Acculturation and Drug Use among Dually Diagnosed Hispanic Adolescents 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 and 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 Factors 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 society Segmented assimilation/differential acculturation

Acculturation and Drug Abuse More acculturation associated with more drug use (Epstein et al, 2001, 2003; Gil et al., 2001) 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

Participants 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 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 outcomes 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) Clinical analysis entails intensive examination of each participant’s progress in treatment. Culturally relevant processes are observed in a bottom-up manner. Clinical decision making not only affects what occurs in treatment of the individual case, but as generalities are observed, refinement of the intervention itself.

Implications 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