1. 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

2. 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

3. 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

4. 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

5. 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?

6. 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)

7. 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

8. 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

9. 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

10. 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.

11. Any Drug Use by Birthplace
Birthplace significant predictor of severity of drug use at intake (p<.05)

12. 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.

13. 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