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

14. Substance Abuse in Minority Populations 325some evidence that substance abuse in whites may be associated with greaterunderlying psychopathology, whereas African Americans may have greatersocial and environmental factors (Roberts, 1999). Early initiation of sexualactivity may be predictive of later substance abuse in African Americans(Stanton et al., 2002).Historically, a greater proportion of African Americans abstain from illicitdrug use than do whites. This difference is especially pronounced in the 12–25 agegroups. However, public databases such as the Client Data Acquisition Processand Drug Abuse Warning Network (DAWN) suggest that African Americansand Hispanics are overrepresented in categories of heroin and cocaine use. Sincethe 1980s, we have seen up-and-down patterns of perceived harm among highschool students. However, data still show a higher overall prevalence of illicitdrug use in blacks: 8.2% in blacks versus 6.1% in whites (Substance Abuse andMental Health Services Administration, 2000). Higher rates of marijuana andcocaine use account for the difference. In the 1998 National Household Surveyon Drug Abuse (NHSDA), African Americans had higher prevalence of marijuana(5 vs. 6.6%) and cocaine (0.7 vs. 1.3%) (Substance Abuse and MentalHealth Services Administration, 2000). The gap between white and black adolescents’marijuana use has disappeared. African Americans have higher rates ofmarijuana use by age 20 (Brown, Flory, Lynam, Leukefeld, & Clayton, 2004;Reardon & Buka, 2002). Also emerging from epidemiology studies is a somewhathigher concentration of heroin use among blacks as compared to whites. TheNHSDA (Substance Abuse and Mental Health Services Administration, 2000)shows that past-month use of any illicit drug is higher for whites between the agesof 12 and 25, and higher for African Americans age 26 and up. Asian/PacificIslanders show the lowest rates of past-month use across all age groups.As with alcohol, illicit drug use appears to take a greater toll on AfricanAmericans’ health, as measured by emergency department data. African Americansare overrepresented, as a percentage of the population, in emergencyroom (ER) visits. Whites represent 57.5% of ER visits compared to 21.4% byAfrican Americans (DAWN, 2004; National Institute on Drug Abuse, 2003).Although DAWN data are derived from large cities where African Americanpopulations are proportionally high, this is still an overrepresentation of ER visitsfor drug abuse. African Americans are more likely than whites to be treatedand released rather than hospitalized. The 1998 NHSDA showed cocaine is theprimary drug leading to the ER visits for African Americans. African Americansare also overrepresented in medical examiners’ morbidity data. Theyaccount for 30% of drug-related deaths, while making up 23% of the populationof the cities surveyed in DAWN. Cocaine is the most frequent cause of death,56.7%, followed by heroin and morphine. Much of the information about hardcore drug use comes from similar data derived from public facilities. These datamay seriously underestimate the number of persons who obtain alternativetreatment for medical and psychosocial problems.