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									  Acculturation and Drug Use among
      Dually Diagnosed Hispanic

Craig Henderson, Ph.D., Rosemarie Rodriguez, Ph.D.,
      Cynthia Rowe, Ph.D., Kent Burnett, Ph.D.,
               & Howard Liddle, Ed.D

  Center for Treatment Research on Adolescent Drug Abuse
       University of Miami Miller School of Medicine
 University of Miami, Department of Counseling Psychology

          Presented at the National Institute on Drug Abuse
                 Health Disparities Grantee Meeting
                            July 20, 2005
Hispanic Adolescent Drug Abuse
  Comparatively speaking, less use than
   White, Non-Hispanic populations

  However…
      Prevalence of drug use increasing, particularly
       among youngest cohorts
      Rapidly expanding, young population

  In combination, suggests that severe
   drug use problem may be emerging
   in Hispanic population
Risk and Protective Factors
 Multiple interacting risk factors for
  adolescent drug abuse in general:
     Family conflict/ poor communication
     Parenting skills deficits
     Negative peer relationships
     School failure and disconnection
     Behavior problems
     Emotional reactivity
Hispanic Risk and Protective
 Unique risks
     Traumatic experiences relating to exit from
      country of origin
     Stressful immigration experiences entering
      United States
     Intrafamilial stress
     Acculturation
        Degree to which an individual from an ethnic
         minority background participates in the cultural
         traditions, values, and practices of the dominant
     Segmented assimilation/differential
      Acculturation and Drug Abuse
 More acculturation associated with more
  drug use (Epstein et al, 2001, 2003; Gil et al.,
     Consistent with data from ethnic comparisons
      White NH > Hispanic
 Research conducted primarily with
  community samples; sparse research with
  clinical samples
 Using a clinical sample, Gil et al. (2004)
  found opposite pattern
 Findings due to more extensive comorbidity
  in clinical samples?
Multidimensional Family Therapy

   Integrative family-based drug treatment

   Addresses multiple risk factors

   Multisystemic assessment & intervention

   Flexibility in different service settings

   Culturally specific interventions

   Now recognized as a “Best Practice”
    (NIDA, USDHHS, Drug Strategies, CSAT)
      MDFT Core Processes
 Facilitation of development
 Working the four corners: adolescent,
  parent, family, and extrafamilial interventions
 Building adolescents’ connection to school,
  work, family, and prosocial outlets/friends
 Improving parents’ functioning: decreasing
  stress; addressing parenting practices
 Changing family environment
 Targeting multiple domains of functioning in
  addition to reducing drug use
Culturally Specific Interventions
 Investigated use of culturally-relevant themes
  on treatment process with African-American
  youth (Jackson-Gilfort et al., 2001; Liddle,
  Jackson-Gilfort, & Marvel, in press)
 Themes:
    Trust/Mistrust        Anger/rage
    Alienation            Spirituality
    Racial identity       Racism
    Transition from boyhood to manhood
 Exploration of cultural themes increased
  participation and decreased negativity in next
  treatment session
 Clinical analysis of Hispanic cultural themes
             Current Study
 Parent study: RCT comparing intensive
  version of MDFT to residential treatment
  delivered in community
 Examines relationship between acculturation
  and intake levels of drug use among Hispanic
  adolescents referred for residential treatment
    All participants meet criteria for at least one
   comorbid psychiatric diagnosis
 Measures
    Acculturation-relevant demographics: Birthplace,
   years in U.S., language preference
    Timeline Follow-Back
   76 Hispanic adolescents referred for residential
    substance abuse treatment
   Between 13 and 17 (M=15.3); primarily male (74%)
   80% cannabis dependent, 19% cocaine dependent
   76% had at least one failed treatment episode
   Comorbid diagnoses: 75% conduct disorder, 22%
    depressive disorder, 25% ADHD, 6% PTSD
   81% pending adjudication or on probation at intake
   Extensive family impairment: 57% had family members
    with alcohol/drug problems; 53% had family members
    with criminal justice involvement.
         Any Drug Use by Birthplace

   % 25%
                                                                      Born in U.S.
                                                                      Born outside U.S.
              1 to 10     11 to 20 20 to 30         > 30
             Occasions of Drug Use Previous 30 Days

Birthplace significant predictor of severity of drug use at intake ( p<.05)
        Summary and Conclusions
 Findings support the importance of
  acculturation as it relates to drug use in clinical
  samples of Hispanic adolescents
 Contrary to studies from community samples,
  the findings suggest that less acculturated
  adolescents have more severe drug problems
  at entry to treatment
 Future studies will examine the impact of
  acculturation on treatment process and
 MDFT developers continue to conduct clinical
  analysis of culturally relevant themes in
  treatment, which also informs future
  intervention refinement (e.g., Jackson-Gilfort
  et al., 2001; Liddle et al., in press)
 Emerging body of studies suggests that clinical samples
  of less acculturated Hispanic adolescents report more
  drug use than more acculturated adolescents
 Process by which this occurs unclear
      More family stress
      Traumatic immigration experiences
      Comorbidity (these findings indirectly support)
      Marginalization
      Peer induction, desire for acceptance from dominant peer group
 Targeted outreach/early intervention designed to reach
  less acculturated adolescents
    Schools (ESOL programs)
    Court system (juvenile justice, immigration)
 Training for frontline workers
    Screening/assessment
    Cultural competence

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