Table Of ContentYonette F. Thomas · LeShawndra N. Price
Editors
Drug Use
Trajectories
Among
Minority Youth
Drug Use Trajectories Among Minority Youth
Yonette F. Thomas (cid:129) LeShawndra N. Price
Editors
Drug Use Trajectories
Among Minority Youth
Editors
Yonette F. Thomas LeShawndra N. Price
The New York Academy of Medicine and Health Inequities and Global Health Branch
the American Association of Geographers National Heart Lung and Blood Institute,
Glenn Dale , MD , USA National Institutes of Health
Bethesda , MD , USA
ISBN 978-94-017-7489-5 ISBN 978-94-017-7491-8 (eBook)
DOI 10.1007/978-94-017-7491-8
Library of Congress Control Number: 2016946341
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v
Pref ace
Contrary to much popular opinion, African American and Hispanic/Latino persons
in the general population do not consistently show higher rates of substance use
disorders than Whites (Table 1 ). Tobacco use rates are lower for African American
and Hispanic/Latino populations than Whites; illicit drug use disorders are higher
for African Americans, but alcohol disorders are not higher; and neither illicit drug
use disorders nor alcohol disorders are much different for Hispanic/Latino persons
compared to Whites in the general population. Yet, a consistent risk factor for sub-
stance use and addictive disorders is socioeconomic adversity that is more com-
monly experienced in these minority populations. Disparate outcomes and pathways
refl ected in these fi ndings and associated with racial and ethnic status serve as a
starting point for this monograph. By tackling many nuances in the social epidemi-
ology of substance use and addictive disorders among persons from diverse racial
and ethnic backgrounds, the monograph explores a key question—namely, how to
explain the contrasting and similar patterns of substance use and addictive disorders
among different racial and ethnic groups.
Research has shown African American and Hispanic/Latino youth to have differ-
ent pathways or trajectories of drug use compared with White youth, from initiation
to development of problem use. Relative to White youth, African American youth
are less likely to use alcohol and other drugs as adolescents, begin using in early
adulthood, and are more likely to become problem users. Thus, the major risk factor
of early adolescent onset of substance use predicting higher rates of addiction does
not seem to hold true for African American youth as much as for White youth. As
African Americans move into young adulthood and beyond, there appears to be an
onset of substance use and addictive disorders more than for White populations.
Exploring these trajectories is the goal of this monograph, with some research iden-
tifying similar patterns, while others have shown heterogeneity in the developmen-
tal course of substance use and substance use disorders across ethnic and racial
groups, and this heterogeneity may be of etiological signifi cance.
O ne of the complications of substance use research is that the behavior involves
potential toxicity. That is, research on substance use must take into account the
reinforcing/rewarding and brain altering aspects of exposures. This is why early
vii
viii Preface
onset is such a potentially important issue. The brain may be particularly vulnerable
at different stages of development, and adolescence appears to be such a vulnerable
period with heightened risk for establishment of long-term patterns.
T he propensity to use drugs is based on both individual predisposition and on
environmental infl uences that interact with one another across human development.
Environments that may infl uence future drug use include the prenatal intrauterine
environment, infancy and early childhood environments, and later childhood.
Experimentation with psychoactive substances often starts in adolescence, a devel-
opmental stage characterized by risk-taking, novelty-seeking, and heightened sensi-
tivity to peer pressure, which might refl ect incomplete development of brain regions
involved in, for example, executive control, motivation, and decision making. In
addition, epidemiological evidence shows that the process of addiction is much
more likely to be triggered in an adolescent brain: convergent lines of evidence sug-
gest that exposure to drugs or alcohol during adolescence may result in different
neuroadaptations from those that occur during adulthood. For example, recent stud-
ies demonstrate that the adolescent period is distinctly sensitive to long-term altera-
tion by chronic exposure to alcohol or nicotine, which may explain the greater
vulnerability of young initiates to addiction to alcohol or other drugs. How racial
and ethnic status interacts with these fundamental developmental trajectories is a
key question.
Addiction Vulnerability
A nuanced way to think about the issue of variations in substance use and addictive
disorders in different groups is to conceive these substance use and addictive disor-
ders as explained by a cluster of risk and protective factors. These risk and protec-
tive factors include multiple environments from the intraindividual (e.g., genetic
predispositions) to family, peer, neighborhood, legal, and cultural domains.
Importantly, interactions within and across these domains shape the drug use trajec-
tories and serve as the rich material found within the chapters of this text.
I t is estimated that 40–60 % of the vulnerability to addiction is attributable to
genetic factors. Animal studies have identifi ed several genes that are involved in
drug responses and whose experimental modifi cation markedly affects drug self-
administration. In addition, animal studies have also identifi ed candidate genes and
genetic loci for alcohol responses, which overlap with genes and loci identifi ed in
human studies. Progress in identifying candidate genes for alcoholism and alcohol-
related responses continues at a rapid pace. However, identifying the biological
function of these new candidate genes has emerged as a major challenge for the next
decade. The hope is that a better understanding of the myriad interacting genetic
factors and networks that infl uence addiction risk and trajectory will help increase
the effi cacy of substance prevention approaches and improve addiction treatment as
well.
Preface ix
Table 1 P ast 12-month substance use disorders and tobacco use in race and ethnic groups, persons
ages 12 and older in 2012
Illicit drug Alcohol Either illicit drugs
Racial/ethnic group disorder disorder or alcohol disorder Tobacco use
Not Hispanic or Latino
White 2.7 (0.11) 7.0 (0.20) 8.7 (0.22) 34.5 (0.44)
Black or African 4.1 (0.38)* 6.2 (0.42) 8.9 (0.51) 30.9 (0.97)*
American
American Indian or 7.6 (1.87)* 17.3 (3.20)* 21.8 (3.39)* 53.8 (3.94)*
Alaska Native
Native Hawaiian or other 2.3 (0.95) 3.7 (0.97)* 5.4 (1.40)* –
Pacifi c Islander
Asian 0.6 (0.17)* 2.9 (0.49)* 3.2 (0.50)* 14.0 (1.32)*
Two or more races 4.2 (0.79) 7.0 (1.25) 10.1 (1.44) 43.7 (3.05)*
Hispanic or Latino 2.8 (0.26) 7.3 (0.42) 8.0 (0.47) 25.0 (0.86)*
Source: Substance Abuse and Mental Health Services Administration, Results from the 2012
National Survey on Drug Use and Health, Detailed Tables. http://www.samhsa.gov/data/
NSDUH/2012SummNatFindDetTables/DetTabs/NSDUH- DetTabsTOC2012.htm , Accessed July
5, 2014
*Rate compared to White, p < 0.05
One of the best examples of moving from gene identifi cation to biological func-
tion is the association between drug metabolizing genes and protection against sub-
stance use disorders. These polymorphisms operate by modulating the accumulation
of toxic (aversive) metabolites. Therefore, if alcohol or drugs are consumed by indi-
viduals who carry variants that convert their substrate at high rates, then the accu-
mulation of toxic metabolites serves as a negative stimulus to prevent further
consumption. The ways that these and other genetic factors operate in racially and
ethnically diverse populations is a key question.
E nvironmental factors that have been consistently associated with a propensity
to self- administer drugs include low socioeconomic status, poor parental support,
within peer group deviancy, and drug availability. Stress might be a common feature
in a wide variety of environmental factors that increase the risk for drug abuse and
may help explain, for example, why social isolation (which increases anxiety) dur-
ing a critical period of adolescence increases addiction vulnerability. The ways that
racial and ethnic status may alternatively buffer and instigate stress remain an
intriguing window into the onset and maintenance of substance use and addictive
disorders.
Further, the issue of the overlap of mental illnesses with substance use and sub-
stance use outcomes is often under-explored in racial and ethnic subpopulations.
Addressing the ways that mental illnesses vary in the ways they shape substance use
trajectories in different populations is another challenge for the authors of the chap-
ters in this text.
