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Substance Abuse in Latinos

Substance Abuse in Latinos. A Presentation for Cultural Rounds in Mental Health Presented by Clínica Latina UBHC-UMDNJ Monday November 12, 2007 By Carmelo Colon ACSW, LCSW Mental Health Clinician II Adult Outpatient Services, Newark. Does Culture Play a Role in Substance Abuse ?.

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Substance Abuse in Latinos

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  1. Substance Abuse in Latinos A Presentation for Cultural Rounds in Mental Health Presented by Clínica Latina UBHC-UMDNJ Monday November 12, 2007 By Carmelo Colon ACSW, LCSW Mental Health Clinician II Adult Outpatient Services, Newark

  2. Does Culture Play a Role in Substance Abuse ?

  3. Definition of Culture Beliefs, lifestyles, art, customs, traditions, music, rituals, heritage and language identified with a specific group of people.

  4. Culture • Specific to sub-Latino groups • Impact of acculturation • Language • Role of family • Respect and guilt • Influence of urban/ghetto lifestyle • Access to health insurance

  5. Substance Abuse : A maladaptive pattern of substance use leading to clinically significant impairment or distress. Substance Dependence : A maladaptive pattern of substance use leading to clinically significant impairment or distress highlighted by the development of both tolerance and withdrawal to the specific substance. Class of substance both licit and illicit : Alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, nicotine, opiates, phencyclidine, sedatives, hypnotics, anxilolytics and others. Definition: DSM IV 1994

  6. Hispanic/Latinos • Constitute an estimated 44.3 million people or 15% of the US population (not including the 3.9 million residents in Puerto Rico). • About 1 of every two people currently added to the nation’s population is Hispanic, for a growth rate of 3.4%. • This projects to an incredible 102.6 million people of Hispanic origin in the US by July 1, 2050. • The United States is the 3rd largest most Hispanic/Latino populated country in the world , after Mexico and Colombia. • Hispanic /Latinos are generally younger median age of 27.4 yrs), more ambitious (31% of new businesses) and more likely to vote (47%) then their non-Hispanic counterparts.

  7. Cause of Substance Abuse • Multi-determined etiology • With social, economic, cultural and biological factors influencing cause and outcome

  8. Role of Culture in Substance Abuse • May play a role in prevalence • Cultural or peer acceptance • “coping mechanism” to deal with stress • Country or family “Tradition”, i.e.. Wine, growing countries or liquor manufacturing regions

  9. Prevalence Data • In past substance abuse research has lumped all Hispanic subgroups into a single group, complicating community run program development and planning. • Recent trend has been to specify groups.

  10. The DASIS ReportThe Drug and Alcohol Services Information System- September 20, 2002 • Hispanics in Substance abuse Treatment 1999 • Most common primary substance of abuse among Hispanic treatment admissions • alcohol 36% • opiates 32 % • marijuana 14%

  11. The DASIS Report 2The Drug and Alcohol Services Information System- September 20, 2002 • Hispanic admissions for opiate abuse represented 32% vs.. 15% for non-Hispanic • Hispanic admissions were 77% males and 23% females compared to 60% male and 31% female among non-Hispanic admissions • Of almost 186,000 Hispanic admissions • 42% were Mexican • 35% were Puerto Rican • 2% were Cuban • 21% were other Hispanics

  12. National Household Survey on Drug Abuse (NHSDA) • NHSDA 1991-1993 combined the data from three years of this national study to address substance use prevalence rates of illicit drug use, alcohol abuse and dependence, tobacco use and need for substance abuse treatment in 9 ethnic sub -groups. • Asian/Pacific Islanders • Native Americans • Caribbean Americans • Central Americans • Cuban Americans • Puerto Ricans • South Americans • Mexican Americans • Other Hispanic Americans

  13. Subgroup Comparison: • Related to the total US population (age 12 and older) • Major findings: • 20% illicit drug use in last year among Native Americans • 13% among Mexican American, Puerto Rican and African Americans • 8% or less among Asian/Pacific Islanders, Caribbean Americans, Central Americans and Cuban Americans • Among the Seven Hispanic American subgroups, substance use, alcohol dependence and need for substance abuse treatment varied significantly with Mexican /American and Puerto /Rican exhibited high prevalence of illicit drug use, heavy alcohol use, alcohol dependence and need for substance abuse treatment

  14. NCSR- Drug Abuse or Dep-12Mo Ethnicity Females Males Total N % N % N % Hispanic 314 0.9 213 3.1 527 2.0 Black 460 0.5 257 2.1 717 1.2 Other 158 0.5 110 1.8 268 1.0 White 2378 0.7 1802 2.1 4180 1.4 Total 3310 0.7 2382 2.2 5692 1.4 Logistic regression Odds --95% Conf-- Black vs. White 0.912 0.459 1.815 Hispanic vs. White 1.423 0.823 2.458 Other vs. White 0.786 0.316 1.958 SEX 0.311*** 0.214 0.452

  15. NCSR- Alcohol Abuse or Dep-12Mo Ethnicity Females Males Total N % N % N % Hispanic 314 2.9 213 6.6 527 4.8 Black 460 0.6 257 3.2 717 1.7 Other 158 3.7 110 4.5 268 4.0 White 2378 1.8 1802 4.4 4180 3.0 Total 3310 1.8 2382 4.5 5692 3.1 Logistic regression Odds --95% Conf-- Black vs. White 0.578 0.322 1.040 Hispanic vs. White 1.579 0.857 2.910 Other vs. White 1.409 0.769 2.582 SEX 0.393*** 0.287 0.538

  16. TreatmentDisease Model- Brain disease with genetic component • Alcohol and/or drug abuse is a chronic degenerative disease with specific symptoms and an expected cause that left untreated will result in major affects to one’s health up to and including death. • Continuation of Care • Inpatient for detox • Rehabilitation in residential or outpatient basis to begin lifestyle change in coping with various familiar and environmental stressors that trigger the past addictive behavior

  17. Treatment 2Disease Model- Brain disease with genetic component • Individual and group therapy • Cognitive therapy, motivational interviewing and family therapy • Introduction to 12 step program, 90/90 • Pharmacological- Campral helps people with alcohol dependence stay alcohol free Suboxone helps relieve withdrawal symptoms and cravings to opiates • Cessation vs.. harm reduction • Relapse prevention

  18. Treatment for Hispanic/Latinos • Includes all the above plus the following: • Cultural and language sensitivity • Accessible (i.e. Multimodal-provision of services in various community settings) • Limit the use of confrontation • Threats are ineffective as they are taken as “final” and not an “opportunity “to change.

  19. Case Presentation 36 year old Hispanic single male of Costa Rica decent seen at Adult Outpatient Psychiatric Services since January 18, 2007. Referred by our psychiatric inpatient service at University Hospital where he was admitted for 10 days earlier in the month because of Alcohol Induced Psychotic Disorder characterized by multiple auditory hallucinations and intense paranoia. He denied any previous psychiatric treatment or any family history of mental illness. Patient did admit to alcohol dependence in gradually increasing amounts since the age of 14. At the time of his hospitalization he was drinking one bottle of brandy and two cans of beer per day. Patient was the 9th of 13 children born to an intact household. Birth and development were normal, until later in latency when he developed epileptic seizures of unknown etiology, that responded to anti-convulsive medication, and apparently remitted as he grew older with no further need of treatment.

  20. He was very popular in school and particularly enjoyed mathematics and participating in organized sports. He left school abruptly in the 6th grade to help tend to the family farm with his father and siblings, while his mother ran the household. He has been working ever since then, and soon thereafter relocated to the Capitol to work for a produce manufacturer processing locally grown pineapples. In 2000, he immigrated to the United States through the Mexican border, in search of a better life. He currently works for a landscaper, while sharing an apartment with a relatives.

  21. Upon Outpatient intake his psychotic symptoms were well controlled on Risperdal 1mg at bedtime, Depakote ER 500mgs in the morning, and Depakote ER 750mgs at bedtime, along with a multivitamin that he was instructed to take daily. Two months after his Depakote ER was changed in dosing to 1250mgs at bedtime and his Risperdal was no longer available to us as samples, so he was changed to Invega 3mgs at bedtime. Patient was no longer drinking at the time, and he has remained sober throughout the course of his treatment. He is seen for bi-weekly individual supportive psychotherapy, case management and psychotropic medication maintenance with samples provided by us.

  22. Throughout treatment he has been a model patient, and is fully compliant with all his clinic appointments. His return to work was uneventful. Plan is to gradually titrate his medication over the next 6 months since all his symptoms have remained in a sustained remission. He continues to maintain his sobriety, and denies any cravings to drink again since he views it as toxic at present to his system after it triggered his psychotic breakdown.

  23. Does Culture Play a Role in Substance Abuse? Maybe. It depends on the group Further research is needed. We need to observe with a narrow focus i.e.. Substance abuse in a group of Mainland Puerto Ricans gang members Effects of acculturation on substance abuse Understand individualized beliefs to address them in treatment (Like viewing alcohol as “toxic” in our case example)

  24. SPANISH MICA PROGRAM The Adult Outpatient Psychiatric Services of University Behavioral HealthCare announces the start of its Spanish MICA Program in Newark. This program targets adults already in mental health treatment who have a primary psychiatric diagnosis, but who also have a co-morbid substance abuse disorder that is affecting the course and outcome of their treatment. The program will start out as a weekly two hour group on Friday mornings from 10:00 am – 12:00 noon beginning on January 4, 2008. The sessions will be facilitated by a bi-lingual/bi-cultural therapist (Spanish) and be adjunctive to their current treatment at the clinic with a primary mental health clinician and psychiatrist who will be responsible for the main treatment.

  25. Random urine screening will be conducted in coordination with the clinic LPN to monitor abstinence and treatment compliance. The only exclusionary criteria is for clients who are floridly psychotic or who cannot manage their anger in group settings and present a danger of assaultive behavior. Clients on methadone maintenance are welcomed Referrals will be accepted through E-mail, and must include the client’s initials and unit identification number, with a copy to our support staff for inclusion in the programs’ group list. A copy of patient’s baseline blood work and most recent toxicology reports should also be forwarded to the program coordinator.

  26. Speaker • Carmelo A. Colon, ACSW, LCSW is a 1978 graduate of the Columbia University School of Social Work in New York City and subsequently trained extensively in the areas of substance abuse and the treatment of sexual disorders. He completed a three year fellowship program in Short-term Dynamic Psychotherapy in 1997. Besides these areas of interest he also has lectured locally on Hispanic/Latino issues and has been an active member in the UMDNJ Hispanic Heritage Month Committee from its inception. He is currently employed as a senior clinician in the Adult Outpatient Psychiatric Services, and coordinates the Clinica Latina in the Newark Campus. • He is a long time resident of Newark, where he resides with his wife Carmen, their two children and a granddaughter.

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