SUBSTANCE USE DISORDERS

In

AFRICAN-AMERICANS

Jean-Joel Villier, M.D.

                                          Howard University College of Medicine

                                                           Washington, D.C.

 

I.    Introduction

 

S2 A. The objective of this lecture is to review the use of  both licit or illicit       substances in African Americans.

 

1.      Data on alcohol, tobacco and other drug use and their associated   consequences in African Americans are relatively rare.

 

2.         This situation has seriously hampered policy planning.

 

3.      Blacks are different from other groups in many important ways which     make generalizations between groups difficult.(James & Johnson,  1996).

 

 

    B. Why these materials are so important?

 

1.      The traditional uses of alcohol and drugs in Africa are different from other groups.

2.      The traumas suffered by Africans as they were transported away from their homeland may have contributed to vulnerabilities and must be understood.(James & Johnson, 1996).

 

     S3 C. An outline of what will be covered consists of:

 

1.   The historical patterns of alcohol and drug use in African-Americans.

 

2.    I will review the dimensions of the problems caused by substances in    African-Americans during the past half century.

 

3.    The last part will review vocational programs, prevention programs and treatment recommendations applicable to African-Americans.

 

II.   Early Use Patterns of Alcohol

 

S4. A. The slavery period:

1.      Slaves in America often came from tribes familiar with fermentation where alcohol was an important part of social interactions and religion.(Heath, 1975).

 

 

 

2.      Such societies with well established drinking patterns might be expected to have histories of minimal disruptive behaviors related to alcohol use.       (Netting, 1964).

 

S5 B.  Early patterns of drug use:

 

1.   The use of drugs has a long history in Africa. Most tribal groups south of  the Sahara were exposed to marijuana long ago by Arab traders and neighboring tribes.(Du toit, 1991).

 

2.   Once slaves came to America, they were exposed to all opportunities to use drugs, as was true in other American groups.

 

S6 C.  Exposure in the New World

 

        1.   The widespread availability of opiates in patent medicines.

 

 2.   The development of the hypodermic syringe in the 1850’s(Morgan,1974).

 

                    3.   Nevertheless, contrary to popular belief, drug use and related problems were relatively less among African-Americans than many other American groups.(James & Johnson, 1996).

 

III. Recent Patterns

 

S7 A. Late 1940’s

 

1.      Heroin was easily available to urban African American communities.(O’Donnell et al. 1976).

 

2.  Additional exposure came through the availability of alcohol-based cough          syrup and prescription drugs such as propoxyphene (Darvon) and   methylphenidate (Ritalin).

 

  B.1960’s:

 

1.        Marijuana became a favored drug in the African American culture.(O’Donnell et al, 1976).

 

2.        This pattern was similar to that in the general population, specially among young men.

 

 

                   

 

 

S8 B. Patterns of use during the Vietnam War

 

 

1.     25% of American forces in Vietnam were African-Americans.

 

2.     These soldiers were under great stress and had easy access to opioids,     including  heroin.

 

3.        Veterans returning to the U.S. influenced a new wave of drug use and problems in African American communities.(James & Johnson, 1996).

 

S9 C. Subsequent Patterns

 

 

1.          The post Vietnam racial integration increased exposure among African Americans to other less traditional drugs, such as hallucinogens.(James & Johnson, 1996).

 

2.          As cocaine use increased in the U.S., so did exposure to this drug among African Americans. Street marketing of these drugs often focused on Black communities.

 

                    3.    Gangs in Black areas contributed to the rapid spread of these drugs.

                                                                                                                                                                                                                                                                                                                          

        4.   Crack cocaine was developed by these gangs to increase purity and to produce a form of drug that could be more easily smoked.

 

 5.   By the early 1990’s, interdiction and police slightly reduced the cocaine available on the streets(James & Johnson, 1996).

 

6.      Crack users tended to turn to alcohol to help them calm down after a run of cocaine use and to enhance the effects of cocaine by increasing its half-life.

 

7.      Heroin and cocaine began to be injected together as a  “speedball”, and to be smoked together as “ brown rock”.

 

8.   By the early 1990’s, substance use became more entrenched in African-American communities where, for example, 23% of Blacks  in Manhattan and 16% in Chicago admitted to ever having used opiates.      ( U.S. Dept. of Justice, 1993).

 

IV.   Use Patterns Across  Racial Groups

 

S10  A. There have been some disparities among different ethnic groups for  the type of drugs used. (NIDA, 1998).

 

1.      The slide highlights this for alcohol. In most age groups, Blacks are less likely to be drinkers than Whites. Blacks and Hispanics are more similar.

 

S11 B. This slide indicates few marked racial differences in drug use. The similarity regarding drugs holds for two common substances: marijuana and cocaine.(NIDA, 1998).

 

 

 

V. Areas of Possible Vulnerabilities for Blacks

 

S12 A. These can be divided, at least, into three major categories:

 

         1.  Education

 

a)      Schooling was denied blacks during slavery  and, for the most part, in the post civil war period.

 

b)      Even currently, education is considered inferior in central city areas where some Black populations reside.

 

 

 

 

        2.  Family structure

 

a)      As part of slavery, families were destroyed and  the damage was intensified by modern day approaches to welfare which undercut the cohesiveness of the family structure.

b)      Therefore, the proportion of Black youth in single parent households is relatively high.

c)      A consequence of this situation is a decreased amount of supervision during free time and after school.

d)      Data support the contention that decreased levels of parental monitoring are associated with higher levels of substance use in youth. ( Genet , 1998  )

 

3.          Issues related to religion

 

a)      In the post civil war era, the Christian churches helped to decrease exposure to drugs and heavy drinking.

b)      Over the years, the influence of the church waned at the same time that exposure to drugs and pressures to drink increased.(James & Johnson, 1996).

 

S13A. Summary

                  1.    This slide summarizes the first two major points of this lecture regarding the early and more recent patterns of use of alcohol and drugs in African-Americans. Areas of possible vulnerabilities that may lead to such a problem were also discussed.

 

                  2.    The next section will point out the implications for vocational functioning and prevention programs, as well as for treatment recommendations.        

 

 

 

VIII. Implications for Functioning on the Job

 

S14A. To prevent legal, behavioral and psychological problems, programs have been established where substance-dependent Blacks reside, at work, in schools, in several states:

 

                    1.   For instance, the D.C Central Kitchen offers recovering substance- dependent Black people job training.

 

 

2.      The Ready to work, Able to Recover program is made of blue-uniformed recovering African American  workers who live in group homes funded by private contributions and city, federal and corporate contracts.

 

 

S15 B.  Prevention programs relevant to Blacks include:

                   

        1.    Community coalitions in the District of Columbia, where a good number of drug-dependent Blacks live, have addressed the need for prevention programs include:The  D.C. Addiction Prevention and Recovery Administration ( APRA) and the National Capital Prevention Network (NCPN).These provide a comprehensive approach through alternative activities, community mobilization projects, technical assistance and culturally specific programs for African American youth.(D.C. survey, 1998) 

1.            

 

                    2.     For youth,drug prevention program such as Students Taught Awareness And Resistance (STAR) appear to be effective in reducing alcohol, tobacco and marijuana use.(D.C. Survey, 1998)                          

                

 

S16 C.  Additional preventive measures include:

     

 

1.   Schools serving large African-American populations should coordinate their efforts closely with after-school programs, coalition activities and other local organizations to produce a comprehensive prevention strategy. ( D.C. Survey, 1998)

 

                     2.   The Center for Substance Abuse Treatment should promote the education of African American clergy about mental health and substance misuse problems so that they in turn can help their church members with such problems. (Harper, 1976)

 

 

 S17 D.  Treatment recommendations for Blacks include:

 

               1.        Changes such as: expansion in eligibility and more coverage need to be made in Medicaid/Managed Care Systems in order to allow more Black drug-dependent individuals to receive drug treatment. (Johnson Foundation, 1999)

 

                2.        Local/state’s efforts should include restrictions on alcohol advertising in    areas accessible to susceptible African American youth. (Bonderman Foundation, 1999)

 

 

S18 E.  Other implications

 

        1.    States should expand in Medicaid eligibility and coverage that would        ensure access to drug treatment services for all lower income Black residents.(Johnson Foundation, 1999)

 

    2.     Funding for treatment services for Blacks should be significantly increased.

 

 

S19 F.  And finally,

 

     1.    The Congressional Black Caucus should continue its monetary contribution in large cities to improve care for African Americans with substance use disorders.(D.C. Survey, 1998).

 

     2.    Continuity of care, which is crucial to long-term treatment success, should be built into contracts with treatment providers.(Treichel, 2001).

 

 

S20A. Summary

                

                 1.    To sum up, this lecture has reviewed the historical and most recent trends of substance use disorders in African-Americans. Because data on above patterns are relatively rare, policy planners have been having hard time making sound, concrete and practical decision to alleviate or eradicate such a dilemma.

 

                 2.    Furthermore, treatment recommendations and preventive measures were discussed that may serve as a template for future round table on alcohol and drug use in African-Americans.

 

 

Literature cited

 

 

Atkins, B.J., Klein, M.A. and  Mosley, B.  Black adolescents’ attitude toward the use of alcohol and other drugs. Int. J. Addict. 22: 1201-1211, 1987.

 

Baker, F.M., and Bell, C.C. Issues in the psychiatric treatment of African-Americans.Psychiatric Services. 3: 362-368, 1999.

 

Barth, R.P., Petirzak, J., and Ramler,M. Families living with drugs and HIV. New York, Guilford Press, 18-36, 1993.

 

Bonderman Family Foundation/Robert Johson Wood Foundation. Drug Strategies. Facing Facts: drugs and the future of Washington, D.C. 1999.

 

Booth, R. E., and Kwiatkowski, C.F. Substance Abuse Treatment for High-Risk Adolescent. Current Psychiatric Reports. 2: 185-190, 1999.

 

Brunswick, A.F., and Messeri, P.A. Life stage, substance use and health decline in African-Americans. Journal of Addictive diseases. 1: 53-71, 1999.

 

City View on Drug Abuse: A Washington, D.C. Survey, 1998.

 

De La Rosa, M., Vega R., and Radisch, M.A. The role of acculturation in substance use behavior of African-Americans. Journal of psychoactive drugs. 1: 33-42, 2000.

 

Gomberg, E.S.L. Women and Alcohol: Use and Abuse. J. Nerv. Ment. Dis. 181: 211-219, 1993.

 

Harper, F.D. Etiology: Why do Blacks drink? 1976.

 

Harper, F.D. Alcohol and Black youth: An overview. Journal of drugs. 1: 7-14, 1988.

 

Heath, D. A critical review of ethnographic studies of alcohol use. Vol 2 New York: John Wiley and Sons, 1975.

 

Herd, D. Prohibition, racism and class politics in the post Reconstruction South. Journal of Drugs. 1: 77-94, 1983.

 

Horton, J., Compton, W., and Cottler, L.B. Reliability of substance use disorders in African-Americans. Drug and Alcohol dependence. 57: 203-209, 2000.

 

Joan, Arechart-Treichel. Experts shine spotline in Racial Differences in illness. Psychiatric News. 1: 16-19, 2001.

 

Kleinman, P.H., and Lukoff, I.F. Ethnic differences in factors related to drug use. 2: 190-199, 1978.

 

Marczynski, K.S., Welte, J.W., Marshall, J.R., and Ferby, E.N. Prevalence and determinant of alcohol-related problems. Am. J. Drug Alcohol Abuse. 4: 715-730, 1999.

 

Morgan, H. W. Yesterday’s Addicts American Society and Drug  Abuse. 1865-1910 Norman: University of Oklahoma Press, 1974.

 

Netting, R. Mc. C. Beer as a locus of value among the West African Kofyar. American Anthropologist 66: 375-384, 1964.

 

William, H.J. and Stephen, L.J.  Doin’ Drugs. Patterns of African-American Addiction. University of Texas Press, Austin, 1996.

 

                                                                                                                                                       Marczynski, K.S., Welte, J.W., Marshall, J.R., and  Ferby, E.N. Prevalence and determinant of alcohol-related problems. Am. J. Drug Alcohol Abuse. 4: 715-730, 1999.

 

                                                                                                                                                                                                       Booth, R.E., and Kwiatkowski, C.F. Substance Abuse Treatment for High-Risk Adolescent. Current Psychiatric Reports. 2: 185-190, 1999.

 

Brunswick, A.F., and Messeri, P.A. Life stage, substance use and health decline in African Americans. Journal of Addictive diseases. 1: 53-71, 1999.

 

 

Kleinman, P.H.,  and Lukoff, I.F. Ethnic differences in factors related to drug use. 2: 190-199, 1978.

 

 

Horton, J., Compton, W., and  Cottler, L.B. Reliability of substance use disorders in African Americans. Drug and Alcohol dependence. 57: 203-209, 2000.

 

 

Baker, F.M., and Bell, C.C. Issues in the psychiatric treatment of African Americans. Psychiatric Services. 3: 362-368, 1999.

 

 

 

De La Rosa, M., Vega, R., and Radisch, M.A. The role of acculturation in substance use behavior of African Americans. Journal of psychoactive drugs.1: 33-42, 2000.

 

 

Barth, R.P., Petirzak, J., and Ramler, M. Families living with drugs and HIV. New York, Guilford Press, 18-36, 1993.

 

 

Gomberg, E.S.L. Women and Alcohol: Use and Abuse. J. Nerv. Ment. Dis. 181: 211-219, 1993.

 

Bonderman Family Foundation/ Robert Johnson Wood Foundation.  Drug Strategies. Facing Facts:drugs and the future of Washington, D.C. 1999.

 

 

City View on Drug Abuse: A Washington, D.C. Survey, 1988.

 

 

Joan, Arehart-Treichel. Experts shine spotlight in Racial Differences in illness. Psychiatric News. 1: 16-19, 2001.

 

 

Harper, F.D. Etiology: Why do Blacks drink? 1976.

 

Harper, F.D. Alcohol and Black youth: An overview. Journal of drugs. 1:7-14, 1988.

 

Heath, D. A critical review of ethnographic studies of alcohol use. Vol 2 New York: John Wiley and Sons, 1975.

 

Herd, D. Prohibition, racism and class politics in the post Reconstruction South. Journal of Drugs.1:77-94, 1983.

 

Morgan, H. W. Yesterday’s Addicts American Society and Drug Abuse. 1865-1910 Norman: University  of Oklahoma Press, 1974.

 

Netting, R. Mc.C.  Beer as a locus of value among the West African Kofyar. American Anthropologist 66:375-384, 1964.

 

William, H.J. and Stephen, L.J.  Doin’ Drugs. Patterns of African American Addiction. University of Texas Press, Austin, 1996.