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

14. Substance Abuse in Minority Populations 329women. Mexican American men are more likely to abstain than other Hispanicmen. However, they drink more heavily and report more alcohol-related problems.Puerto Rican men have the highest prevalence of illicit drug use, 10%versus 5% of Mexican Americans (Substance Abuse and Mental Health ServicesAdministration, 2000). White Hispanic men have high rates of cirrhosis,especially among Mexican Americans (Stinson, Grant, & Dufour, 2001). Selfreportedrates of drinking and driving are highest in Hispanics and whites(Caetano & Clark, 2000). In New York City, cocaine- and opiate-positiveurine analysis in victims of firearms deaths are highest in Latino men (Galea etal., 2003). Also, Latinos and African Americans have higher rate of overdosedeaths. Cuban men had fewer abstainers, a smaller proportion of heavy drinkers,and fewer alcohol-related problems. Drinking increases with education andincome for both sexes (Caetano, 1989).According to the 1995 NHSDA, for all age groups except 12–17 years,Hispanics had the fewest members in the “ever used any illicit drug” category ascompared to whites and African Americans. Data derived from the NHSDA(1996–1997) reported that Hispanics are more likely to binge drink and usedrugs more heavily. Caetano and Medina-Mora (1990) compared the drinkingpatterns of Mexican Americans and Mexicans living in Mexico. A more permissiveattitude about alcohol use was associated with acculturation. Alcoholuse increased with acculturation in both Mexican men and woman. However,Mexican Americans reported fewer alcohol-related problems than did Mexicanmen living in Mexico. For Mexican women born in the United States, abstentionrates steadily decreased and rates of infrequent drinking steadily increasedwith acculturation. This pattern is not seen in Mexican-born women living inthe United States (Caetano & Medina-Mora, 1990). Similarly, in SouthFlorida, U.S.-born Hispanic young adults have increased rates of substanceabuse and mental health problems compared to Hispanic immigrants. Inhalantuse is reported to be high among Hispanic youth in southwestern border states.Polymorphism of the alcohol dehydrogenase 2 gene and P450 2E1 has beenreported to contribute to development of alcoholism in Mexican Americanmen (Konishi et al., 2003).Among people of need, Hispanics and African Americans compared towhites have greater unmet need for alcohol and drug abuse treatment. Hispanicsreceive active treatment 22.4% of the time, and African American 25% ofthe time, versus whites at 37% (Wells, Klap, Koike, & Sherbourne, 2001). Languagecan be the most concrete barrier to adequate treatment for Hispanics incommunities without adequate Spanish-speaking facilities. However, culturalsensitivity is not guaranteed by just speaking the language. In the state of Massachusetts,Latinos are one-third less likely to enter residential treatment(Lundgren, Amodeo, Ferguson, & Davis, 2001). For example, Spanish-speakingmale staff must be able to treat female clients with respect and be sensitive tosexual, family, and child-rearing issues. A number of authors (e.g., Szapocznik