Immigration and Substance Use

by

Christopher P. Salas-Wright, María Duque, Sariya Idriss, Audrey Hang Hai, Seth J. Schwartz

• LAST REVIEWED: 29 November 2022
• LAST MODIFIED: 29 November 2022
• DOI: 10.1093/obo/9780195389678-0319

Introduction

The purpose of the present article is to provide an annotated bibliography of key references that provide information pertinent to substance use among immigrants in the United States over the past two decades. This includes studies examining immigrants from multiple sending regions (e.g., Africa, Asia), but—as a reflection of the long-standing trend in this area of research—the bulk of the literature cited in this article is focused on immigrants from Latin America. We focus on several main streams of research. First, we provide an overview of recent studies examining substance use risk among immigrants using national data. Second, we explore the question of why rates of alcohol and drug use—and, indeed, other behavioral health outcomes—tend to be lower among foreign-born individuals than among those born in the United States. This pattern has opened scholarly inquiry to examine the importance of pre-migration cultural factors, self-selection factors related to migration, and post-migration deterrent factors related to risky/illegal behaviors, including drug use. Another important research stream has examined the complex interplay between acculturation and substance use risk among immigrants, emphasizing the importance of factors such as age of migration, time spent living in the United States, ethnic enclaves, and other contextual factors. Additionally, scholars have begun in earnest to examine adverse migration-related cultural stress experiences such as discrimination, stereotyping, and marginalization as risk factors for alcohol and drug misuse among immigrants. In this article, we examine these and other factors to provide social work practitioners and scholars with an informed overview related to immigrants and substance use.

Evidence from National Studies

There is general scholarly consensus that, on average, foreign-born individuals are less likely than individuals born in the United States to use and misuse alcohol and other drugs and to meet criteria for an array of substance use disorders. The most highly cited and influential studies in this area tend to be epidemiologic studies with large samples—often surveying thousands of immigrants—designed to produce national estimates of substance use and other behavioral health outcomes. Dating back to the early-to-mid-2000s, studies such as Grant, et al. 2004; Alegría, et al. 2008; and Caetano, et al. 2009 showing far lower rates of alcohol and drug use and misuse among immigrants were influential and thus merit reference in any scholarly work looking at immigration and substance use, especially among Latin American immigrants. Recent studies have extended drug use epidemiology focused on immigrants to include findings specific to important subpopulations. Salas-Wright, et al. 2016 examined the experiences of immigrant teens with a focus both on substance use, finding that the prevalence of problem behavior was markedly lower among immigrant youth compared to their US-born counterparts. Bui 2013 added additional nuance to this analysis by examining the ways in which the protective effects of foreign birth may differ by self-identified race/ethnicity among adolescents. In studies focused on adults, we have also learned more about new subpopulations. For example, Salas-Wright, et al. 2014 found that rates of substance use disorders were lower among refugees than among nonrefugee immigrants and US-born individuals. Nevertheless, several important caveats and points of caution are worth noting. First, we should note the challenges of cross-cultural measurement. Lopez-Vergara, et al. 2021 considers the assumptions frequently made by researchers, including the assumption that survey measures are valid for cross-cultural comparisons. Large national surveys are a wonderful source of information in terms of broad observations, but they often are lacking in terms of group-specific measurement. Additionally, most studies cited here do not consider how abstainers may skew a study sample. The study Salas-Wright, et al. 2022 found that a disproportionate number of foreign-born Latin Americans in the United States abstain from alcohol use entirely. This is in keeping with other research presented in this section. Importantly, however, Salas-Wright, et al. 2022 also found that, among drinkers, the prevalence of binge drinking among foreign-born Latin American men and women was comparable to or greater than that of US-born non-Hispanic Whites.

• Alegría, M., G. Canino, P. E. Shrout, et al. 2008. Prevalence of mental illness in immigrant and non-immigrant US Latino groups. American Journal of Psychiatry 165.3: 359–369.

  DOI: 10.1176/appi.ajp.2007.07040704

  This is a highly influential study that provides national estimates of substance use disorders and other psychiatric disorders among US-born and foreign-born Latinos and non-Latinos using NCS-R data. This study also examines the complex interplay between nativity (or foreign birth) and country of origin among Latinos in the United States.

• Bui, H. N. 2013. Racial and ethnic differences in the immigrant paradox in substance use. Journal of Immigrant and Minority Health 15.5: 866–881.

  DOI: 10.1007/s10903-012-9670-y

  Focused on youth, this study builds on prior work by examining rates of self-reported substance use by immigrant generation and race/ethnicity using Add Health data. An interesting study finding is that the protective effects of foreign birth were observed for non-Hispanic White, Asian, and Hispanic youth, but not among non-Hispanic Black youth.

• Caetano, R., S. Ramisetty-Mikler, and L. A. Rodriguez. 2009. The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association between birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups. Drug and Alcohol Dependence 99.1–3: 215–221.

  DOI: 10.1016/j.drugalcdep.2008.08.011

  Using data from the HABLAS study, this study provides estimates for Latino adults in Miami, New York, Philadelphia, Houston, and Los Angeles. This study provides insight into the heterogeneity within Latin American national/regional subgroups (i.e., Mexican, Cuban, Puerto Rican, Central/South American) and pays particular attention to birthplace (United States versus foreign birth) as a predictor of alcohol use disorder. Differences were found only among Puerto Ricans.

• Grant, B. F., F. S. Stinson, D. S. Hasin, D. A. Dawson, S. P. Chou, and K. Anderson. 2004. Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic Whites in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61.12: 1226–1233.

  DOI: 10.1001/archpsyc.61.12.1226

  Using data from the NESARC-I (2002–2003), this study provides critical information regarding the prevalence of substance use disorders among foreign-born and US-born individuals of Mexican descent in the United States with comparisons to non-Hispanic Whites as well.

• Lopez-Vergara, H. I., M. Yang, N. H. Weiss, A. L. Stamates, N. S. Spillane, and S. W. Feldstein Ewing. 2021. The cultural equivalence of measurement in substance use research. Experimental and Clinical Psychopharmacology 29.5: 456–465.

  DOI: 10.1037/pha0000512

  This article provides a narrative review focused on underlying assumptions related to cross-cultural substance use and health disparity research. The article also provides concrete recommendations for improving cross-cultural equivalence and comparisons.

• Salas-Wright, C. P., M. Cano, A. H. Hai, et al. 2022. Alcohol abstinence and binge drinking: The intersections of language and gender among Hispanic adults in a national sample, 2002–2018. Social Psychiatry and Psychiatric Epidemiology 57: 727–736.

  DOI: 10.1007/s00127-021-02154-1

  This article examines the degree to which alcohol abstainers (individuals who consumer no alcohol) may be influencing our understanding of alcohol misuse among Latin American immigrants vis-à-vis US-born individuals. The paper shows that Latin American immigrants are more likely to abstain entirely from drinking, but—among drinkers—rates of binge drinking are disconcerting for Latin American immigrant men and women.

• Salas-Wright, C. P., M. G. Vaughn, T. T. Clark, L. D. Terzis, and D. Córdova. 2014. Substance use disorders among first- and second-generation immigrant adults in the United States: Evidence of an immigrant paradox? Journal of Studies on Alcohol and Drugs 75.6: 958–967.

  DOI: 10.15288/jsad.2014.75.958

  Using NESARC-II (2004–2005) data, this study shows that first-generation immigrants to the United States are far less likely than US-born Americans to meet criteria for all substance use disorders. Second-generation immigrants are also less likely than other US-born individuals to meet criteria for a number of substance use disorders. This provides novel information regarding age of immigration and duration in the United States, and examines differences by global region.

• Salas-Wright, C. P., M. G. Vaughn, S. J. Schwartz, and D. Córdova. 2016. An “immigrant paradox” for adolescent externalizing behavior? Evidence from a national sample. Social Psychiatry and Psychiatric Epidemiology 51.1: 27–37.

  DOI: 10.1007/s00127-015-1115-1

  Using NSDUH (2002–2009) data, this study provides national evidence that the prevalence of binge alcohol, cannabis, and other illicit drug use among foreign-born adolescents is markedly lower than that of their US-born counterparts. Additionally, the study shows that, among immigrants, rates are lower among youths who arrived after age twelve and who have spent less time in the United States.