Drug Abuse/Addiction /4 pages /Follow outline/Peer Reviewed Journals attached/ 8% Plagiarism

Prevalence of Substance Use Disorders Among Latinos in the United States: An Empirical Review Update

Bianca T. Villalobos and Ana J. Bridges University of Arkansas

In 2001, the Department of Health and Human Services released the Surgeon General’s Report on Mental Health: Culture, Race and Ethnicity. This landmark report identified gaps in addressing the mental health needs of underserved populations and highlighted Latinos with substance use disorders as a vulnerable population. The current article provides readers with an update on the characteristics of Latinos in the United States and a review of the epidemiological research conducted since 2001 that has advanced our knowledge of the prevalence of substance use disorders and co-occurring mental illness among Latinos. Four epidemiological surveys are reviewed: the National Co- morbidity Survey—Replication, the National Latino and Asian American Study, the Hispanic Americans Baseline Alcohol Survey, and the National Epidemiological Sur- vey on Alcohol and Related Conditions. Compared with 15 years ago, these studies reveal: (a) Latinos’ prevalence rate of substance use disorders continues to be equal to or less than that of Whites; (b) Latino men continue to have higher prevalence rates of alcohol and drug use disorders compared with Latina women; and (c) nativity remains a strong predictor of alcohol and drug use disorders, with U.S.-born Latinos demon- strating higher rates of SUDs. On the whole, results from the 2001 report accurately reflect the current state of alcohol and drug use disorders among Latinos in the United States. We recommend future national surveys include measurement of sociocultural predictors beyond nativity and gender and consider changes in immigration patterns and language use to better understand risk and protective factors among this vulnerable population.

Keywords: Latinos, substance use, nativity, gender differences, ethnic differences

In 2001, the U. S. Department of Health and Human Services (USDHHS) released the Sur- geon General’s Report on Mental Health: Cul- ture, Race and Ethnicity (USDHHS, 2001). This report highlighted the mental health dis- parities that existed for ethnic minority popula- tions, including Latinos.1 At the time, the La- tino population comprised 35.3 million people in the United States and was projected to rise to

97 million by the year 2050 (Guzman, 2001). The findings highlighted by the USDHHS (2001) landmark report have helped identify gaps in addressing the needs of underserved populations, like Latinos, but the question re- mains whether the research and development of interventions in the last 15 years has reduced the substance use disparities that Latinos experi- enced before 2001.

The Surgeon General’s Report on Mental Health (USDHHS, 2001) revealed three key points regarding alcohol and drug problems in the Latino population:

1 In this article, the term “Latino” will be used to refer to individuals of Latin American descent, except when citing research conducted by others. When citing the research of others, the ethnic label used in the primary source will be retained. We also acknowledge that the use of the term “Latino” does not adequately address the vast social, cul- tural, and political differences among Latino subgroups in the United States.

This article was published Online First August 28, 2017. Bianca T. Villalobos and Ana J. Bridges, Department of

Psychological Science, University of Arkansas. This research was supported in part by funds awarded to

Bianca T. Villalobos from the American Psychological As- sociation, Minority Fellowship Program.

Correspondence concerning this article should be ad- dressed to Bianca T. Villalobos, who is now at the Depart- ment of Psychiatry and Behavioral Sciences, Mental Health Disparities and Diversity Program, Medical University of South Carolina, 67 President Street, Charleston, SC 29425. E-mail: [email protected]

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Journal of Latina/o Psychology © 2017 American Psychological Association 2018, Vol. 6, No. 3, 204–219 2168-1678/18/$12.00 http://dx.doi.org/10.1037/lat0000097

204

• Latinos’ rates of substance use disorders were comparable to Whites (odds ratio [OR] � 1.04; Kessler et al., 1994).

• Latino men, in particular, showed higher rates of alcohol abuse and dependence (31%) compared with White men (21%; Karno et al., 1987).

• Latinos’ use of substances was related to nativity status: U.S.-born Latinos had higher odds of drug abuse or dependence compared with immigrants2 with less than 13 years residing in the United States (OR � 9.3; Vega et al., 1998).

Given that Latinos with alcohol and drug problems are among the vulnerable popula- tions identified by the Surgeon General’s re- port (USDHHS, 2001), who additionally ex- perience numerous barriers to accessing quality mental health services (Young, Klap, Sherbourne, & Wells, 2001), the current arti- cle focuses on providing readers with an up- date on the research conducted in the last 15 years that has advanced our knowledge of the prevalence of substance use disorders and co- occurring mental illness. A particular focus will be placed on reviewing the national sur- veys that have been conducted since 2001.

The U.S. Latino Population: Then and Now

In 2000, the United States census reported that the population of Latinos rose to 35.3 million, comprising 12.5% of the total popu- lation and demonstrating an increase of about 58% since the last census in 1990 (Guzman, 2001). The 2000 census also showed the ma- jority of Latinos identified as Mexican (58.5%), while other major groups of Latinos included Puerto Ricans (9.6%), Cubans (3.5%), Dominicans (2.2%), and Salvadorians (1.9%). Comparing these statistics to the 2014 American Community Survey, the population of Mexicans has increased slightly to 64.0% and, today, continues to make up the majority of Latinos in the United States (Stepler & Brown, 2016). Moreover, the Salvadorian population in the United States increased from 655,000 in 2000 to more than 2 million in 2014, and is now the third largest Latino group, surpassing both Cubans and Domini- cans (Guzman, 2001; Stepler & Brown, 2016). In terms of geographical locations, most Latinos in 2000 resided in the West or

the South and made up only 9.8 and 4.9% of the total population in the Northeast and Mid- west, respectively. Since then, the Midwest and South have experienced the largest growth of Latinos (Ennis, Rios-Vargas, & Albert, 2011). For example, seven of the eight states whose Latino populations more than doubled from 2000 to 2010 were in the South (Ennis et al., 2011).

Census projections from the late 1990s for this rapidly growing group showed that Lati- nos would comprise one fourth of the popu- lation (97 million) by 2050 (US Census Bu- reau, 1998). Now, these numbers are closer to 119 million for 2060 projections (Colby & Ortman, 2015). Growth of the Latino popula- tion continued into 2014 with 55.4 million Latinos in the United States and trends actu- ally showing a slower rate of growth than predicted after changes in immigration pat- terns (Krogstad, 2014). Even so, the number of U.S.-born Latinos continues to increase as the foreign-born or immigrant Latino popula- tion declines (Krogstad & Lopez, 2014). This more recent shift in nativity status has many implications as studies have shown that na- tivity is related to higher rates of psychiatric disorders and, specifically, greater use of sub- stances among U.S.-born Latinos (Vega et al., 1998). Moreover, as Latinos continue to be the nation’s largest ethnic minority popula- tion, the availability of culturally and linguis- tically appropriate services poses another challenge.

Key Epidemiological Surveys Before 2001

Statistics from the Surgeon General’s Re- port on Mental Health (USDHHS, 2001) on Latinos and substance use disorders came from three epidemiological studies: the Los Angeles Epidemiologic Catchment Area (LAECA) study (Robins & Regier, 1991), the National Comorbidity Survey (NCS; Kessler et al., 1994), and the Mexican American Prev- alence and Services Survey (MAPSS; Vega et al., 1998). While there have been other sur- veys that have examined Latinos’ prevalence rates of heavy drinking and drug use (like the

2 For brevity, the term “immigrant” will be used to refer to first-generation immigrants.

205SUBSTANCE USE AMONG LATINOS

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Hispanic Health and Nutrition Examination Survey, or H-HANES), this review focuses on the three previously mentioned surveys as they were specifically cited in the Surgeon General’s Report (USDHHS, 2001). Al- though each of these surveys contributed sub- stantially to the mental health field’s knowl- edge of alcohol and drug use disorders in the Latino population, they are also characterized by significant methodological limitations.

The LAECA study (1980 –1985; Robins & Regier, 1991) was the first community survey to estimate the prevalence of Diagnostic and Statistical Manual for Mental Disorders- Third Edition disorders (DSM–III; American Psychiatric Association, 1980). The Hispanic sample in this survey was comprised of Mex- ican Americans from Los Angeles (N � 1,243). The LAECA included interviews with participants in English and Spanish to esti- mate the lifetime and 6-month prevalence of alcohol and drug abuse and dependence. Al- though the number of Hispanics in the ECA allowed for comparisons with non-Hispanic Whites, issues of generalizability meant find- ings could not be related to Hispanics of other descents or those living in other geographic regions.

The NCS (1990–1992; Kessler et al., 1994) was the first epidemiological survey to estimate the lifetime and past-year prevalence rates of DSM–III-Revised diagnoses (American Psychi- atric Association, 1987). It was also the first survey to include a more nationally representa- tive sample of Hispanics, but did not collect data on the specific subethnic populations stud- ied. The sample of Hispanics in the NCS (N � 719) was not as substantial as other surveys and included English-speakers only, which may have left those less acculturated and assimilated immigrants unaccounted for in analyses (Canino & Alegria, 2009).

Finally, the MAPSS (1994–1996; Vega et al., 1998), conducted about 10 years after the ECA, utilized a Mexican American sample from Fresno, California. Data collected by the MAPPS included lifetime, 12-, 6-, and 1-month prevalence rates of alcohol and drug use and abuse. Like the ECA, the MAPSS included a Spanish-speaking sample, but results were again limited to Hispanics of Mexican descent in California.

Epidemiological Surveys After 2001

Since 2001, the number of national epidemio- logical studies that examine rates of substance use disorders for the Latino population has increased considerably. Four epidemiological studies will be reviewed in this article: the National Comorbidity Survey—Replication (NCS-R; Kessler & Meri- kangas, 2004), the National Latino and Asian American Study (NLAAS; Alegria et al., 2004), the Hispanic Americans Baseline Alcohol Survey (HABLAS; Caetano, Ramisetty-Mikler, & Rodri- guez, 2008), and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC; Grant & Dawson, 2006). Although other national surveys have been conducted that include estimates of substance use and alcohol disorders in Latinos residing in the United States, they do not include sufficient details regarding the Latino population or measure variables that are unique to this population, limiting our ability to identify specific risk and protective factors. These four studies (NCS-R, NLAAS, HABLAS, and NESARC) address some of the limitations that existed in the prior sampling of Latino partici- pants, such as small sample sizes, inclusion of English-speaking participants only, and lack of subethnic variability with regard to participants’ countries of origin. Information regarding each study’s sample, diagnostic measures, and subeth- nic groups is presented in Table 1.

Of note, the NCS-R does not give specific information about Hispanic subethnic groups, while comparison groups for the other na- tional surveys consisted mostly of Mexicans, Puerto Ricans, and Cubans. In addition, the HABLAS collected data from Hispanic pop- ulations in only five metropolitan areas of the United States: Miami, Los Angeles, Philadel- phia, New York, and Houston. The largest Hispanic/Latino population sample comes from the NESARC, which oversampled His- panics for their study (Grant et al., 2006). All surveys utilized face-to-face diagnostic inter- views with adults 18 years and older. Al- though the NCS-R did not survey Spanish- speaking populations, the NLAAS, which used the same study procedures, collected data on this special population. For all sur- veys, criteria for substance abuse and depen- dence was based on the Diagnostic and Sta- tistical Manual of Mental Disorders-Fourth Edition (DSM–IV; American Psychiatric As-

206 VILLALOBOS AND BRIDGES

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sociation, 1994) and was used to asses past year, past month, or lifetime alcohol and drug use disorders. Overall, response rates for the surveys ranged roughly between 70 – 80%.

Prevalence Rates of Substance Use in Latino Populations

The 2014 National Survey on Drug Use and Health (Substance Abuse and Mental Health Ser- vices Administration, Center for Behavioral Health Statistics and Quality, SAMHSA, 2015) provides the most recent statistics for prevalence rates of substance use and substance use related disorders (see Table 2). Findings show that, com- pared with the general non-Hispanic White popu- lation, Latinos have similar rates of past month illicit drug use (10.4 vs. 8.9%) though demonstrate slightly lower rates of past month alcohol use (53.8 vs. 44.4%; SAMHSA, 2015). Additionally, Latinos’ prevalence rates for past year illicit drug use and alcohol use disorders was slightly higher than their non-Hispanic White counterparts, while no differences were found for co-occurring mental health and substance use disorders. Lastly, statis- tics showed that 1% of Latino adults received any kind of substance use treatment for illicit drugs or alcohol in the past year. These findings from 2014 remain consistent with those of previous national surveys (see Alvarez, Jason, Olson, Ferrari, & Davis, 2007).

Method

A review of the literature was conducted by searching databases, such as PsycINFO and EBSCO, for articles examining prevalence rates for substance use in populations of adult Lati- nos. Only articles focusing on reporting data from national epidemiological surveys are included in the review. Below we summarize the findings of 17 studies that have presented data collected from the four national surveys (HABLAS, 3 studies; NESARC, 5 studies; NCS-R, 1 study; NLAAS, 5 studies; and NLAAS and NCS-R, 3 studies). In- formation regarding key results for Latinos from these 17 studies is presented in Table 3 and cate- gorized by type of disorder: substance use disor- ders (SUDs) in general, alcohol use disorders (AUDs), drug use disorders (DUDs), and co- occurring substance use and nonsubstance use disorders (CODs). Specific results about com-

parisons made by gender, nativity status, race, and subethnic group are presented in table col- umns. Of note, a number of other variables have demonstrated significant differences across groups, including age, language proficiency, ed- ucation, and marital status, but are not presented here because of their low occurrence among the 17 studies. In addition, while there are several other studies that have examined Latinos’ prev- alence rates of binge drinking, alcohol-related problems, and general alcohol and drug use, this review focuses on only those results related to the prevalence of substance use disorders (not just use or problems related to use). Lastly, although a number of studies provided preva- lence rates for subgroups (e.g., Latino subeth- nicity, nativity, or gender), not all studies con- ducted their own significance tests comparing each group to the other. For those studies, the authors conducted their own analyses using �2

statistics.

Results

Gender Differences

In total, five studies presented data on Latino prevalence rates by gender. In general, Latina women had lower odds of developing a substance use disorder (OR � 0.12) compared with men (Alegria et al., 2007b). More specifically, the prevalence of any lifetime SUD was 17.4% for men and 4.8% for women, while 4.5% of men and 1.1% of women reported a SUD in the past year (Canino, Vega, Sribney, Warner, & Alegría, 2008). This pattern was consistent across alcohol abuse and dependence lifetime and past-year prev- alence rates (Alvanzo et al., 2011; Caetano, Ramisetty-Mikler, & Rodriguez, 2008, 2009; Grant et al., 2004a). In addition, no studies con- ducted gender comparisons for prevalence rates of drug abuse and dependence. Regarding the life- time prevalence of dual diagnoses, Latino men showed higher prevalence rates (9.9%) compared with women (3.4%; Vega, Canino, Cao, & Alegria, 2009). When comparisons were made to distinguish between co-occurring AUDs and co- occurring DUDs with any nonsubstance disorders, results showed men had higher rates of the former than women (3.8 vs. 1.4%) and comparable rates for the latter (0.6 vs. 0.4%; Vega et al., 2009).

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Nativity Differences

All studies analyzing nativity differences among Latinos (n � 9) found that U.S.-born La- tinos showed higher lifetime and past-year preva- lence rates of substance use disorders compared with immigrants. For example, compared with U.S.-born Latinos, both immigrant men and women showed significantly lower odds of life- time SUDs, OR � 0.31 and 0.07, respectively (Alegría et al., 2007a). About one-fifth of U.S.- born Latinos reported a lifetime SUD (18.9–20.4%), while immigrants showed lower prevalence rates (5.0–7.0%; Alegría et al., 2008; Alegría, Sribney, Woo, Torres, & Guarnaccia, 2007c; Canino et al., 2008). Moreover, a pattern of increasingly higher rates with more time spent in the United States as a child was also found for lifetime SUDs (11.3% for immigrants with age of arrival up to age 6; 5.4% for immigrants whose age of arrival was between seven and 17 years old; 4.9% for immi- grants arriving as adults; Alegría et al., 2007c). This pattern was also consistent for past-year SUDs. Regarding specific substance abuse and dependence, U.S.-born Latinos had higher life- time rates of AUDs (15.0–30.5%) and DUDs

(10.8 –12.0%) compared with immigrants (4.5–15.3% and 1.7–3.9%, respectively; Borges et al., 2011; Canino et al., 2008; Grant et al., 2004a). This further extended to dual diagnoses, which showed U.S.-born Latinos’ prevalence was 12.3%, while immigrants had a significantly lower rate of 2.9% (Vega et al., 2009). When analyzed further, this significant difference remains only for co-occurring AUDs, but not for co-occurring DUDs.

Ethnic/Racial Differences

Nine studies conducted ethnic/racial compari- sons between Latinos and Whites, Blacks, Asians, and/or Native Americans. Overall, these studies found that compared with Whites, Latinos have lower prevalence rates of lifetime and past-year SUDs. Rates for Latinos ranged between 11.2 to 22.8%, while Whites’ rates were significantly higher and ranged from 14.8 to 36.1% (Alegría et al., 2008; Breslau et al., 2006; Mulvaney-Day, DeAngelo, Chen, Cook, & Alegría, 2012). Prev- alence rates specific to AUDs showed, Latinos’ rates were higher than Asians and Blacks’, lower than Native Americans’, and comparable or lower than Whites’ (Breslau et al., 2006; Grant et al., 2004b; Smith et al., 2006). Regarding DUD prev- alence rates, Latinos’ rates were comparable to Asians’, comparable or lower than Blacks’, and Whites’, and lower than Native Americans’ (Bre- slau et al., 2006; Compton, Thomas, Stinson, & Grant, 2007; Grant et al., 2004b; Smith et al., 2006). Of the three studies on co-occurring disor- ders, two examined racial/ethnic differences. One study found that Latinos were two and a half times less likely to have a COD compared with Whites and three times more likely compared with Asians (Mericle, Ta Park, Holck, & Arria, 2012). Smith and colleagues (2006) found that, compared with other racial groups, Hispanics were at increased risk for both a past-year AUD with a co-occurring mood (OR � 3.1) or anxiety disorder (OR � 1.9), and DUD with a co-occurring mood (OR � 5.1) or anxiety disorder (OR � 2.8).

Subethnic Group Differences

Five studies conducted analyses comparing Latino subethnic groups. Overall past-year prevalence rates of SUDs were equal among Puerto Ricans (3.8%), Cubans (3.4%), Mexi- cans (2.7%), and other Latino groups (3.3%; Alegria et al., 2007b). Although past-year

Table 2 National Survey on Drug Use and Health 2014 Prevalence Rates of Substance Use in Percentages: General Population Versus Hispanics/Latinos

Substance use Non-Hispanic

Whites Hispanics or

Latinos

Illicit drug use Lifetime��� 53.8% 38.9% Past year��� 16.9% 15.6% Past month��� 10.4% 8.9%

Alcohol use Lifetime��� 87.0% 73.8% Past year��� 71.0% 59.9% Past month��� 57.7% 44.4%

Illicit drug use disordera��� 2.4% 2.8% Alcohol use disordera�� 6.5% 6.9% Co-occurring mental health

and SUDa 3.2% 3.3% Received any SU treatmenta

Illicit drugs .9% .9% Alcohol 1.0% 1.0%

Note. All percentages are for individuals 12 years and older except for percentages for co-occurring mental health and substance use disorders. SUD � substance use disorder; SU � substance use. a Past year. �� p � .01. ��� p � .001.

209SUBSTANCE USE AMONG LATINOS

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

T ab

le 3

N at

io na

l Su

rv ey

P re

va le

nc e

R es

ul ts

fo r

L at

in os

W it

h Su

bs ta

nc e

U se

D is

or de

rs ,

A lc

oh ol

U se

D is

or de

rs ,

D ru

g U

se D

is or

de rs

, an

d C

o- O

cc ur

ri ng

D is

or de

rs

A ut

ho r

(y ea

r) N

at io

na l

su rv

ey N

C om

pa ri

so n

w ith

no n-

L at

in os

C om

pa ri

so ns

am on

g L

at in

o gr

ou ps

N at

iv ity

st at

us co

m pa

ri so

ns G

en de

r co

m pa

ri so

ns

A ny

Su bs

ta nc

e U

se B

re sl

au et

al .

(2 00

6) N

C S-

R 5,

42 4

L if

et im

e SU

D ra

te s:

N on

e N

on e

N on

e L

at in

os �

W hi

te s

L at

in os

� B

la ck

s A

le gr

ía et

al .

(2 00

7a )

N L

A A

S 2,

55 4

N on

e O

dd s

of li

fe ti

m e

SU D

s: Pu

er to

R ic

an m

en an

d w

om en

� C

ub an

m en

an d

w om

en ,

M ex

. w

om en

O dd

s of

li fe

ti m

e SU

D s:

U .S

.- bo

rn �

Im m

ig ra

nt N

on e

A le

gr ia

et al

. (2

00 7b

) N

L A

A S

2, 55

4 N

on e

P as

t- ye

ar SU

D ra

te s:

Pu er

to R

ic an

s �

C ub

an s

� M

ex .

� O

th er

L at

in os

P as

t- ye

ar SU

D ra

te s:

U .S

.- bo

rn �

IU SC

IU SC

� L

A I

O dd

s of

pa st

-y ea

r SU

D s:

L at

in o

m en

� L

at in

o w

om en

A le

gr ía

et al

. (2

00 7c

) N

L A

A S

2, 55

4 N

on e

N on

e L

if et

im e

SU D

ra te

s: U

.S .-

bo rn

� IU

SC an

d L

A I

IU SC

� L

A I

P as

t- ye

ar SU

D ra

te s:

U .S

.- bo

rn �

IU SC

an d

L A

I

N on

e

A le

gr ía

et al

. (2

00 8)

N C

S- R

, 6,

77 6

L if

et im

e SU

D ra

te s:

L if

et im

e SU

D ra

te s:

L if

et im

e SU

D ra

te s:

N on

e N

L A

A S

L at

in os

� W

hi te

s C

ub an

s �

Pu er

to U

.S .-

bo rn

� Im

m ig

ra nt

R ic

an s,

M ex

., an

d O

th er

L at

in os

C an

in o

et al

. (2

00 8)

N L

A A

S 2,

55 4

N on

e N

on e

L if

et im

e SU

D ra

te s:

U .S

.- bo

rn �

Im m

ig ra

nt P

as t-

ye ar

SU D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

L if

et im

e SU

D ra

te s:

L at

in o

m en

� L

at in

o w

om en

P as

t- ye

ar SU

D ra

te s:

L at

in o

m en

� L

at in

o w

om en

V eg

a et

al .

(2 00

9) N

L A

A S

2, 55

4 N

on e

N on

e L

if et

im e

SU D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

(M ex

. an

d O

th er

L at

in os

) U

.S .-

bo rn

� Im

m ig

ra nt

(P ue

rt o

R ic

an s

an d

C ub

an s)

N on

e

M ul

va ne

y- D

ay et

al .

(2 01

2) N

E SA

R C

42 ,3

92 L

if et

im e

an d

pa st

-y ea

r SU

D ra

te s:

L at

in os

� W

hi te

s L

at in

os �

B la

ck s

L at

in os

� A

si an

s

N on

e N

on e

N on

e

210 VILLALOBOS AND BRIDGES

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

T ab

le 3

(c on

ti nu

ed )

A ut

ho r

(y ea

r) N

at io

na l

su rv

ey N

C om

pa ri

so n

w ith

no n-

L at

in os

C om

pa ri

so ns

am on

g L

at in

o gr

ou ps

N at

iv ity

st at

us co

m pa

ri so

ns G

en de

r co

m pa

ri so

ns

A lc

oh ol

U se

D is

or de

rs G

ra nt

et al

. (2

00 4a

) N

E SA

R C

43 ,0

93 P

as t-

ye ar

ab us

e ra

te s:

H is

pa ni

cs �

A si

an s

H is

pa ni

cs �

B la

ck s

an d

N at

iv e

A m

er .

H is

pa ni

cs �

W hi

te s

P as

t- ye

ar de

pe nd

en ce

ra te

s: H

is pa

ni cs

� A

si an

s H

is pa

ni cs

� B

la ck

s, N

at iv

e A

m er

., an

d W

hi te

s

N on

e N

on e

P as

t- ye

ar ab

us e

ra te

s: H

is pa

ni c

m en

� H

is pa

ni c

w om

en P

as t-

ye ar

de pe

nd en

ce ra

te s:

H is

pa ni

c m

en �

H is

pa ni

c w

om en

G ra

nt et

al .

(2 00

4b )

N E

SA R

C 29

,3 61

L if

et im

e A

U D

ra te

s: H

is pa

ni cs

� W

hi te

s U

.S .-

bo rn

M ex

. A

m er

. �

FB W

hi te

s U

.S .-

bo rn

an d

FB M

ex .

A m

er .

� U

.S .-

bo rn

W hi

te s

FB M

ex .

A m

er .

� FB

W hi

te s

N on

e L

if et

im e

A U

D ra

te s:

U .S

.- bo

rn M

ex .

A m

er .

� FB

M ex

. A

m er

. O

dd s

of li

fe ti

m e

A U

D s:

U .S

.- bo

rn M

ex .

A m

er .

� FB

M ex

. A

m er

.

N on

e

B re

sl au

et al

. (2

00 6)

N C

S- R

5, 42

4 L

if et

im e

A U

D ra

te s:

L at

in os

� W

hi te

s L

at in

os �

B la

ck s

N on

e N

on e

N on

e

C ae

ta no

et al

. (2

00 8)

H A

B L

A S

5, 22

4 N

on e

P as

t- ye

ar ab

us e

ra te

s (m

en ):

C ub

an A

m er

. �

M ex

. A

m er

., Pu

er to

R ic

an s,

an d

S/ C

A m

er .

P as

t- ye

ar de

pe nd

en ce

ra te

s (m

en ):

C ub

an A

m er

. �

M ex

. A

m er

., Pu

er to

R ic

an s,

an d

S/ C

A m

er .

S/ C

A m

er .

� M

ex .

A m

er .

an d

Pu er

to R

ic an

P as

t- ye

ar de

pe nd

en ce

ra te

s (w

om en

): Pu

er to

R ic

an �

M ex

. A

m er

., Pu

er to

R ic

an s,

an d

S/ C

A m

er .

N on

e O

dd s

of pa

st -y

ea r

ab us

e: H

is pa

ni c

m en

� H

is pa

ni c

w om

en

C an

in o

et al

. (2

00 8)

N L

A A

S 2,

55 4

N on

e N

on e

L if

et im

e A

U D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

P as

t- ye

ar A

U D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

N on

e

(t ab

le co

nt in

ue s)

211SUBSTANCE USE AMONG LATINOS

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

T ab

le 3

(c on

ti nu

ed )

A ut

ho r

(y ea

r) N

at io

na l

su rv

ey N

C om

pa ri

so n

w ith

no n-

L at

in os

C om

pa ri

so ns

am on

g L

at in

o gr

ou ps

N at

iv ity

st at

us co

m pa

ri so

ns G

en de

r co

m pa

ri so

ns

C ae

ta no

et al

. (2

00 9)

H A

B L

A S

5, 22

4 N

on e

O dd

s of

li fe

ti m

e de

pe nd

en ce

: Pu

er to

R ic

an s

an d

M ex

. A

m er

. �

C ub

an A

m er

.

O dd

s of

li fe

ti m

e de

pe nd

en ce

: U

.S .-

bo rn

� FB

H is

pa ni

cs O

dd s

of li

fe ti

m e

ab us

e an

d de

pe nd

en ce

: H

is pa

ni c

m en

� H

is pa

ni c

w om

en A

lv an

zo et

al .

(2 01

1) N

E SA

R C

21 ,1

06 L

if et

im e

de pe

nd en

ce ra

te s:

H is

pa ni

cs �

W hi

te s

(m en

an d

w om

en )

H is

pa ni

cs �

B la

ck s

(w om

en on

ly )

N on

e N

on e

L if

et im

e de

pe nd

en ce

ra te

s: H

is pa

ni c

m en

� H

is pa

ni c

w om

en

B or

ge s

et al

. (2

01 1)

N L

A A

S, N

C S-

R 1,

20 8

N on

e N

on e

L if

et im

e ab

us e

an d

de pe

nd en

ce ra

te s:

U .S

.- bo

rn �

L A

I U

.S .-

bo rn

� IU

SC U

.S .-

bo rn

w ith

1 U

.S .-

bo rn

pa re

nt �

U .S

.- bo

rn w

ith no

U .S

.- bo

rn pa

re nt

s

N on

e

D ru

g U

se D

is or

de rs

G ra

nt et

al .

(2 00

4b )

N E

SA R

C 29

,3 61

L if

et im

e D

U D

ra te

s: M

ex .

A m

er .

� W

hi te

s U

.S .-

bo rn

M ex

. A

m er

. �

FB W

hi te

s O

dd s

of L

if et

im e

D U

D s:

U .S

.- bo

rn an

d FB

M ex

. A

m er

. �

U .S

.- bo

rn W

hi te

s FB

M ex

. A

m er

. �

FB W

hi te

s

N on

e L

if et

im e

ab us

e an

d de

pe nd

en ce

ra te

s: U

.S .-

bo rn

� FB

O dd

s of

L if

et im

e D

U D

s: U

.S .-

bo rn

� FB

M ex

. A

m er

.

N on

e

B re

sl au

et al

. (2

00 6)

N C

S- R

5, 42

4 L

if et

im e

D U

D ra

te s:

L at

in os

� W

hi te

s an

d B

la ck

s N

on e

N on

e N

on e

Sm ith

et al

. (2

00 6)

N E

SA R

C 43

,0 93

P as

t- ye

ar D

U D

ra te

s: H

is pa

ni cs

� W

hi te

s an

d A

si an

s H

is pa

ni cs

� B

la ck

s an

d N

at iv

e A

m er

.

N on

e N

on e

N on

e

C om

pt on

et al

. (2

00 7)

N E

SA R

C 43

,0 94

O dd

s of

pa st

-y ea

r D

U D

s: H

is pa

ni cs

� W

hi te

s N

on e

N on

e N

on e

212 VILLALOBOS AND BRIDGES

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

T ab

le 3

(c on

ti nu

ed )

A ut

ho r

(y ea

r) N

at io

na l

su rv

ey N

C om

pa ri

so n

w ith

no n-

L at

in os

C om

pa ri

so ns

am on

g L

at in

o gr

ou ps

N at

iv ity

st at

us co

m pa

ri so

ns G

en de

r co

m pa

ri so

ns

C an

in o

et al

. (2

00 8)

N L

A A

S 2,

55 4

N on

e N

on e

L if

et im

e D

U D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

P as

t- ye

ar D

U D

ra te

s: U

.S .-

bo rn

� Im

m ig

ra nt

N on

e

B or

ge s

et al

. (2

01 1)

N L

A A

S, N

C S-

R 1,

20 8

N on

e N

on e

L if

et im

e ab

us e

an d

de pe

nd en

ce ra

te s:

U .S

.- bo

rn �

L A

I U

.S .-

bo rn

� IU

SC

N on

e

C o-

oc cu

rr in

g D

is or

de rs

Sm ith

et al

. (2

00 6)

N E

SA R

C 43

,0 93

O dd

s of

pa st

-y ea

r A

U D

w it

h an

y m

oo d

di so

rd er

or an

xi et

y di

so rd

er :

H is

pa ni

cs �

W hi

te s,

B la

ck s,

N at

iv e

A m

er .,

an d

A si

an s

O dd

s of

pa st

-y ea

r D

U D

w it

h an

y m

oo d

di so

rd er

or an

xi et

y di

so rd

er :

H is

pa ni

cs �

W hi

te s,

B la

ck s,

N at

iv e

A m

er .,

an d

A si

an s

N on

e N

on e

N on

e

V eg

a et

al .

(2 00

9) N

L A

A S

2, 55

4 N

on e

N on

e L

if et

im e

C O

D ra

te s:

U .S

.- bo

rn �

Im m

ig ra

nt L

if et

im e

C O

D ra

te s

(A U

D on

ly w

it h

an y

no n-

su bs

ta nc

e di

so rd

er ):

U .S

.- bo

rn �

Im m

ig ra

nt L

if et

im e

C O

D ra

te s

(D U

D on

ly w

it h

an y

no ns

ub st

an ce

di so

rd er

): U

.S .-

bo rn

� Im

m ig

ra nt

L if

et im

e C

O D

ra te

s: L

at in

o m

al es

� L

at in

o fe

m al

es L

if et

im e

C O

D ra

te s

(A U

D on

ly w

it h

an y

no n-

su bs

ta nc

e di

so rd

er ):

L at

in o

m al

es �

L at

in o

fe m

al es

L if

et im

e C

O D

ra te

s (D

U D

on ly

w it

h an

y no

n- su

bs ta

nc e

di so

rd er

): L

at in

o m

al es

� L

at in

o fe

m al

es

213SUBSTANCE USE AMONG LATINOS

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

T ab

le 3

(c on

ti nu

ed )

A ut

ho r

(y ea

r) N

at io

na l

su rv

ey N

C om

pa ri

so n

w ith

no n-

L at

in os

C om

pa ri

so ns

am on

g L

at in

o gr

ou ps

N at

iv ity

st at

us co

m pa

ri so

ns G

en de

r co

m pa

ri so

ns

M er

ic le

et al

. (2

01 2)

N L

A A

S, N

C S-

R 20

,0 13

O dd

s of

li fe

ti m

e C

O D

s: L

at in

os �

W hi

te s

L at

in os

� A

si an

s L

if et

im e

C O

D ra

te s

(D U

D an

d de

pr es

si ve

di so

rd er

): L

at in

os �

W hi

te s

L if

et im

e C

O D

ra te

s (a

ny SU

D an

d an

xi et

y di

so rd

er ):

L at

in os

� W

hi te

s

N on

e N

on e

N on

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214 VILLALOBOS AND BRIDGES

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rates show no differences, analyses using life- time prevalence of SUDs show Cubans have overall lower rates (2.7–6.6%) than all other subethnic groups (Puerto Rican � 4.5–13.8%; Mexican � 4.3–11.8%; Other Latinos � 4.8 –9.8%; Alegría et al., 2008; Vega et al., 2009) and are at decreased risk of lifetime SUDs (Cuban men OR � 0.31; Cuban women OR � 0.33) compared with their Puerto Rican counterparts (Alegria et al., 2007b). Regard- ing alcohol abuse and dependence rates, Cu- ban men showed the lowest rates (1.8 and 5.3%) compared with men from Puerto Rico (5.2 and 15.3%), Mexico (5.6 and 15.1%), and South/Central America (4.2 and 9.0%; Caetano et al., 2008). For women, results showed that those from Puerto Rico (6.4%) had the highest rates of dependence compared with other subethnic groups whose rates ranged from 0.8 to 2.1%. Rates for a dual diagnosis of substance abuse/dependence and a nonsubstance use disorder were as follows: 9.4% for Puerto Ricans, 7.1% for Mexicans, and 3.6% for Cubans (Vega et al., 2009).

Discussion

Over the past decade and a half, the number of studies evaluating Latino substance use has in- creased dramatically. Given the substantial contri- butions of more recent surveys, we ask: how do Latinos’ rates of SUDs compare to the statistics presented by the Surgeon General’s Report in 2001 (USDHHS, 2001). Overall, results suggest three key findings. First, Latinos’ prevalence rate of substance use disorders appears equal to or less than that of their White counterparts. Second, La- tino men continue to have higher prevalence rates of alcohol and drug use disorders compared with Latina women. What remains unknown is whether Latino men’s and women’s rates would remain similar to or below that of Whites if results were stratified by gender. Lastly, nativity differences remain strong predictors of alcohol and drug use disorders with U.S.-born Latinos demonstrating higher rates of SUDs.

Little has changed about the prevalence of substance use disorders among Latinos since the landmark findings of the 2001 Surgeon Gen- eral’s Report. Although, this may be the case, there is still much to be learned about how these prevalence rates might represent a continued gap between need and treatment rates across

substance use disorders. Moreover, the national surveys reviewed in this article collected data on adults only, leaving much to be discovered about Latino youth and substance use disorders over the last 15 years. Indeed, the 20-page Sur- geon General’s Report chapter on Latinos dis- cussed substance use among Latinos in only two paragraphs, with one sentence dedicated to La- tino youth (USDHHS, 2001).

Statistics showing the current increase in the Latino population is driven mostly by U.S. births, and less so by immigration, highlight the need to consider how immediate exposure to life in the United States might impact future rates of SUDs. These findings also bear considerable weight given misconceptions of Latinos as high utilizers of substances. As Latinos remain underrepre- sented in the mass media, they are overrepresented as stereotypical forms, including drug dealers and substance users (see Picker & Sun, 2012). More recently, illegal immigration has been a focus of news coverage and political debates, with many associating drug trafficking with immigration near the U.S.-Mexico border. The statistics reveal a different story, especially for Latino immigrants, who are less likely to use substances and experi- ence drug and alcohol-related problems than their U.S.-born counterparts (Whites or Latinos). Al- though most Latinos are of Mexican origin, not all research on Latinos can generalize to this popula- tion. Given trends in immigration patterns and the rapid increase of specific subethnic populations in the United States, more recent studies have recog- nized the importance of addressing variability among Latinos by including samples of Cubans, Puerto Ricans, and South/Central Americans, in addition to Latinos of Mexican descent. Although we acknowledge this variability among sub- groups, we continue to use the term “Latino” as this reflects the current status of the research con- ducted within the field. We urge researchers to recognize the social and political differences among these cultural groups to move away from generic statements and toward more nuanced cross-cultural comparisons in the future.

Future epidemiological studies should consider the characteristics of Latinos in the United States when addressing methodological issues of past surveys. For example, about one third of US La- tinos do not speak English or rate their English speaking proficiency as less than “very well” (Krogstad & Lopez, 2014). Omitting these indi- viduals from surveys meant to be representative of

215SUBSTANCE USE AMONG LATINOS

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the US Latino population would alter the gener- alizability of results because those with limited English proficiency are mostly foreign-born (Krogstad, Stepler, & Lopez, 2015) and, as de- scribed above, nativity matters.

Moving forward, epidemiological studies should also consider variables less often ex- plored in the study of substance use among Latinos. The examination of acculturation may represent a more nuanced method of under- standing how increased exposure to U.S. culture is associated with higher rates of substance use. As shown by Alegría and colleagues (2007a, 2007b, 2007c), age at the time of immigration, English-language proficiency, generational sta- tus, and perceived social standing in the United States are also important variables that demon- strate an increased use of substances along with time spent in the United States. However, only one study thus far has assessed rates of sub- stance use disorders by degree of acculturation using a measure that evaluated language use, preference for media, values, and the ethnic composition of peers and their neighborhood (Caetano et al., 2009). Given that this pattern of differences by nativity status has also been dem- onstrated among foreign-born and U.S.-born non-Hispanic Whites (Grant et al., 2004b), vari- ables related to the acculturative process can move studies away from basic racial and ethnic comparisons and toward more contextual expla- nations of group differences.

In addition to the identification of sociocultural risk factors for substance use disorders, future surveys should also evaluate nativity, cultural norms, and situational/intrapersonal factors asso- ciated with co-occurring disorders in Latinos. Fur- thermore, the identification of risk factors and protective factors that distinguish between those with substance use disorders only, mental health disorders only, and those with comorbid substance use and mental health disorders has the potential to further our conceptual understanding of co- occurrence.

Another important consideration for future surveys will be the utilization of DSM–5 cri- teria for substance-related disorders. The cri- teria for abuse and dependence combined now into one list with a threshold of two or more criteria will mean that individuals who did not previously meet diagnostic criteria for depen- dence before may now receive a substance use disorder. A study comparing the preva-

lence rates of substance use disorders with DSM–IV and DSM–5 criteria found that the prevalence rates of disorders under DSM–5 criteria were modestly and consistently higher (Peer et al., 2013). How this might affect the prevalence rates of substance use disorders among Latinos is another question. For in- stance, families of varying levels of accultur- ation may differ in their acceptance of alcohol and drug use and this could result in interper- sonal conflict for some families but not oth- ers. Thus, endorsement of continued sub- stance use despite interpersonal problems might be more likely for less acculturated households who see a family member’s drink- ing or drug use as problematic. Further, de- bate continues about the DSM’s ability to incorporate culture in the classification of dis- orders and its adherence to a universalistic approach based on Western conceptualiza- tions of mental illness (Murphy, 2015). In an effort to improve the DSM’s incorporation of culture in diagnostic assessment and treat- ment planning, the Cultural Formulation In- terview (CFI) was developed and presented in the DSM–5 (Lewis-Fernandez et al., 2014). It is hoped that the structured nature of the CFI facilitates the collection of cultural data and results in increased sensitivity to individual perceptions of illness within the context of culture (see Díaz, Añez, Silva, Paris, & Da- vidson, 2017 for an example of its use with Spanish-speaking adults from Latin Amer- ica).

On the whole, the greater attention paid to methodological considerations in evaluation of Latinos residing in the United States through epidemiological studies is an encour- aging and welcome change. Continued efforts in this direction, likely facilitated by technol- ogy, will allow researchers to better document prevalence rates, risk and protective factors, and help seeking patterns for alcohol and substance use disorders among Latinos. These are critical efforts that will enhance our abil- ity to tailor prevention and treatment efforts in the future.

Abstracto

En el 2001, el Departamento de Salud y Servicios Humanos de Estados Unidos publicó el Informe del Cirujano General sobre la Salud Mental: Cultura,

216 VILLALOBOS AND BRIDGES

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Raza y Orígen Étnico. En este informe monumen- tal se identificó brechas en abordar las necesidades de salud mental de las poblaciones marginadas, y destacó los Latinos con trastornos de uso de sus- tancias (SUDs) como una población vulnerable. Este documento ofrece una actualización de las características de los Latinos en los Estados Uni- dos y una revisión de las investigaciones epidemi- ológicas llevadas a cabo desde el año 2001 que han avanzado el conocimiento de la prevalencia de SUDs y la coocurriencia de enfermedades mentales en Latinos. Se revisan cuatro estudios epidemi- ológicos: la Replicación del Estudio Nacional de Comorbilidad (National Comorbidity Survey- Replication), el Estudio Nacional Latino y Asiático Americano (National Latino and Asian American Study), la Encuesta de Línea de Base de Alcohol en Hispanos Americanos (Hispanic Americans Base- line Alcohol Survey), y la Encuesta Nacional Epi- demiológica sobre Alcohol y Condiciones Relacio- nadas (National Epidemiologic Survey on Alcohol and Related Conditions). En comparación con hace 15 años, estos estudios revelan: (1) la prevalencia de Latinos con SUDs sigue siendo igual o menor que la de los Euro-Americanos; (2) los hombres Latinos siguen teniendo una alta prevalencia de trastornos de alcohol y drogas en comparación con las mujeres Latinas; y (3) la natividad sigue siendo un fuerte predictor de trastornos de alcohol y dro- gas, con los inmigrantes Latinos mostrando tasas más bajas de SUDs. En conjunto, los resultados del informe de 2001 reflejan el estado actual de los trastornos de alcohol y drogas entre los Latinos viviendo en los Estados Unidos. Recomendamos que, en el futuro, encuestas nacionales incluyen la evaluación de predictores sociales-culturales aparte de la natividad y el género, y consideren cambios en los patrones de inmigración y la pref- erencia de lenguaje para entender mejor los riesgos y factores protectores en esta población vulnerable.

References

Alegría, M., Canino, G., Shrout, P. E., Woo, M., Duan, N., Vila, D., . . . Meng, X. L. (2008). Prevalence of mental illness in immigrant and non- immigrant U.S. Latino groups. American Journal of Psychiatry, 165, 359–369. http://dx.doi.org/10 .1176/appi.ajp.2007.07040704

Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007a). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–75. http://dx.doi.org/10.2105/AJPH .2006.087205

Alegria, M., Shrout, P. E., Woo, M., Guarnaccia, P., Sribney, W., Vila, D., . . . Canino, G. (2007b).

Understanding differences in past year psychiatric disorders for Latinos living in the US. Social Sci- ence & Medicine, 65, 214–230. http://dx.doi.org/ 10.1016/j.socscimed.2007.03.026

Alegría, M., Sribney, W., Woo, M., Torres, M., & Guarnaccia, P. (2007c). Looking beyond nativity: The relation of age of immigration, length of res- idence, and birth cohorts to the risk of onset of psychiatric disorders for Latinos. Research in Hu- man Development, 4, 19–47. http://dx.doi.org/10 .1080/15427600701480980

Alegria, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X. L., . . . Gong, F. (2004). Considering context, place and culture: The Na- tional Latino and Asian American Study. Interna- tional Journal of Methods in Psychiatric Research, 13, 208–220. http://dx.doi.org/10.1002/mpr.178

Alvarez, J., Jason, L. A., Olson, B. D., Ferrari, J. R., & Davis, M. I. (2007). Substance abuse prevalence and treatment among Latinos and Latinas. Journal of Ethnicity in Substance Abuse, 6, 115–141. http://dx.doi.org/10.1300/J233v06n02_08

Alvanzo, A. A., Storr, C. L., La Flair, L., Green, K. M., Wagner, F. A., & Crum, R. M. (2011). Race/ethnicity and sex differences in progression from drinking initiation to the development of al- cohol dependence. Drug and Alcohol Dependence, 118, 375–382. http://dx.doi.org/10.1016/j.drugal- cdep.2011.04.024

American Psychiatric Association. (1980). Diagnos- tic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

American Psychiatric Association. (1987). Diagnos- tic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.

American Psychiatric Association. (1994). Diagnos- tic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Borges, G., Breslau, J., Orozco, R., Tancredi, D. J., Anderson, H., Aguilar-Gaxiola, S., & Mora, M. E. M. (2011). A cross-national study on Mexico-US migration, substance use and substance use disor- ders. Drug and Alcohol Dependence, 117, 16–23. http://dx.doi.org/10.1016/j.drugalcdep.2010.12 .022

Breslau, J., Aguilar-Gaxiola, S., Kendler, K. S., Su, M., Williams, D., & Kessler, R. C. (2006). Spec- ifying race-ethnic differences in risk for psychiat- ric disorder in a USA national sample. Psycholog- ical Medicine, 36, 57– 68. http://dx.doi.org/10 .1017/S0033291705006161

Caetano, R., Ramisetty-Mikler, S., & Rodriguez, L. A. (2008). The Hispanic Americans Baseline Alcohol Survey (HABLAS): Rates and predictors of alcohol abuse and dependence across Hispanic national groups. Journal of Studies on Alcohol and Drugs, 69, 441–448. http://dx.doi.org/10.15288/ jsad.2008.69.441

217SUBSTANCE USE AMONG LATINOS

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

Caetano, R., Ramisetty-Mikler, S., & Rodriguez, L. A. (2009). The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association be- tween birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups. Drug and Alcohol Dependence, 99, 215–221. http://dx.doi.org/10.1016/j.drugalcdep.2008.08 .011

Canino, G., & Alegria, M. (2009). Understanding psychopathology among the adult and child Latino population from the United States and Puerto Rico. In F. A. Villaruel, G. Carlo, J. M. Grau, M. Azmi- tia, N. Cabrera, & T. J. Chahin (Eds.), Handbook of US Latino psychology: Developmental and com- munity-based perspectives (pp. 31–44). Thousand Oaks, CA: Sage.

Canino, G., Vega, W. A., Sribney, W. M., Warner, L. A., & Alegría, M. (2008). Social relationships, social assimilation, and substance use disorders among adult Latinos in the U.S. Journal of Drug Issues, 38, 69–101. http://dx.doi.org/10.1177/ 002204260803800104

Colby, S. L., & Ortman, J. M. (2015). Projections of the size and compositions of the U.S. population: 2014 to 2060, Current population reports, P25- 1143, U.S. Census Bureau. Washington, DC: U. S. Government Printing Office. Retrieved from https:// www.census.gov/content/dam/Census/library/ publications/2015/demo/p25-1143.pdf

Compton, W. M., Thomas, Y. F., Stinson, F. S., & Grant, B. F. (2007). Prevalence, correlates, disabil- ity, and comorbidity of DSM–IV drug abuse and dependence in the United States: Results from the national epidemiologic survey on alcohol and re- lated conditions. Archives of General Psychiatry, 64, 566–576. http://dx.doi.org/10.1001/archpsyc .64.5.566

Díaz, E., Añez, L. M., Silva, M., Paris, M., & Da- vidson, L. (2017). Using the Cultural Formulation Interview to build culturally sensitive services. Psychiatric Services, 68, 112–114. http://dx.doi .org/10.1176/appi.ps.201600440

Ennis, S. R., Rios-Vargas, M., & Albert, N. G. (2011). The Hispanic population: 2010, 2010 Cen- sus Briefs, C2010BR-04. U.S. Census Bureau. Washington, DC: U. S. Government Printing Of- fice. Retrieved from http://census.gov/library/ publications.html

Grant, B. F., & Dawson, D. A. (2006). Introduction to the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29, 74–78.

Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. P., Dufour, M. C., & Pickering, R. P. (2004a). The 12-month prevalence and trends in DSM–IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol De-

pendence, 74, 223–234. http://dx.doi.org/10.1016/ j.drugalcdep.2004.02.004

Grant, B. F., Stinson, F. S., Hasin, D. S., Dawson, D. A., Chou, S. P., & Anderson, K. (2004b). Im- migration and lifetime prevalence of DSM–IV psy- chiatric disorders among Mexican Americans and non-Hispanic whites in the United States: Results from the National Epidemiologic Survey on Alco- hol and Related Conditions. Archives of General Psychiatry, 61, 1226–1233. http://dx.doi.org/10 .1001/archpsyc.61.12.1226

Guzman, B. (2001). The Hispanic Population: 2000, 2000 Census Briefs, C2KBR/01–3. U.S. Census Bu- reau. Washington, DC: U. S. Government Printing Office. Retrieved from http://census.gov/library/ publications.html

Karno, M., Hough, R. L., Burnam, M. A., Escobar, J. I., Timbers, D. M., Santana, F., & Boyd, J. H. (1987). Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non- Hispanic whites in Los Angeles. Archives of Gen- eral Psychiatry, 44, 695–701. http://dx.doi.org/10 .1001/archpsyc.1987.01800200021004

Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., . . . Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM– III–R psychiatric disorders in the United States. Re- sults from the National Comorbidity Survey. Ar- chives of General Psychiatry, 51, 8–19. http://dx.doi .org/10.1001/archpsyc.1994.03950010008002

Kessler, R. C., & Merikangas, K. R. (2004). The Na- tional Comorbidity Survey Replication (NCS-R): Background and aims. International Journal of Methods in Psychiatric Research, 13, 60–68. http:// dx.doi.org/10.1002/mpr.166

Krogstad, J. M. (2014). With fewer new arrivals, Census lowers Hispanic population projections. Washington, DC: Pew Hispanic Center. Retrieved from http://www.pewresearch.org/fact-tank/2014/ 12/16/with-fewer-new-arrivals-census-lowers- hispanic-population-projections-2/

Krogstad, J. M., & Lopez, M. H. (2014). Hispanic Nativity shift: U.S. births drive population growth as immigration stalls. Washington, DC: Pew His- panic Center. Retrieved from http://www.pew hispanic.org/2014/04/29/hispanic-nativity-shift/

Krogstad, J. M., Stepler, R., & Lopez, M. H. (2015). English proficiency on the rise among Latinos: U.S. born driving language changes. Washington, DC: Pew Hispanic Center. Retrieved from http:// www.pewhispanic.org/2015/05/12/english-pro ficiency-on-the-rise-among-latinos/

Lewis-Fernández, R., Aggarwal, N. K., Bäärnhielm, S., Rohlof, H., Kirmayer, L. J., Weiss, M. G., . . . Lu, F. (2014). Culture and psychiatric evaluation: Operationalizing cultural formulation for. DSM–5. Psychiatry, 77, 130–154. http://dx.doi.org/10 .1521/psyc.2014.77.2.130

218 VILLALOBOS AND BRIDGES

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

Mericle, A. A., Ta Park, V. M., Holck, P., & Arria, A. M. (2012). Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: Variations by race/ethnicity. Comprehensive Psychiatry, 53, 657–665. http://dx .doi.org/10.1016/j.comppsych.2011.10.002

Mulvaney-Day, N., DeAngelo, D., Chen, C. N., Cook, B. L., & Alegría, M. (2012). Unmet need for treatment for substance use disorders across race and ethnicity. Drug and Alcohol Dependence, 125(Suppl. 1), S44–S50. http://dx.doi.org/10.1016/ j.drugalcdep.2012.05.005

Murphy, D. (2015). “Deviant deviance”: Cultural diversity in DSM–5. In S. Demazeux & P. Singy (Eds.), The DSM–5 in perspective: Philosophical reflections on the psychiatric babel (pp. 97–110). Dordrecht, Netherlands: Springer.

Peer, K., Rennert, L., Lynch, K. G., Farrer, L., Gelernter, J., & Kranzler, H. R. (2013). Prevalence of DSM–IV and DSM–5 alcohol, cocaine, opioid, and cannabis use disorders in a largely substance dependent sample. Drug and Alcohol Dependence, 127, 215–219. http://dx.doi.org/10.1016/j.drugal- cdep.2012.07.009

Picker, M., & Sun, C. (Director & Producers). (2012). Latinos beyond reel: Challenging a media stereotype. United States: The Media Education Foundation.

Robins, L. N., & Regier, D. A. (1991). Psychiatric disorders in America: The epidemiologic catch- ment area study. New York, NY: Free Press.

Smith, S. M., Stinson, F. S., Dawson, D. A., Gold- stein, R., Huang, B., & Grant, B. F. (2006). Race/ ethnic differences in the prevalence and co- occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alco- hol and Related Conditions. Psychological Medi- cine, 36, 987–998. http://dx.doi.org/10.1017/ S0033291706007690

Stepler, R., & Brown, A. (2016). Statistical portrait of Hispanics in the United States. Washington,

DC: Pew Hispanic Center. Retrieved from http:// www.pewhispanic.org/2016/04/19/statistical- portrait-of-hispanics-in-the-united-states/

Substance Abuse and Mental Health Services Administra- tion, Center for Behavioral Health Statistics and Qual- ity. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15–4927, NSDUH Series H-50). Retrieved from http://www .samhsa.gov/data/

U.S. Census Bureau. (1998). Population Profile of the United States: 1997, Current Population Re- ports, P23-194. Washington, DC: U.S. Govern- ment Printing Office. Retrieved from https://www .census.gov/prod/3/98pubs/p23-194.pdf

U.S. Department of Health and Human Services (USDHHS). (2001). Mental health: Culture, race, and ethnicity—A Supplement to mental health: A report of the Surgeon General. Rockville, MD: Author.

Vega, W. A., Canino, G., Cao, Z., & Alegria, M. (2009). Prevalence and correlates of dual diagno- ses in U.S. Latinos. Drug and Alcohol Depen- dence, 100, 32–38. http://dx.doi.org/10.1016/j .drugalcdep.2008.08.018

Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Al- derete, E., Catalano, R., & Caraveo-Anduaga, J. (1998). Lifetime prevalence of DSM–III–R psychi- atric disorders among urban and rural Mexican Americans in California. Archives of General Psy- chiatry, 55, 771–778. http://dx.doi.org/10.1001/ archpsyc.55.9.771

Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The quality of care for depressive and anxiety disorders in the United States. Ar- chives of General Psychiatry, 58, 55–61. http://dx .doi.org/10.1001/archpsyc.58.1.55

Received May 31, 2016 Revision received June 1, 2017

Accepted June 4, 2017 �

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