for treatment and prevention are discussed.