|| Bridging Science and Culture to Improve Drug Abuse Research in Minority Communities
This Conference was held at the Wyndham Franklin Plaza hotel in Philadelphia, P.A., September 24-26, 2001.
Race and Racism in Scientific Research
James M. Jones, Ph.D.
Although race is historically a biological idea, scientific evidence leads to a conclusion that it has little explanatory power in human behavior. However, race still matters in our society and in people's lives because of its socially constituted significance. Racism captures one of the enduring aspects of race for its targets. The presentation argues that race is an accessible psychological construct for targets of racism and thus influences their judgments and experiences on a daily basis. Research in social psychology will reveal some evidence for the reality of perceptions of racism and some of the behavioral and psychological responses its targets make. It is further argued that culture is confounded with race. Systematic variations in experience because of one's race lead to differences in culture, which in turn shape differences in behavior. Cultural psychology argues that culture and psyche are intertwined and thus "make each other up." Recent evidence suggests that drug use may follow from elevated levels of stress. Racism is a stressor. A psychological theory of African American culture called TRIOS is presented as an illustration of how culture can reveal within-race differences as well as identify some relevant aspects of adaptation and coping with racism.
The Power of Race/Ethnicity, Culture, and Science in Understanding Drug Abuse
Kathy Sanders-Phillips, Ph.D.
This presentation will focus on the biological, social, and cultural definitions of race with particular emphasis on relationships among race, health, and risk behaviors such as substance abuse in ethnic minority groups. Theoretical constructs of race will be reviewed, and the mechanisms by which race and culture may influence substance use in ethnic minority populations will be assessed. The relative contributions of SES, poverty, education, and experiences of oppression to relationships between race and substance abuse will also be examined. A conceptual framework for understanding and examining relationships between race and substance abuse will be presented.
An Overview of Drug Use and Associated Problems Experienced by Racial and Ethnic Minority Populations in the United States
James C. Anthony, Ph.D.
With respect to illegal drug use and other problems, epidemiology primarily seeks answers to five questions: (1) Within the population at large, how many are affected? (2) Where in the population are affected individuals most likely to be found, with focus on subgroups defined mainly by characteristics of person, place, and time? (3) What individual conditions, factors, or processes account for the observed variations? (4) What are the linkages of states and processes, or causal mechanisms, that account for the observed variations? (5) What can we do to prevent, delay, or reduce the impact of the associated problems? This presentation offers a selection of recent epidemiologic evidence on the first three of these questions, with a focus on variations observed in relation to self-identification with respect to racial and ethnic minority subgroups of the U.S. population.
Social Consequences and Criminalization of Drug Use in Minority Communities
Martin Y. Iguchi, Ph.D.
This presentation will argue that one manner in which drug use disproportionately affects the health of minority communities is through the devastating consequences of a felony conviction and subsequent entry into prison. The presentation will discuss the disproportionately large numbers of Black and Hispanic men and women entering prison for a drug offense and will explore the numerous related consequences of such an event. Specifically discussed will be how current drug policy may negatively impact and perpetuate patterns of health and well-being in minority communities. Multiple ways in which a felony drug conviction and subsequent entry into prison might interact with other Federal policies to impact the health and well-being of an individual and his or her community will be discussed. These areas of impact include, but are not limited to, children and families, access to health benefits, access to housing benefits, access to higher education assistance, immigration status, employment, eligibility to vote, and drug use.
The Medical Consequences of Drug Use in Minority Populations
Henry L. Francis, M.D.
The American population underestimates which drugs of abuse are most dangerous and does not know the characteristics of drug use in the United States. In general, the drug most associated with crime and property damage is alcohol. At least 11 million persons have five drinks per day at least five times each month. The number of addicted alcohol users is larger than the number of users of heroin, cocaine, methamphetamines, and hallucinogens combined. Different population groups use different drugs. White American populations tend to abuse alcohol and methamphetamines whereas African Americans and Hispanics prefer to use heroin and cocaine, respectively.
Numerous legal and illegal addictive drugs and behaviors are associated with crime, illness, and social disturbance. Illicit drugs most commonly used in the United States include, in descending order, marijuana, cocaine, heroin, methamphetamines, inhalants, hallucinogens, and anabolic steroids. Alcohol, cigarettes, food, sex, and gambling addictions, however, are responsible for more morbidity and mortality than are illicit drugs. Rates of illicit drug use vary by ethnicity, gender, age, education level, and geographic location. Although 74 percent of all current illicit drug users are White non-Hispanics, the rates of drug use are similar between ethnic groups—7.5 percent of the Black population, 6.4 percent of the White population, and 5.9 percent of the Hispanic population.
Although minority groups make up about 26 percent of the U.S. population, about 74 percent of drug-related AIDS cases occur in minority populations. Women are up to eight times more likely than men to contract HIV sexually and are the fastest growing group of AIDS cases. About 60 percent of the cases in women are drug-related. About one-half of drug-related, female AIDS cases are among Black women, for whom AIDS has been the leading cause of death since 1993.
Minority groups suffer significantly from drug use and HIV-related medical problems. Prevention and treatment of drug use, HIV infection, and comorbid conditions simultaneously will be critical for controlling and reducing these major problems.
Testing the Effectiveness of a Public Health Approach to Treating Substance-Abusing Women on Welfare
Jonathan Morgenstern, Ph.D.
Substance abuse (SA) among disadvantaged, parenting women has long been identified as a major public health problem. However, as States move to implement welfare reform, efforts to effectively address this problem take on greater urgency. This report describes preliminary findings from a study currently in progress to test the effectiveness of a public health approach to intervening with this population. The report will (1) describe the study rationale, design, and interventions, (2) compare baseline characteristics of substance-abusing women on welfare with a nonaffected comparison group, and (3) report on SA treatment entry and retention data for an initial cohort of participants. A standardized battery was administered to women (N=220) recruited in a welfare setting who either met current DSM-IV substance-dependence criteria or did not meet criteria for a substance use disorder in the prior 5 years. Substance-dependent women had significantly greater employment, mental health, family, medical, and housing problems, suggesting they would experience substantially greater barriers to employability. Substance-dependent women were then randomly assigned to receive a referral either to SA treatment or to an intensive case management intervention (ICM). Women assigned to ICM had significantly higher rates of SA treatment entry and attendance. Overall, women who received a referral only to SA treatment had low rates of treatment attendance. Findings are discussed in the context of the current interface between substance abuse and welfare-to-work services.
Behavioral Interventions With Minority Populations
Karen Y. Mechanic, M.D.
The objectives of this presentation are as follows:
Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. (1997) Substance Abuse: A Comprehensive Textbook. Third Edition. Philadelphia: Lippincott Williams & Wilkins.
- To define Cognitive Behavioral Therapy
- To compare and contrast Cognitive Behavioral Therapy with other behavioral treatments such as:
- Cognitive Therapy
- Community Reinforcement
- Motivational Enhancement Therapy
- The 12-Step Model
- Interpersonal Therapy
- To discuss the role of research in the development of behavioral treatments specifically with regard to:
- Research methods
- Research findings
- Future research directions
National Institute on Drug Abuse Therapy Manuals for Drug Addiction.
Drug Abuse and Co-Occurring Conditions in Racial/Ethnic Populations
Linda B. Cottler, Ph.D.
Data on the comorbidity of drug abuse and addiction and psychiatric disorders in racial/ethnic minority communities are sparse. Often, the sample size is too small to make comparisons by race. In this presentation, research findings will be disseminated concerning this area of investigation. Relying on the findings from several NIDA-funded studies, specific issues such as the co-occurrence of alcohol abuse and dependence, nicotine dependence, and illicit drug abuse and dependence along with DSM-III-R or DSM-IV psychiatric illnesses will be covered. The effect of cultural bias attributed to assessments, sample selection, and even the diagnostic criteria themselves will be discussed for their impact on research findings. Literature will also be reviewed for studies that compare comorbidity rates by race and gender in order to expand the dialogue and increase and improve drug abuse research in minority communities.
Comorbidity of Addiction and Severe Mental Illness
E. Cabrina Campbell, M.D.
The purpose of this presentation is to discuss substance abuse in bipolar disorder and schizophrenia. The lifetime prevalence of substance abuse in both of these disorders exceeds 50 percent (Regier et al., 1990; Dixon et al., 1991).
We will explore the more commonly abused substances in bipolar disorder. We will reflect on the problems encountered in making an accurate diagnosis when substances are involved and elucidate how addiction affects the course of illness. Treatment options for dual diagnosed patients will be given as well.
In schizophrenia, we will concentrate on abuse of cocaine in particular. Cocaine addiction in schizophrenia is an intriguing area of study because of the proposed involvement of the neurotransmitter dopamine in both disorders. Schizophrenics who abuse substances are more likely to experience symptom exacerbation, rehospitalization, treatment noncompliance, and poor outcomes (Westermeyer, 1992; Siebyl et al., 1993). A framework for treatment with atypical versus typical antipsychotics will be presented.
Implementing HIV/AIDS Risk Reduction Interventions
Torrance Stephens, Ph.D.
A standard protocol for implementing HIV/AIDS, STD, and other infectious disease risk reduction interventions for soon-to-be-released adult male inmate populations will be presented. Specific focus will be placed in curriculum development, use of patient education, and self-help methodologies for reducing the occurrence of problem behaviors as well as recidivism. Moreover, a summary of the study in concert with a descriptive profile of study participants will be presented as well as qualitative observations regarding the significance of using peers (former inmates) to implement study activities (interviewing, curriculum, and community followup).
Drug Treatment and Minority Populations in Prison and Work Release
Steven S. Martin, M.A., Ronald A. Beard, M.H.S.
Given the disproportionate number of minorities in prison and work release, particularly African Americans, it is not surprising that minorities are often the majority in correctional treatment programs. In this presentation, we discuss some of the issues involving minority status and substance abuse treatment, particularly as they apply in therapeutic communities. Then we examine some data on short- and long-term outcomes of treatment by minority status. The data come from an ongoing investigation of the treatment effects of a therapeutic community continuum of treatment in the Delaware correctional system. Results suggest that effective treatment can reduce racial disparities in the likelihood of relapse to drug use and recidivism.
Preventing HIV/AIDS With Hispanic and Native American Women
Barbara Estrada, M.S., Sally Stevens, Ph.D., A. Estrada
AIDS surveillance data by race/ethnicity indicate a disproportionately high percentage of people from minority groups who have AIDS (Centers for Disease Control and Prevention, 1999). Nearly equal numbers of AIDS cases were reported among Hispanic and White women in 1999, although the percentage of AIDS cases was over seven times higher among Hispanic women. In addition, recent data indicate an increase in the number of new cases of HIV infection among American Indians and Alaska Natives (Stevens and Estrada, 2000). Women in the United States are being diagnosed with AIDS at a rate four times higher than that for men. Given these trends, gender and culturally competent prevention strategies are urgently needed.
This presentation focuses on the development, implementation, and success of two HIV prevention interventions for minority women in southern Arizona. The first intervention was developed from feminist theory and utilized feminist methodology for an ethnically diverse group of drug-involved women. The second intervention incorporated a culturally innovative intervention for injection drug-using Hispanic women. These interventions resulted in statistically significant reductions in both drug- and sex-related risk behaviors in the populations served.
HIV Risk Reduction Targeting African American Female Crack Users
Claire E. Sterk, Ph.D.
HIV risk reduction interventions have shown the need for gender- as well as race-specific programs that take the daily lives of members of the target population into consideration. Available research also has shown HIV risk reduction interventions among drug users to have a larger effect in sexual than in drug use-related behavioral change. When studying female crack users, it is important to focus not only on individual but also on household and community risk and protective factors. Prevalence and incidence data show crack use among women to be highest among African American women, and research also shows crack use specifically has been marketed in inner-city neighborhoods. Challenges emerge in identifying risk and protective factors at all levels, designing interventions that are appropriate, linking research and individual/community needs, and developing programs that give ownership to members of the target population. Future research challenges include, but are not limited to, the need to provide comprehensive interventions, to acknowledge the multiple social roles occupied by the women and their relationships with others, and to connect micro-level conditions with macro-level forces such as racism, sexism, and classism.
Sterk C. (1999) Building bridges: Community involvement in HIV and substance abuse research. Drugs and Society 14(1-2):107-121.
Sterk C. (1999) Fast Lives: Women Who Use Crack Cocaine. Philadelphia: Temple University Press.
Sterk C, Elifson K, Theall K. (2000) Women and drug treatment experiences: A generational comparison of mothers and daughters. Journal of Drug Issues 30(4):839-862.
From Research to Practice: The Case of Project ALERT
Phyllis L. Ellickson, Ph.D.
Using Project ALERT as an example, this presentation discusses the process of taking an exemplary drug prevention program from research trial to national dissemination. The curriculum, which was developed and tested in the late 1980s, is now one of the most widely disseminated among the evidence-based drug prevention programs for middle school students. The presentation discusses the challenges facing programs when they scale up to a national level, how Project ALERT has met those challenges, ongoing issues related to program fidelity and institutionalization, and the Federal role in disseminating research-based prevention programs.
Ellickson PL. (1999) School-based substance abuse prevention: What works, for whom, and how? In S. Kar (ed.), Substance Abuse Prevention: A Multicultural Perspective. Amityville, New York: Raywood Publishing Company, Inc.
Ellickson PL, Bell RM. (1990) Drug Prevention in junior high: A multi-site longitudinal test. Science 247:1299-1305; also RAND, R-3919-CHF.
Ellickson PL, Bell RM, McGuigan K. (1993) Preventing adolescent drug use: Long-term results of a junior high program. American Journal of Public Health 83(6):856-861; also RAND, RP-208.
Preventing Drug Abuse With Life Skills Training
Kenneth W. Griffin, Ph.D., M.P.H., Gilbert J. Botvin, Ph.D.
National survey data indicate that drug abuse among American youth increased consistently during the 1990s. Fortunately, over the past few decades, our understanding of the etiology and prevention of drug abuse among youth has increased as well. Prevention programs have evolved from traditional information-dissemination approaches to more comprehensive contemporary programs that focus on drug-related expectancies (attitudes, norms) and social resistance skills. The Life Skills Training (LST) program, one of the most thoroughly evaluated school-based programs, is an effective competence enhancement program that teaches important personal self-management skills and social skills, in addition to drug-specific content. The LST program has been shown to be highly effective in short- and long-term evaluation studies in terms of preventing tobacco, alcohol, marijuana use, gateway polydrug use, and illicit drug use. The LST program has also been shown to be effective for a variety of populations, including both suburban White youth and inner-city minority youth. The primary aim of this presentation will be to describe the LST program and its theoretical basis and review the scientific evidence on its effectiveness with different target populations. Findings from a recent large-scale randomized controlled trial of the LST program among inner-city minority youth in New York City will be reviewed. In addition, some future directions for prevention intervention research for minority youth will be discussed, including issues in disseminating programs that have been proven to be effective.
Career-Oriented Prevention for African American Middle School Students
James P. Griffin, Jr., Ph.D.
The BRAVE (Building Resiliency and Vocational Excellence) Program's overarching goal is to facilitate young people's successful compliance with ATOD- and violence-free lifestyles. This vocationally oriented prevention research initiative serves eighth grade African American (AA) adolescent males and females, ages 12-15, who attend a regular, public middle school. It uses a resiliency-grounded, vocational context along with mentoring, peer support, and goal-setting.
Participants include, but are not limited to, the following AA male and female adolescents: youths who have current, historical, or pending rule violations (e.g., school infractions or legal charges), youths originating from economically disadvantaged or female-headed households, and youths in danger of facing academic probation or becoming dropouts. Other participants could be considered model students whose appropriate adaptive skills for navigating their community in accord with the aims of the initiative the program organizer seeks to reinforce and augment.
Consequently, the BRAVE Program operates on the following premise. Youths who cultivate appropriate adaptive skills through prosocial skill-training for community settings, internalize social norms that equate manhood and womanhood with personal responsibility, develop potentially rewarding vocational careers, and attach themselves to positive, successful community role models will be less likely to become involved with alcohol, tobacco, and other drugs and to engage in violence.
The presentation examines lessons learned from implementation of the program to date and presents preliminary findings regarding the operation of the program.
Research was funded by the National Institute on Drug Abuse.
Hooked on Tobacco: Issues in African American Teen Smokers
Eric T. Moolchan, M.D., Miqun L. Robinson, M.D., Ph.D., Ivan Berlin, M.D., Jean Lud Cadet, M.D.
Previous reports have indicated ethnic differences in both tobacco-related morbidity and treatment outcome for smoking cessation among adults. We assessed smoking-related characteristics in African American (AA) and non-African American (non-AA) teenagers applying to a cessation trial. A total of 399 teens (15.6±1.5 years, 62 percent females, 33 percent AA) responded via telephone to media ads. Self-reported sociodemographic, medical, and smoking-related data were obtained to determine preeligibility for trial participation. Compared with non-AA, AA had lower FTND scores (5.37±2.18 versus 6.16±2.10; p<.01) and smoked fewer cigarettes per day (12.1±8.47 versus 15.7±7.3; p<.04). AA teens reported shorter duration of smoking (3.16±1.93 versus 4.0±2.05 years; p<.001) and time elapsed between first cigarette ever smoked and daily smoking (0.88±1.05 versus 1.31±1.33 years; p<.002). AA and non-AA teens had similar frequency of reported health problems (e.g., asthma, psychiatric conditions). These data suggest that cessation treatment programs designed for African American youth should include lower Fagerström-defined levels and possibly other criteria for tobacco dependence. Our findings also highlight the importance of ethnocultural issues in treatment research programs.
Culturally Sensitive Family-Based Treatment for Adolescent Substance Abuse
Tanya Quille, Ph.D., Howard A. Liddle, Ed.D.
This presentation focuses on the research processes and products of studying culturally sensitive treatments for adolescent substance abusers. It details the treatment development framework that guides our clinical research. This framework includes significant attention to the rationale and methods for developing culturally specific interventions as well as the execution of diverse research strategies to facilitate this process. Specific examples from our therapy development of culturally specific, multiple systems-oriented, community-based interventions with African American and Hispanic teenagers and families will be presented, and therapy videotapes will be used to illustrate the steps and nuances of the culturally rooted interventions.
Jackson-Gilfort A, Liddle HA, Dakof G, Tejeda M. (in press) The relationship of cultural theme discussion to engagement with drug using, African American male adolescents in family therapy. Journal of Black Psychology.
Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M. (2001) Multidimensional family therapy for adolescent substance abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse 27(4):651-687.
Rowe CL, Liddle HA, McClintic K, Quille T. (in press) Integrative treatment development: The case of Multidimensional Family Therapy for adolescent substance abuse. In J. Lebow (ed.), Handbook of Psychotherapy (Volume on Integrative Therapies). New York: John Wiley and Sons.