From “Kickeando las malias” (Kicking the Withdrawals) to “Staying clean”: The Impact of Cultural Values on Cessation of Injection Drug Use in Aging Mexican-American Men

Abstract

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users’ adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

Keywords :

• Heroin use
• cultural values
• Hispanics
• Mexican Americans
• cessation
• aging
• injection drug use
• risk factor
• protective factor
• qualitative research

THE AUTHORS

David V. Flores, Ph.D., L.M.S.W., M.P.H., C.P.H., is currently an Assistant Professor at the University of Texas Medical School Houston, the Associate Director of the Texas Elder Abuse and Mistreatment Institute, an Adjunct Assistant Professor for the Houston Geriatric Elder Center, and has a Research Appointment at the Center for Drug and Social Policy Research at the University of Houston. David is also a Licensed Masters level Social Worker and holds a Certification in Public Health. He received his Doctorate and Masters in Social Work from the University of Houston's Graduate College of Social Work, a Masters of Public Health with a focus on “Health promotions and Behavioral Science” from the University of Texas Health Science Center's School of Public Health Houston, a Bachelor of Arts in Sociology from the University of Houston, and a Bachelor of Arts in Psychology from the University of Houston. His primary research has been centered on health disparities among underserved populations including substance abuse, elder mistreatment, minorities, older adults, and health issues over the life course.

Luis R. Torres, Ph.D., is an Assistant Professor in the Graduate College of Social Work at the University of Houston and a researcher with both the Center for Drug and Social Policy Research and the Child and Family Center for Innovative Research. Prior to coming to the University of Houston, Dr. Torres completed a two-year National Institute of Drug Abuse (NIDA)-funded Post-Doctoral Research Fellowship in the George Warren Brown School of Social Work at Washington University in St. Louis. His research agenda focuses on health disparities, specifically co-occurring mental health, substance use and medical disorders in Hispanics, and on family-strengthening efforts with a focus on Hispanic communities. He is currently the Project Director of an NIDA-funded study examining health consequences of long-term injection heroin use in aging Mexican-American men. Dr. Torres is also a Co-Principal Investigator in a national implementation evaluation of grantees in the federal Hispanic Healthy Marriage Initiative, focusing on issues of cultural resonance and cultural adaptations, and a Co-Principal Investigator in a national study examining programs that serve Hispanic fathers. Dr. Torres, a native of Puerto Rico, has a Doctorate in Clinical Psychology from Fordham University in New York City and over 20 years of clinical, administrative, and research experience.

Isabel Torres, Dr.P.H., is an Associate Professor at the Graduate College of Social Work, University of Houston, and a Visiting Associate Professor in the Department of Palliative Care and Rehabilitation Medicine and the Dorothy I. Height Center for Health Equity and Evaluation Research at the University of Texas MD Anderson Cancer Center. Her current area of research addresses ethnic health disparities in palliative cancer care with an emphasis on factors that influence the quality of advanced cancer care among underserved or vulnerable populations. She recently completed a National Cancer Institute (NCI)-funded research supplement to Promote Diversity in Health-Related Research titled “Caregiver Assessments of the Quality of Home Hospice Care: A Comparison Across 3 Ethnic Groups” and is expanding this line of inquiring through a 5-year NCI-funded Mentored Research Scientist Development Award (K01), titled “End-of-Life Treatment Preferences of Latino Medicare Beneficiaries with Cancer”. Dr. Torres has extensive expertise in conducting cross-national surveys that include the successful completion of three landmark cross-national surveys of Latin American physicians assessing the quality of advanced cancer care, parenteral hydration prescribing patterns, and attitudes and beliefs regarding communication with advanced cancer patients. Her research training and experience spans cross-cultural health, health services organization, survey and intervention design and analysis, and qualitative research methods. Her research interests include cancer health disparities, community-based participatory research, palliative and geriatric care, international health, medical mistrust/racism, and informed decision making. The recipient of numerous academic, research and community awards, Dr. Torres was recently invited by Lancet Oncology to participate in the 2011 Latin American Oncology Summit and in the Commission on the Status of Cancer Care in Latin America report to be published in 2013. Dr. Torres has well established, strong relationships with the Latino community(ies) and a proven track-record of successful collaborations.

Patrick S. Bordnick, Ph.D., M.P.H., M.S.W., is the Director of the Virtual Reality Clinical Research Lab, the Child and Family Center for Innovative Research, the Center for Drug and Social Policy Research, and a behavioral scientist. Dr. Patrick S. Bordnick is a Professor with the Graduate College of Social Work, University of Houston. Dr. Bordnick has over 17 years experience in clinical and laboratory research on cocaine, marijuana, alcohol, amphetamine, and nicotine addiction. His research interests include clinical medication trials, treatment development, human laboratory studies, virtual reality, and novel data collection/techniques. Dr. Bordnick received research grants from the National Institutes of Health (NIH) for nicotine craving, alcohol craving, and vertual reality (VR) alcohol treatment development. Dr. Bordnick is also a Coresearcher on many NIH-funded projects and has had numerous state and privately funded projects on drug craving and reactivity. Dr. Bordnick received an international award in 2004 for outstanding scientific merit in VR drug abuse research from the Canada Chair in Cyber Psychology. As a human–computer interaction (HCI) futurist, Dr. Bordnick envisions a world where humans interact seamlessly with technology, to improve teaching, research, therapy, and aid in knowledge building. Using technology to solve real-world problems has been the hallmark of Dr. Bordnick's work. His current projects include virtual reality systems for assessing drug use triggers and craving, virtual reality treatment software for nicotine dependence, virtual reality programs for studying drug use contexts, web-based self-help programs for obsessive–compulsive disorder (OCD) and program to aid veterans locate resources, and testing clinical teaching systems based on artificial intelligence platforms. Dr. Bordnick is one of the foremost experts in the world on virtual reality cue reactivity.

Yi Ren, M.A., is currently a Ph.D. student of the Graduate College of Social Work at the University of Houston since 2011. Yi received a Bachelor's degree in English Culture and Language from the University of International Relations in Beijing, China, in 2002. In 2004, she received a Master's degree in Social and Public Policy with an emphasis on China's welfare policy design from Leeds University in England. In 2011, she received her second Master's degree in Sociology from the University of Houston. Yi's professional and research interests included cross-ethnic and cross-national research in child welfare policy and substance abuse.

Melissa I. M. Torres, M.S.W., is a Ph.D. student at the University of Houston's Graduate College of Social Work. She is currently a Research Assistant for at the University of Houston's Center for Drug and Social Policy Research and the University of Texas Health Science Center's School of Public Health. Her work, internship, and volunteer experiences have ranged from being an outreach worker to conducting HIV tests to researching and advocating for child trafficking victims during legislative sessions of Texas. Her research interests include international sex trafficking, global AIDS, IDUs, conflict, and crisis response, all from a feminist perspective and with a focus on Latina/os. Her current projects and research focus on heroin use in Latino communities, Latinas in the international sex trade, and HIV risk behaviors among high-risk social networks.

Freddie DeLeon, M.S.W., has extensive experience conducting outreach and field work on numerous NIH-funded research projects. He is a bilingual Social Worker and highly knowledgeable about street social networks in Mexican-American communities. He is trained in various qualitative research approaches, including ethnography and participant observation.

Irene Pericot-Valverde, M.S., PhDc (PhD Candidate), is a Ph.D. student at the Department of Psychology of the University of Oviedo, Spain. In 2009, Irene completed her degree in Psychology from the University of Barcelona and finished her Master degree on Personality and Behavior in 2010. In the same year, Irene has been awarded with a predoctoral scholarship at the University of Oviedo. Mrs. Pericot-Valverde research field is focused on the efficacy of virtual reality exposure techniques for smoking cessation. As a member of the Addictive Behaviors Research Group at the University of Oviedo, her major research areas are the assessment, prevention, and treatment of addictive behaviors. Specifically, her research lines are the use of contingency management techniques, the assessment of impulsivity and neuropsychological functioning, and the use of cue exposure treatment through virtual procedures.

Tenee Lopez, B.A., is currently an undergraduate student attending the University of Houston with a major in biochemistry. She began taking an interest in research while enrolled at the University of Texas at Brownsville during her freshman year and worked with Dr. Luis Colom in his Septo-Hippocampal Pathophysiology lab. But it was not until she became a recipient of the NIDA Underrepresented Minorities 2011 Summer Research Program that she began to focus on drug abuse research. Once at the University of Houston, she began working with Dr. Luis Torres in the Center for Drug and Social Policy Research. Then during the summer of 2012, she undertook a project with Drs. Patrick Bordnick and Luis Torres as part of University of Houston's Summer Undergraduate Research Fellowship (SURF) program. She is also a proud midshipman in the Naval Reserve Officers Training Corps (NROTC) program at Rice University to serve as a commissioned officer upon graduation, with the hopes of becoming a Naval doctor in the near future.

GLOSSARY

• Barrio: Hispanic neighborhoods that are steeped in poverty and psychosocial strife; similar to ghetto.

• Cut: relapse, going back to injection heroin use.

• Familismo: (familism) is a passionate obligation to the family that de-emphasizes focus on the individual.

• Fatalismo: a sense that things are predetermined and there is no use in fighting over them (fatalism).

• Las Malias: withdrawals, specifically from heroin.

• Machismo: has been described in both negative and positive terms. Negative attributes of machismo connote male domination, abusive masculinity, and repression over women, whereas positive attributes include courage, independence, and the role of the protector of the family.

• Personalismo: (derived from the term “personal”) denotes a “formal friendliness” that emphasizes warm and sincere personal interactions with others.

• Tecato: Mexican American slang, a heroin-injecting Mexican American whose subculture maintains a distinct street identity and street-based criminal networks.

Notes

1 Mexican American injection drug user.

2 CHIVA is slang for heroin in Mexican-American Spanish.

3 Participants have been assigned fictitious names in order to protect their anonymity.

4 Literally, to tie your eggs. Huevos (eggs) is Spanish slang for testicles. In this case, the phrase is used to connote “manning up” and doing what is needed.