Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

322 IV. SPECIAL POPULATIONSican woman of a similar background than to a single, unemployed AfricanAmerican mother dwelling in an inner city. Their experiences within ethnicgroups can be vastly different. There are scant data about differences in biologicalvulnerability for substance abuse between ethnic groups (Berrettini &Persico, 1996; Chan, McBride, Thomasson, Ykenny, & Crabb, 1994; Goldmanet al., 1993), but new, yet unconfirmed biological findings are presented later inthis chapter. This chapter highlights socioeconomic issues in substance abusetreatment for minorities.Ethnic differences among women have received attention in the literature.In terms of alcohol, African American families produce more abstainers thando European and Hispanic American families. African American women mayexpress more conservative drinking norms (Herd, 1997). African Americanwomen have rates of heavy drinking comparable to European American rates;however, they report fewer social and personal problems related to drinking.African American women may be more insulated from alcohol-related socialproblems by their families, communities, and churches. A larger proportion ofAfrican American women, however, experience alcohol-related health problemsthan do European American cohorts (Herd, 1989). One study of AfricanAmerican and Native American pregnant women shows African Americanwomen using higher quantities of malt liquor (higher alcohol content) (Graves& Kaskutas, 2001). African American women exhibit higher rates of fetal alcoholsyndrome. These findings may be attributed to issues such as nutrition andaccess to health care. Concurrent illicit drug use may also be a contributing factor.In 1998, the percentage of African American women using illicit drugs duringthe preceding month, compared to European American cohorts, was 8.1versus 7.6% in whites (Substance Abuse and Mental Health Services Administration,2000). There are higher rates of cocaine use in African American andHispanic women compared to Asian or Hispanic women.Hispanic American women are more likely than European Americanwomen to abstain, though there is a one-sided convergence with increasingacculturation. For example, in one study, 75% of Mexican immigrant womenabstained from alcohol, whereas 38% of third-generation Mexican Americanwomen were abstainers (Gilbert, 1991). Younger American-born Hispanicwomen are more likely to report moderate to heavy drinking than their immigrantcohorts. Mexican American women who use substances suffer significantlyhigher lifetime rates of physical and sexual assault (Lown & Vega, 2001).A substantially higher percentage of Native American/Alaskan Native womendrink compared to whites, blacks, or Hispanics.African American women in treatment often have myriad needs: employment,child care, and treatment for victimization and psychiatric symptoms.Personal losses, such as death of loved ones, separation, and loss of child custody,have a profound impact on drug use in African American women (Roberts,1999). Women in substance abuse treatment are oversampled in terms of