The aim statement for this journal describes our emphasis on studies and research that contribute to understanding ethnic and cultural variation in alcohol, tobacco, and licit and illicit forms of substance use and abuse. Despite a promising body of work that examines race/ethnicity in substance abuse, some scholars continue to blindly apply findings based on other groups to specific racial/ethnic groups. Others attend to diversity by including a small, albeit representative, sample of an ethnic group and then concluding that the overall findings apply to that group. In the future, whenever colleagues question the need for a more thorough examination of racial/ethnic differences in their work, I will refer them to this issue. Overall, the set of articles demonstrates racial/ethnic differences in the link between mental health risk factors and substance abuse and the characteristics of clients upon treatment entry. Other articles demonstrate variations in the prevalence of drug use patterns within and across age groups. Finally, an examination of issues related to operationally defining race/ethnicity in substance abuse research is also included.
The presence of mental disorders as a risk factor for substance abuse has been widely investigated. However, racial/ethnic differences in the relationship of mental disorders to substance abuse have not received much attention. The article by Sumstine and colleagues makes a strong case for devoting more thought to such differences in future work. Specifically, although inattention predicted stimulant drug use in both White and Latino college students, inattention was also associated with cocaine use among Latinos but not Whites. Moreover, psychological distress was linked to marijuana use among Whites but to tobacco use and prescription painkillers among Asians. These differences may have significant implications for effective services for specific racial/ethnic groups.
Two other articles demonstrate racial/ethnic differences in the characteristics that clients bring to substance abuse treatment. Bart and colleagues described differences in the psychosocial characteristics that Hmong clients bring to methadone treatment compared to others (primarily Whites, Blacks, and Latinos). Although the Hmongs had lower scores than all other groups on sensitivity, depression, hostility, and paranoid ideation and were less likely to bring a mental health diagnosis to treatment, their scores on the employment and legal scales of the Addiction Severity Index were not different from those of the other groups. This pattern suggests that programs that primarily serve Hmong clientele may not need to devote as much attention to mental health but that their Hmong clients may need as much support as other groups in addressing employment and legal barriers. Lewis and colleagues examined racial/ethnic differences in treatment entry. However, their focus was on the stage of the addiction in which clients enter treatment. In a sample of treatment seekers, Lewis demonstrated that Blacks were likely to enter treatment later in the progression of their substance abuse than Whites. Clearly, since the stage of the illness may have important implications for the treatment strategies most likely to be effective, programs that largely serve Black clients should be aware of this difference.
Several articles in this issue present evidence of racial/ethnic differences in the prevalence of drug use across age groups. Among youth, Hamilton and colleagues report that South Asian or East/Southeast Asian youth had lower odds of cannabis use than either White, Black, or mixed-race youth. Among elderly prostate cancer patients, Chhatre and colleagues found that substance abuse disorders were more prevalent among Blacks than either Whites or Latinos. Lewis and colleagues add that the racial/ethnic differences are evident not only within age groups but also in the progression of substance use. Their analyses revealed that racial/ethnic differences in the progression varied by drug. While the progression for both marijuana and cocaine use was more rapid for Whites, Blacks had a more rapid progression for alcohol use. Mulia and colleagues demonstrate that the trajectory to heavy drinking is steeper for Latino men and Black women than for White men and women. Additional analyses by both Lewis and Mulia reveal the impact of socioeconomic disadvantage in these disparities. Nevertheless, these differences have implications for effective treatment programming for specific racial/ethnic subgroups.
Hunt and colleagues encourage future researchers to move away from fixed and discrete categorizations of ethnicity to more fluid classifications. That recommendation may prompt future researchers to attend to the impact of contextual factors on within-group racial/ethnic differences. A study by Thrash and colleagues illustrates the benefit of considering contextual factors that result in within-group differences. Specifically, they reported differences in the drug-using social networks of rural and urban drug-using Puerto Ricans. Specifically, heavy drug users in urban areas were more likely to affiliate primarily with other heavy drug users. However, heavy drug users in rural areas were not as likely to limit their affiliations to other heavy drug users. This contextual factor, which Thrash labels as their “risk networks,” has implications not only for their substance abuse but also for exposure to HIV and HCV.
I recommend this set of articles as valuable curriculum for any course addressing diversity in the precursors of drug use, racial/ethnic differences in the prevalence of drug usage, treatment issues, or the operational definition of race/ethnicity in substance abuse research.