Contextual and Cultural Influences of Opiate Abuse among U.S. Hispanics

1. Contextual and Cultural Influences of Opiate Abuse among U.S. Hispanics Avelardo Valdez, Ph.D. University of Houston Graduate School of Social Work Office for Drug and Social Policy Research National Hispanic Science Network, National Conference Miami 2005

2. Substance Use is A ComplexPhenomena

3. Universe of Determinants • Genes • Physiologic factors • Traits/personality • Psychosocial factors • Neighborhood factors • Societal factors Source: Yonette, T. NHSN, Summer Res. Institute, 2005

4. Drug Abuse Research and the Social Environment • Drug abuse research has focused largely on individual risks. • There is a need to focus and extend this research to understand an individual’s susceptibility to opiate use in interaction with the social environment, especially among U.S. Hispanics.

5. Opiates Substances isolated from the opium poppy or synthetic relatives include: • morphine • codeine • heroin • methadone • oxycodone The most common used opiate among Hispanics is heroin.

6. Focus of Today’s Presentation • Patterns and trends of Heroin use among U.S. Hispanics • Contextual factors associated with IDU • Cultural factors associated with IDU

7. Heroin Use Patterns and Trends among U.S. Hispanics

8. Lifetime Heroin Use by Race/Ethnicity 2003 Source: Youth Risk Behavior Surveillance System 2003

9. … … … ADAM % of Arrestees Testing Positive for Heroin by Sites: Adult Male 2000-2003 Highest % Lowest % Cities with at least 30% of the arrestee population Hispanic

10. Admissions for Heroin Abuse by Race/Ethnicity: 2003 (Percent Distribution) Source: Treatment Episode Data Set (TEDS) 2003

11. Hispanic Admissions According to Primary Substance Abuse: 2003 % Distribution (n=238,090) Source: Treatment Episode Data Set (TEDS) 2003

12. Why is there a high prevalence rate of heroin use among Hispanics?

13. CONTEXTUAL FACTORS Source: Don Normark. 1999. Chavez Ravine, 1949 A Los Angeles Story. Chronicle Books.

14. HISTORICAL INFLUENCES • Importance of ecological context in linking Hispanics and heroin use. • Hispanic urban settlement patterns in and around vice districts. • Thisdeviance containment is a historical feature of minority communities (Reckless 1933, Osofsky 1963, Kornblum 1993). • As a result, this has: • Shaped early perceptions of drug use, crime, etc • Created cultural patterns of learning and, • Illegal Opportunities.

15. San Antonio’s Vice District, 1911

16. San Antonio’s High Density MA Residential Areas

17. Ethnic Specific Puerto Rican Drug Injection Pattern* • IDU among Puerto Ricans (PR) began after their migration and during and after WWII. • IDU spread among PR in NYC (1950-60s) • PR migrate out of NYC (i.e. Chicago) in the 1960’s and increase opportunity in drug trade. • Return migrants to island appear to be primary source of transferring IDU knowledge and practice. Source: Singer, M. 1999. Why do Puerto Rican Injection Drug Users Inject So Often? Anthropology And Medicine 6(1):31- 58.

18. Source: Don Normark. 1999. Chavez Ravine, 1949 A Los Angeles Story. Chronicle Books.

19. CONTEMPORARY ECONOMIC INFLUENCES • Persistent Poverty • Overall, the burden of povertyhas disproportionately affected U.S. born Hispanics vs. immigrants. • Low Educational Attainment • Example of a social institution shaping the nature and consequences of low income Hispanic neighborhoods. • Disparities in Health Care & Drug Treatment Utilization • Economic circumstances limit access to health care.

20. STRUCTURAL INFLUENCES • Social Isolation • Decrease in conventional norms (Sampson & Wilson 1995; Andersen 1999; Vigil 1988). • Drug Policy • Disproportionately target poor Hispanic minorities. • Drug Markets • Stimulated the creation of thriving illicit markets with reduced prices and higher purity of heroin (Valdez 2005).

21. CULTURAL FACTORS

22. CULTURAL INFLUENCES • Cholo Identity • Tecato subculture with a distinct street identity, distinct street-based criminal social networks (Valdez et al. 2000). • Intergenerational Transmission • Familismo (traditional vs. cholo family context) (Castro & Alarcon 2002; Moore 1991) • Gender Roles • Machismo / hypermasculinity (Jorquez 1984; Quintero & Estrada 1998)

23. Etiological Model of Heroin Use among U.S. Hispanics Contextual Factors • Cultural • Factors • Cholo Identity • Intergenerational • Transmission • Gender Roles Historical Influences Injecting Heroin Use Economic Influences Structural Influences

24. Conclusion Future research on opiate use among Hispanics needs to take into consideration these contextual and cultural factors in explaining • tolerance, • addiction, and • physical dependence given their etiological importance.