2. Copyright Alcohol Medical Scholars Program1 Substance Use Disorders in African Americans Jean-Joel Villier, M.D. Howard University College of Medicine Washington, D.C.

3. Copyright Alcohol Medical Scholars Program2 INTRODUCTION Goal of this lecture Rare data Policy/planning Blacks are different: -traditional use of drugs in Africa -traumas suffered by Blacks

4. Copyright Alcohol Medical Scholars Program3 This lecture will cover: Historical Patterns Recent patterns Implications

5. Copyright Alcohol Medical Scholars Program4 During the slavery period:  Many tribes knew alcohol  Impact on use patterns

6. Copyright Alcohol Medical Scholars Program5  Long history  Marijuana and south Sahara

7. Copyright Alcohol Medical Scholars Program6 Exposure in the New World  Patent medicine  Syringe development  Yet, use less common

8. Copyright Alcohol Medical Scholars Program7 1940’s:  Heroin  Cough syrups  Prescription drugs 1960’s:  Marijuana

9. Copyright Alcohol Medical Scholars Program8  25 % of Vietnam soldiers were Black  Easy access to drugs(heroin)  Brought experiences home

10. Copyright Alcohol Medical Scholars Program9 Racial integration (hallucinogens) Widespread cocaine use Gangs/crack -interdiction -combinations with alcohol and heroin

11. Copyright Alcohol Medical Scholars Program10 Type of drug Age group 12-17 18-2526-3435+ Alcohol White Black Hispanic Any type of drug White Black Hispanic 20.4 65.666.0 54.3 14.749.6 55.742.0 19.9 49.850.644.0 9.217.0 8.8 2.9 8.6 15.710.63.8 9.210.95.71.5

12. Copyright Alcohol Medical Scholars Program11 Type of drug Age group Marijuana White Black Hispanic Cocaine White Black Hispanic 12-1726-34 35+ 7.3 14.4 6.6 1.9 18-25 13.99.2 3.3 7.3 6.9 8.33.61.0 0.5 2.3 1.3 0.4 1.13.10.6 1.1 2.11.40.6

13. Copyright Alcohol Medical Scholars Program12  Education: -Schooling was denied to Blacks -Current education  Family: -?cohesiveness -Home supervision -Black youth/single household  Religion: Role of Christian churches (then & now)  53 % of African American population  43% abstention vs 34% for White women  Inverse correlation with good income

14. Copyright Alcohol Medical Scholars Program13 Summary Discussion of historical and recent patterns. Areas of probable vulnerabilities. Next section will focused on workplace/prevention programs and treatment recommendations.

15. Copyright Alcohol Medical Scholars Program14  D.C. Central Kitchen  Ready to work, Able to Recover

16. Copyright Alcohol Medical Scholars Program15 Community Coalitions: -D.C. Addiction Prevention and Recovery Administration(APRA) -National Capital Prevention Network(NCPN) - Youth based Programs ( STAR)

17. Copyright Alcohol Medical Scholars Program16 Coordination schools/local organizations African American clergy education

18. Copyright Alcohol Medical Scholars Program17 ® Changes in Medicaid/Managed care ® Alcohol advertising/ Black children

19. Copyright Alcohol Medical Scholars Program18 Other Implications  Service expansion /low income residents  Increasing funding

20. Copyright Alcohol Medical Scholars Program19  Congressional Black Caucus  Continuity of care

21. Copyright Alcohol Medical Scholars Program20 Patterns of alcohol and drug use in African- Americans reveal lower rates than the general population. Lack of data hampered policy planning. Possible treatment and preventive steps might be useful. patterns of alcohol and drug use in African- Americans. Because above data are somewhat rare, policy planners are not able to make practical decision. Treatment recommendations and preventive measures may serve as a template for future round table on substance use disorders in African- Americans.