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

326 IV. SPECIAL POPULATIONSLiterature reviewed by Brown, Alterman, Rutherford, Cacciola, and Zaballero(1993) suggest that correlates of heroin abuse may be educational impairment,poor employment history, history of legal problems, including incarceration,and possibly psychiatric problems. A national sample of by Kandel and Davies(1991) showed that early sexual intercourse was associated with elevated lifetimecocaine use among all ethnic groups; and that a correlate to cocaine usewas daily marijuana use (defined by use at least 20 times in the last 30 days).Low rates of condom use among cocaine, marijuana, and alcohol abusersmay be contributing to an HIV epidemic among African Americans (Kingree& Betz, 2003; Timpson, Williams, Bowen, & Keel, 2003). Cocaine use, in particular,may contribute to intracerebral bleeding, renal failure, chest pain, andmyocardial infarctions in African Americans (Oureshi et al., 2001). In addition,the severity of asthma exacerbation seems to be worse in African Americanurban settings (Rome, Lippmann, Dalsey, Taggart, & Pomerantz, 2000).Several groups are also studying strategies to decrease cigarette smoking in AfricanAmericans (Ahluwalia, Harris, Catley, Okuyemi, & Mayo, 2002; Benowitz,2002; Okuyemi, Ahluwalia, Richter, Mayo, & Resnicow, 2001).A coarse reading of this literature might imply that some intrinsic naturewithin the ethnic groups accounts for the differences. Lillie-Blanton, Anthony,and Schuster (1993) conducted a study in which they regrouped participantsaccording to neighborhood rather than race or ethnicity. They held constantsocial and environmental risk factors that likely influence the racial comparisonsand applied this design to the apparent differences in crack cocaine useamong whites, Hispanics, and African Americans. This interesting analysisrevealed that the odds ratios did not vary significantly among the ethnic groups.Being African American did not place individuals at higher risk for crack use.Though this analysis does not refute the epidemiological findings of the study,it does suggest that the apparent differences may be more a product of socialconditions, including availability of drugs, than are issues intrinsic to ethnicity.Drug trafficking, often concentrated in minority neighborhoods, is a risk factorfor use (Li, Feigelman, Stanton, Galbraith, & Huang, 1998).Among African American and European Americans, there may be differentmu receptor polymorphisms (Crowley et al., 2003). However, strong evidencehas yet established that these gene findings are associated with actualdrug use (Kranzler, Gelernter, O’Malley, Hernandez-Avila, & Kaufman, 1998).One report found no association between particular dopamine receptor allelesand cocaine dependence in African Americans (Gelernter, Kranzler, & Satel,1999). Negative findings have also been reported for the association betweenserotonin transporter polymorphisms and aggression in African Americancocaine dependence (Patkar et al., 2002).It is well-known that as a result of the “war on drugs” and other pressures,African Americans arrested for drug-related charges are overrepresented in pris-