Chapter 7: Substance Abuse

Katharine Wickel Didericksen (Medical Family Therapy Program, East Carolina University), Jennifer McCleary (School of Social Work, Tulane University), Nicholas Newstrom (Family Social Science, University of Minnesota), Glenda Mutinda (Medical Family Therapy Program , East Carolina University), & Jamie Ballard (Family Social Science, University of Minnesota).

Introduction

“The area we are living [in] is very, very bad. . . . So the kids you cannot discipline them . . . they’re going to school, the kids are smoking weed, there are drug-addicted kids . . . But I don’t have a choice because that’s where I live and that’s where they go to school.”

– Somali Refugee mother (Betancourt et al., 2015, p. 117)

Substance abuse occurs among every community, regardless of race, ethnicity, culture, country of origin, and socioeconomic status. Immigrants and refugees living in the in the United States are no different. However, the resettlement process adds additional complexities to understanding how immigrant and refugee communities are impacted by substance abuse. Immigrants have acquired habits and customs of substance use from their home country, and they must navigate these customs and any clashes with local United States customs. Additionally, immigrants often face limited employment and housing options, which means they may be unable to leave neighborhoods with prevalent substance use (as in the example above). Immigrants frequently have stressors associated with scarce employment, the need to send money to family, past traumatic exposure, and separation from family. Some immigrant and refugee groups may be at greater risk for abusing substances as a means of coping with these stressors. However, immigrants also have significant protective factors, such as specific cultural norms and family support.

Upon entering the United States, immigrants are at lower risk of alcohol abuse than United States-born citizens, even in comparison to those with the same ethnic identity (Breslau & Chang, 2006; Escobar, Nervi, & Gara, 2000). Research has also found that for immigrants, there is a positive correlation between the length of stay in the United States and the increased risk of alcohol abuse (Szaflarski, Cubbins, & Ying, 2011). This may be due to protective factors shared by immigrants or to a lack of culturally validated assessments for substance use in immigrant communities. Understanding the influences of substance abuse within immigrant and refugee populations in the United States is incredibly complex due to two main considerations: (1) the breadth of substances that can be used and abused (e.g., alcohol, tobacco, illicit drugs, and non-prescribed prescription drugs) and (2) the diversity of peoples and cultures that are represented within the United States immigrant and refugee populations.

Definition of substance use disorders:

The American Psychological Association (APA) defines substance abuse disorders as recurrent use of alcohol or drugs that cause significant impairment. Individuals with substance abuse disorders have impaired control, social impairment, risky use, and/or meet pharmacological criteria (2013). There are separate diagnoses by each substance (alcohol, tobacco, cannabis, stimulant, hallucinogen, and opioid). Diagnoses are classified into five categories: use disorder, intoxication, withdrawal, other, substance-induced disorder, and substance-related disorder.

The purpose of this chapter is to more thoroughly explore some of these complexities by utilizing a systemic framework that places problems of substance abuse—within immigrant and refugee communities—within the broader context of families. We begin by reviewing the literature on prevalence and risk factors for substance use among immigrants, followed by an exploration of the specific role of the family. Next, we review the theoretical frameworks on substance abuse, policy, and prevention and intervention models. The scope of this chapter is not to provide a comprehensive review of the substance abuse literature for all immigrant and refugee groups but rather to introduce a general review of the existent research to promote dialogue of current and future research directed at strengthening immigrant and refugee communities within the United States.