Substance abuse in African Americans: in search of a culturally competent research agenda.

The Healthy People 2010 guidelines identify substance abuse as a major public health problem in need of effective interventions for diverse populations including racial and ethnic minorities (United States Department of Health and Human Services [USDHHS], 2000). However, the literature with regard to substance abuse in the African American community is rather scant (Bass & Kane-Williams, 1993; Dent, Sussman, Ellickson, Brown, & Richardson, 1996). Further compounding this problem is the way that African Americans are classified in our country, which does not adequately capture the diversity within this group (Sellers, Smith, Shelton, Rowley, & Chavous, 1998). At least four different groups with differing sets of needs, cultures, socio-economic status, self concept, and substance abuse patterns are imbibed in this single categorization. The first subgroup consists of the blacks that have been living in the country for three or four generations or longer. The second subgroup is comprised of individuals that have migrated from the Caribbean countries. The third subgroup is made up of individuals who are first generation immigrants from Africa, which too has a lot of diversity. The final subgroup consists of multiracial individuals, many of whom are often misclassified as African Americans.

Most of the studies done on blacks have involved a comparison of American and immigrant blacks and have failed to focus on all possible groups of immigrant blacks (Dodoo, 1997). Dodoo (1997) also examines that even though there has been some focus on Caribbean blacks, other blacks--most importantly the Africans--are conspicuously missing from the literature. Hence, the first need in substance abuse literature is to correctly identify the subgroups inherent in the term "African American."

During the past decade, some concern has been raised regarding the adverse outcomes experienced by some African American youth due to substance use and abuse. Although African American youth consume fewer drugs than white youth, they are more likely to experience social problems as a result of their use (Scheier & Botvin, 1998). Research into modifiable constructs that can prevent this from happening needs to be undertaken. In exploring the role of personal and racial identity on drug attitudes among African American males, Townsend and Belgrave (2000) found that earlier research suggested that alcohol and drug initiation began early in this ethnic group. More research is needed in comprehending factors for alcohol and drug initiation that are unique to this racial group.

In studies exploring the ethnic disparities in the unmet needs for alcoholism, drug abuse and mental health care a greater unmet need for alcoholism and drug abuse treatment and mental health care among African American and Hispanics relative to whites has been well documented (Wells, Klap, Koike, & Sherbourne, 2001). It is noteworthy that whites are more likely than African Americans or Hispanics to use alcohol, smoke or consume illicit drugs (USDHHS, 2000). Treatment gap for illicit drug use and treatment gap for problem alcohol use are the twin objectives of Healthy People 2010 that relate directly to this significant concern for ethnic disparities and their unmet needs and aim to reduce the same.

Presently, a major limitation of the prevention literature has been the paucity of research that examines the extent to which substance use risk factors identified in studies of white adolescents generalize to African American youth. To circumvent this absence of information on the racial differences in risk factor exposure and vulnerability, current preventive interventions are based on two main assumptions that 1) the risk factors for African American and white adolescents' substance use are identical; and 2) that African American and white adolescents are equally exposed and equally vulnerable to these risk factors.

It has been reported that African Americans differ significantly in their exposure to more than half of the 55 risk factors examined. Similarly, nearly one third of the 165 tests for race differences in vulnerability were highly significant (Wallace & Muroff, 2002). Based upon the results of this study it is clear that additional theoretically and empirically rigorous race-specific research is needed to better understand the etiology of substance use among African American adolescents. Further research is also needed to identify those risk factors that are most salient for African American adolescents and most amenable to change through well designed, and culturally tailored preventive interventions.

Research studies investigating the role of cultural factors on alcohol and other drug (AOD) use have found significant relationships between the two. A recent study conducted to examine the effects of an alcohol and other drug use (AOD) intervention with minority juvenile offenders, cultural factors (discrimination, acculturation, ethnic pride and cultural mistrust) were found to be associated with pre-intervention levels of alcohol and marijuana use (Gil, Wagner, & Tubman, 2004).

In summary, it would be advisable to design all future research studies exploring substance abuse in the African American population keeping in mind the vital role of cultural factors on the same. Further, exploring the cultural dimensions for the sub groups within the "African American" community and analyzing substance abuse vis-a-vis the defining self concept of any African American group should be other important considerations for all future research work in this realm. The need of the hour is to actually replicate most of the previous research done on white populations with African American subgroups, to revalidate the assumed predictors for substance abuse in the "African American" population. This step can provide the much needed groundwork for meaningful research work. Finally, it is recommended that the existential framework of policies be renovated and overhauled mainly with a view to improve access to and quality of alcoholism, drug abuse, and mental health treatment across African American subpopulations.

References

Bass, L. E., & Kane-Williams, E. (1993). Stereotype or reality: Another look at alcohol and drug use among African American children. Public Health Reports, 108, 78-84.

Dent, C., Sussman, S., Ellickson, R, Brown, R, & Richardson, J. (1996). Is current drug abuse prevention programming generalizable across ethnic groups. American Behavioral Scientist, 39(7), 911-918.

Dodoo, F. N. A. (1997). Assimilation differences among Africans in America. Social Forces, 76(2), 527-546.

Gil, A., Wagner, E., & Tubman, J. (2004). Culturally sensitive substance abuse intervention for Hispanic and African American adolescents: Empirical examples from the Alcohol Treatment Targeting Adolescents in Need (ATTAIN) Project. Addiction (Abingdon, England), 99(Suppl. 2), 140-150.

Scheier, L. M., & Botwin, G. J. (1998). Relations of social skills, personal competence, and adolescent alcohol use: A developmental exploratory study. Journal of Early Adolescence, 18, 77-114.

Sellers, R., Smith, M., Shelton, J., Rowley, S., & Chavous, T. (1998). Multidimensional model of racial identity: A reconceptualization of African American racial identity. Personality and Social Psychology Review, 2(1), 18-39.

Townsend, T. G., & Belgrave, E Z. (2000). The impact of personal identity and racial identity on drug attitudes and use among African American children. Challenge, 26, 421-436.

United States Department of Health and Human Services. [USDHHS]. (2000). Healthy People 2010. Retrieved March 18, 2000, from http:// www.health.gov/healthypeople

Wallace, J., & Muroff, J. R. (2002). Preventing substance abuse among African American children and youth: Race differences in risk factor exposure and vulnerability. The Journal of Primary Prevention, 22(3), 235.

Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158(12), 2027-2032.

Manoj Sharma, MBBS, CHES, Ph.D. & Ashutosh Atri, MBBS, M.Ed. (candidate)

Editor, Journal of Alcohol & Drug Education

University of Cincinnati 

526 Teachers College

PO Box 210002

Cincinnati, OH 45221-0002