Not all Hispanic-Americans are the same when it comes to drinking, says a study published in a recent issue of the journal Alcohol and Alcoholism. The study, led by Carlos F. Ríos-Bedoya, ScD, MPH, found that the risk of alcohol use disorders among Hispanics is different across different ethnicities — Mexican, Puerto Rican, Cuban, and increasingly El Salvadorian are the most prevalent in the U.S.
Dr. Ríos-Bedoya’s work points to a larger issue: Current treatment programs for substance use disorders typically put these different ethnic groups into one large group. However, in reality, the one-size-fits-all mentality doesn’t work when it comes to treating addiction disorders across the many Hispanic subgroups.
Stereotyping Hispanics and Alcoholism
The stereotype exists that Hispanics, who are one of the fastest growing populations in the U.S., have a higher risk of developing alcoholism. Dr. Ríos-Bedoya, who is an assistant professor in the College of Human Medicine at Michigan State University, found that among Mexican-American, Puerto Rican and Cuban-American people in the U.S., the annual incidence rate isn’t the same for all subgroups. In fact, he found that Cuban-Americans have the lowest rate at less than 1 percent. They’re also half as likely to develop a drinking problem as non-Hispanic whites are. Moreover, Mexican-Americans are more than twice as likely as Caucasians to develop alcohol use disorders (AUDs), with Puerto Ricans showing almost three times the risk, the study concluded.
“The idea is to try to educate not only the research community, but also the lay public and policymakers that grouping of Hispanics [into one large group] could be misleading when we’re dealing with AUDs,” Dr. Ríos-Bedoya says. “And that could give a misrepresentation of the actual magnitude of the disorder in that ethnic group.”
The Likelihood of Hispanics to Seek Treatment
Hispanics arrive in the U.S. via different means — sometimes as political refugees granted asylum, as is the case with many Cuban-Americans, and sometimes as illegal immigrants looking for a better life, as is the case with many Mexican-Americans. Puerto Ricans are considered U.S. citizens and can travel freely between the mainland and the island of Puerto Rico. These different backgrounds all contribute to how likely it is the person will be able to effectively assimilate — and how likely he or she will seek treatment of any kind, whether for mental health problems or substance use disorders. Furthermore, different education levels and cultural factors also influence how a person of Hispanic descent will develop a substance use disorder.
Studies have shown that Hispanics are unlikely to seek treatment for mental health issues for several reasons, including fear of being deported, language barriers, as well as the idea that treating mental health problems is something the family alone should address. Increasingly, addiction specialists are recognizing that treatment must be tailored to take into account the different cultural backgrounds of Hispanics.
Treatment Tailored to Cultural Background
At Lucida Treatment Center in Lantana, Florida, a member of Elements Behavioral Health’s network of addiction treatment facilities, they are aiming for exactly that type of culturally-sensitive care. Lucida offers one of the nation’s only multicultural, bilingual substance abuse and mental health treatment programs. Highlights of the program include high staff-to-client ratio and a bilingual treatment team with services and program materials provided in Spanish.
“The Multicultural Program for Spanish Speakers is a special addiction treatment program because it accepts and works with two major core beliefs related to the Latino culture,” says Ana Moreno, MS, LMHC, CAP, associate clinical director of the program. “The first is that the Hispanic family is about the collective versus the Anglo culture of individualism. It’s normal for three generations to live together and have adult children well into their 20s still living at home,” she says. “The second is that Hispanic families tend to see substance abuse and mental health as behavioral issues related to ‘bad parenting.’”
Moreno says that at Lucida they use “a very collaborative approach and include the family throughout the entire process,” sometimes even including clergy. Instead of viewing the close-knit family unit as codependent, “we can help the client to utilize their family as part of their recovery.”
Tailoring programs for specific subgroups can be subtle. Dr. Ríos-Bedoya, who is Puerto Rican, says that offering food at meetings is a given when it comes to a successful turnout, but it’s an often-overlooked element of Hispanic culture in mainstream America. “You have to learn how to adapt certain components of those treatment interventions” to target other groups’ needs,” he says.
Improving substance abuse and addiction treatment of Hispanics involves understanding an individual’s immigration status — how did the person come into the country — as well as the level of acculturation. “At Lucida our clinicians not only speak Spanish, they understand the cultural differences,” Moreno says. “We also know what to ask these clients in particular.”
“In working with Latino families, there can be a great struggle in how to best address a problem,” she says. “We offer the Latino way or the Anglo way to provide options. Many times, both approaches are combined based on the families’ comfort level.”