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Immigrants and Addiction

America’s Immigrants:  An Examination of Substance Abuse

“Give me your tired, your poor, your huddled masses yearning to breathe free…”

Immigration brings, almost literally, an undiscovered country’s worth of challenges and experiences to an individual or a family. There is a new language to learn, a new culture to adopt, values and beliefs to uphold in a foreign land, and a new way of looking at a very different world. But among the many tests facing newcomers, an often-unnoticed trial is that of substance abuse. For many immigrants, addiction is an unexpected and insidious menace, striking when they feel homesick and when they feel pressured to assimilate. As cultures clash and the stress of acclimatizing builds, the temptation to use and abuse controlled substances may be too much to bear. Immigrants are, of course, a diverse bunch, and the relationship between immigration and addiction is similarly multifaceted. As is true of any case of substance abuse, a number of factors go into determining whether a person, or a group to which they belong, is prone to developing substance abuse problems.

Part of the complications in the spectrum arise from the demographic of “immigrant” being an incredibly varied and diverse umbrella term for a number of people who are in a foreign country for a wide range of reasons and under an equally wide assortment of arrangements:

  • Workers
  • Students
  • Spouses
  • Refugees
  • Asylum seekers
  • Illegal immigrants

Furthermore, the overall immigration process can be broken down into three broad stages, which helps to understand where and how immigrants can face the difficulties that drive them to substance abuse.[1] The stages are:

  • Pre-migration: making the decision to move and preparing to move
  • Migration: the physical transfer from a country of origin to a host country
  • Post-migration: the assimilation of the immigrant within the appropriate social and cultural settings of their new location

Migration Stressors

In explaining these stages, a module on “Immigrants, Refugees and Alcohol,” the National Institute on Alcohol Abuse and Alcoholism lists some of the problems that might plague foreign visitors, workers, and spouses.[2] Some of the more obvious ones are:

  • Racism
  • Discrimination
  • Language and communication barriers
  • Difficulties in adapting to local customs

While these issues may seem expected and par for the course, immigrants have many other difficulties to contend with that locals and natives may not immediately see. Some of these include:

  • Persecution
  • Fear of deportation
  • Fear of being unable to see relatives in their home country
  • Lack of access to medical facilities or insurance
  • Lack of legal protection
  • Restrictions on work, travel, education, marriage, etc.
  • Trauma experienced as a result of involuntary migration

The Journal of Nervous and Mental Disease called these “migration stressors,” saying that they increase the risk of stress, anxiety, and depression developing among immigrants who might not even be able to articulate their problems because no one can understand them.[3] And mental disorders like stress, anxiety, and depression can lead to various forms of substance abuse, usually in an attempt to self-medicate.[4]

Acculturation and Stress

The idea of difficulties related to immigration leading to drug and alcohol addiction is known as the acculturative stress model (where acculturation is defined as simultaneous cultural and psychological changes that arise when members of two or more cultural groups come into contact,[5] and a model refers to a set of ideas and concepts that explain how elements of the real world work).[6] Writing in the journal of Cultural Diversity and Ethnic Minority Psychology, researchers explained the acculturative stress model is the framework of mental disorders that develop as a result of any number of the migration stressors immigration process.[7] If an immigrant resorts to drug or alcohol abuse as a direct result of hardship caused by alienation and isolation, cultural conflicts, exploitation, legal limitations, or other related difficulties, their behavior is in line with the acculturative stress model. Even positive examples of acculturation – for example, where coming into contact with native English speakers leads to greater proficiency in English – can lead to negative outcomes, especially among groups that encourage the use of controlled substances (such as at-risk teenagers and college students). A study published in the Alcoholism: Clinical and Experimental Research journal reported on findings that showed Latina woman who had high levels of acculturation to American society (spoke English more than they did Spanish, associated more with Americans than other Hispanics, etc.) drank more than women who were not as acculturated.[8] The Hispanic focus of the study is an example of the vast amount of research conducted on Central and South American immigrants to the United States. Since 1980, immigrants from Mexico have accounted for the largest non-native population in America, accounting for 28 percent of the 41 million foreign-born individuals in the country.[9] With that in mind, a majority of the research conducted on immigrants and addiction looks at trends and risks among various Hispanic communities living in the United States, although more recent studies have included immigrants from Asian countries in their focus, since the rate of Asian immigration has now outpaced that of Hispanic immigration.[10] However, it may yet be some time until the body of research compiled on Asian immigrant trends – especially in regard to addiction – matches the pre-existing data and material on decades’ worth of Hispanic immigration.

Speaking to the Addiction Technology Transfer Center Network, the Alcoholism study’s sole author explained that some of the study’s findings were based on descriptive social norms (what someone believes other people should do) and prescriptive social norms (what other people think someone should do). In the same way that people will wear clothing that mimics the clothing of those around them or express opinions that they believe will be accepted by the other members of the group they are in, Latina immigrants to the United States who are more successful at acculturating into American society will drink more than Latina women who, for whatever reason, do not acculturate, because women who acculturate better change their thoughts and behaviors to better fit the social norms regarding alcohol consumption.[11]

The Acculturation Curse

While there is a potential positive element to this – alcohol can be used for social bonding, which may go a long way in helping an immigrant assimilate into their newfound culture – there is also potential danger.[12] A study conducted by Oregon State University found that Hispanic immigrants who adopt American lifestyle norms are more likely to abuse alcohol and use illegal drugs. Conversely, Hispanic immigrants who retained their cultural values to the exclusion of American traditions were 13 times less likely to report using controlled substances or dangerous amounts of alcohol.[13] There is research that connects American acculturation with a rise in alcohol and other forms of drug use among Latino immigrants, specifically adolescents.

Researchers writing for Health Psychology identified that using English among Asian and Hispanic immigrants was associated with an increased risk of developing a lifelong smoking habit.[14]

An article in the Journal of Ethnicity in Substance Abuse cited a number of pre-existing studies that found a consistently positive relationship between adolescent Hispanic immigrants who preferred to converse in English and higher rates of substance abuse and dependence, as opposed to Hispanic immigrants of similar age who preferred to respond to questions in their native Spanish.[15]

‘Preserving Cultural Values and Developing a Sense of Self’

Hispanic immigrants who move to the United States are at an increased risk of developing an addiction than their counterparts who remain in their country of origin.[16] In fact, the younger an Hispanic immigrant, the greater the chance of them developing an addiction problem. Interviewing Mexican-American adults who either lived on the US-Mexico border, or who lived in large cities with a big immigrant population, researchers found that immigrants who moved to the United States before the age of 12 were much more likely to use drugs and even acted more like adolescents who were born in America. Immigrants who arrived in the country after early adolescence were less likely to develop such problems. The researchers suggested that preserving cultural values among immigrants, and the timing of developing a personal sense of identity and self around that age, could play a determining role in an individual immigrant’s chances of acculturating without addiction.[17] In addition to a relatively younger age being a possible predictor of addiction based on acculturation, a study in the Journal of Immigrant and Minority Health identified other risk factors, such as being male, having inferior education, and poorer work status.[18] One such risk factor is what another study published in the Journal of Immigrant and Minority Health referred to as “pre-immigration alcohol use.”[19]

This second study also cited reduced social support and socializing within one’s own cultural group as being related to binge drinking, which is typically defined as the consecutive consumption of four alcoholic drinks for women and five alcoholic drinks for men in a two-hour span.[20] However, a 2013 study in the Journal of Addiction found that first generation South Asians, as well as Vietnamese immigrants who spoke only English (thereby exhibiting acculturation), were at high risk for binge drinking.[21]

The discrepancy may be explained by research published in the Journal of Community Psychology, which found that binge drinking cannot be directly traced back to acculturation. Instead, the authors said, it is social interaction that puts highly acculturated adolescents at risk – not acculturation itself.[22]

Other Models of Immigrant-Addiction Patterns

This diversity of research is reflected in the number of scientific models and perspectives on the topic of immigration, especially when crossed with substance abuse and addiction. While the acculturational model is one such example, another one of those models is multiculturalism, which posits that while alcohol use is worldwide (albeit to different degrees), immigrants take their drinking habits with them when they emigrate. The Substance Use & Misuse journal calls this the “transcultural spread of substance use behaviors.”[23]

Similarly, another model arose as a result of perceived flaws in the acculturation model. The intracultural diversity model argues that various immigrant communities have distinct alcohol and drug use patterns within themselves. Quoting a study published in Social Science & Medicine, the National Institute on Alcohol Abuse and Alcoholism says that it is a misconception to assume that a specific drinking pattern typifies individuals across particular immigrant groups, and that different individuals in the same ethnic community have different patterns of alcohol consumption.[24]

Cultural Differences Within Cultures

For example, the report published by the Addiction Technology Transfer Center Network clarified that while highly acculturated Hispanic women tended to drink more than women who were not highly acculturated, the same could not be said for men. That may come down to cultural differences within the relevant Hispanic culture. Commenting on the report, the study’s author explained that Latina women are discouraged from drinking; Latino men, on the other hand, face no such gender-imposed barrier. When Latina women find themselves in the United States, where more American women are drinking than ever before, they may follow suit in an attempt to acculturate, thereby breaking with their gender mold. Latino men, who have no such gender mold, likely feel no such inclination.[25] Immigrants who have been born in the United States are at a greater risk for adopting more harmful lifestyles, including those related to substance abuse, than those immigrants who were born elsewhere.Foreign-born Hispanics are expected to live three years longer than their countrymen who grew up with other unhealthy behaviors, such as a sedentary lifestyle and eating high-calorie foods, possibly because these foreign-born newcomers adhere more closely to their traditional eating and drinking habits.

Speaking to The New York Times on the topic, a demographer for the National Center for Health Statistics speculated that future generations of immigrants may fare better as their socioeconomic status rises, and that form of social mobility is strongly correlated with better health in the United States.[26] For the immediate generation of immigrants, however, the pressure to acculturate by doing what their American peers and contemporaries do after work, on weekends, on holidays, and at sporting events and weddings, may be leading them down a path of substance abuse and addiction.

Resources

[1]Migration, Cultural Bereavement and Cultural Identity.” (February 2005). World Psychiatry. Accessed January 6, 2015.

[2]Immigrants, Refugees and Alcohol.” (March 2005). National Institute on Alcohol Abuse and Alcoholism. Accessed January 6, 2015.

[3]Depression and Anxiety Among First-Generation Immigrant Latino Youth: Key Correlates and Implications for Future Research.” (July 2011). Journal of Nervous and Mental Disease. Accessed January 6, 2015.

[4]DrugFacts: Comorbidity: Addiction and Other Mental Disorders.” (March 2011). National Institute on Drug Abuse. Accessed January 6, 2015.

[5]The Influence of Acculturation on Drug and Alcohol Use in a Sample of Adolescents.” (December 2008). Addictive Behavior. Accessed January 6, 2015.

[6]Science Uses Models to Explain How the Real World Works.” (January 2012). Science or Not? Accessed January 8, 2015.

[7]Discrimination, Acculturation, Acculturative Stress and Latino Psychological Distress: A Moderated Mediation Model.” (January 2013). Cultural Diversity and Ethnic Minority Psychology. Accessed January 6, 2015.

[8]Re-examining Whether and Why Acculturation Relates to Drinking Outcomes in a Rigorous, National Survey of Latinos.” (May 2006). Alcoholism: Clinical and Experimental Research. Accessed January 6, 2015.

[9]Mexican Immigrants in the United States.” (October 2014). Migration Policy Institute. Accessed January 7, 2015.

[10]In a Shift, Biggest Wave of Migrants is Now Asian.” (June 2012). The New York Times. Accessed January 8, 2015.

[11]Adapting to Life in the U.S. Can Increase Alcohol Consumption Among Latinas.” (n.d.) Addiction Technology Transfer Center Network. Accessed January 7, 2015.

[12]Moderate Doses of Alcohol Increase Social Bonding in Groups.” (June 2012). Association for Psychological Science. Accessed January 7, 2015.

[13]U.S. Culture Boosts Hispanic Immigrants’ Substance Abuse Risk.” (August 2007). HealthDay. Accessed January 7, 2015.

[14]English Language Use as a Risk Factor for Smoking Initiation Among Hispanic and Asian-American Adolescents: Evidence for Medication by Tobacco-Related Beliefs and Social Norms.” (September 2000). Health Psychology. Accessed January 7, 2015.

[15]Substance Abuse Prevalence and Treatment Among Latinos and Latinas.” (March 2011). Journal of Ethnicity in Substance Abuse. Accessed January 7, 2015.

[16]Acculturation and Substance Use: Social Influence as a Mediator Among Hispanic Alternative High School Youth.” (October 2014). Journal of Health and Social Behavior. Accessed January 7, 2015.

[17]Study: Immigration at Young Age for Latinos May Increase Addiction.” (May 2014). Arizona Public Media. Accessed January 8, 2015.

[18]Epidemiology of Alcohol Abuse among US Immigrant Populations.” (August 2012). Journal of Immigrant and Minority Health. Accessed January 7, 2015.

[19]Binge Drinking Among Male Mexican Immigrants in Rural North Carolina.” (August 2011). Journal of Immigrant and Minority Health. Accessed January 7, 2015.

[20]Drinking Levels Defined.” (n.d.) National Institute on Alcohol Abuse and Alcoholism. Accessed January 7, 2015.

[21]Association Between Acculturation and Binge Drinking Among Asian Americans: Results from the California Health Interview Survey.” (2013). Journal of Addiction. Accessed January 7, 2015.

[22]Asian American Adolescents’ Acculturation, Binge Drinking and Alcohol- and Tobacco-Using Peers.” (April 2004). Journal of Community Psychology. Accessed January 7, 2015.

[23]Substance Use and Multiculturalism.” (September 1996). Substance Use & Misuse. Accessed January 8, 2015.

[24]Ethnicity, Alcohol and Acculturation.” (July 1998). Social Science & Medicine. Accessed January 8, 2015.

[25]The Alcoholism Gender Gap: Why Are More U.S. Women Becoming Problem Drinkers?” (September 2011). International Business Times. Accessed January 8, 2015.

[26]The Health Toll of Immigration.” (May 2013). The New York Times. Accessed January 8, 2015.