Drug Use and Abuse in African Americans

Learning Objectives

Become familiar with drug use prevalence among African Americans.
Understand ethnic/racial differences in drug use consequences and disparities.
Become familiar with historical patterns of drug use.
Understand risk and protective factors for drug use among African Americans.
Understand the role of cultural and institutional factors in drug use.
Identify culturally congruent programs for preventing and treating substance use.
Become familiar with methodological and research issues when studying substance use.

Introductions, Definitions, and Historical Perspectives

Tobacco use has severe long-term effects on mortality, illness, and disease among African Americans.
Illegal and illicit drugs cause major problems within many African American communities, particularly urban, low-resource communities.
African Americans do not consume drugs more than members of any other ethnic groups, but they are more likely to suffer negative social and health consequences from their use.
Drug possession, sales, and use account for a large percentage of incarceration among African Americans.
NAACP statistics on disparities in drug incarceration for African Americans:
- African Americans are incarcerated at nearly six times the rate of whites.
- About 14 million Whites and 2.6 million African Americans report using an illicit drug.
- 5 times as many Whites are using drugs as African Americans, yet African Americans are sent to prison for drug offenses at 10 times the rate of Whites.
- African Americans represent 12% of the total population of drug users, but 38% of those arrested for drug offenses, and 59% of those in state prison for a drug offense.
- African Americans serve virtually as much time in prison for a drug offense (58.7 months) as whites do for a violent offense (61.7 months).
- In 2002, African Americans constituted more than 80% of the people sentenced under the federal crack cocaine laws and served substantially more time in prison for drug offenses than did whites, despite the fact that more than 2/3 of crack cocaine users in the U.S. are white or Hispanic.
In inner cities, drug trafficking and use are strongly associated with high levels of crime, violence, and other social problems.
Legal drugs such as alcohol and cigarettes contribute to increased health problems including morbidity and mortality among African Americans.
The chapter will cover definitions relevant to drug use, a historical overview of drug use in Africa, drug use among enslaved Africans, current drug use among African Americans, the etiology and consequences of drug use for African Americans, institutional and societal influences, methodological and research issues, and best practices for addressing problems associated with drug use.

Definitions

NIDA defines a drug as a chemical compound or substance that can alter the structure and function of the body.
Drug abuse is the use of illegal drugs or the inappropriate use of legal drugs.
Illicit drugs are illegal. Illicit drugs as identified by the National Survey on Drug Use and Health are marijuana or hashish, cocaine or crack cocaine, inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.
Marijuana is the illicit drug that is used most frequently.

Historical Patterns of Drug Use in Africa

Enslaved Africans arriving in America often came from ethnic groups that used fermented maize (corn) or millet as a food and a trade product, in social interactions, and as a sacred drink.
Beer was used as an offering to gods and as a reward to those who had worked the land.
From the 16th to the 18th centuries, West, East, and Central Africans brewed beer and wine, and southern Africans engaged in some use of cannabis (marijuana).
Among specific African ethnic groups, alcohol was drunk in a group context-in religious and sacred events-rather than individually.
Other drugs were not commonly seen in West African society.

Role of Drugs in the Slave Trade

By the 1700s, alcohol had acquired an economic function and was used as currency in slave trading; it is estimated that alcohol purchased from 5% to 10% of all slaves in West Africa.
The connection between alcohol and the slave trade was circular, involving New England, Africa, and the West Indies.
Sugar and molasses from the British and Spanish West Indies were shipped to New England, where they were distilled into rum. The rum was then sent to Africa where it was exchanged for slaves. These slaves were shipped to the West Indies to work in the cane fields.

Drug Use During Slavery

Drinking during the period of enslavement was limited due to dawn-to-dusk work demands on slaves.
Social drinking patterns of African Americans living in slavery included weekend and holiday use and drinking at celebrations.
Slave masters permitted and encouraged the use of alcohol as a reward during harvest times.

Drug Use Following the Civil War

Many Blacks became more involved in the Protestant Church, and church doctrine forbade alcohol consumption.
Black Churches of all denominations grew dramatically after the Emancipation Proclamation and promoted either abstinence or moderation in drinking.
Many African Americans migrated North, frequently to urban areas, in search of employment leading to heavier drinking patterns and high levels of addiction among African Americans.
Rather than restricting alcohol use to celebratory occasions, many African Americans began to use alcohol to cope with problems of daily living brought on by poverty and racism.
Opium use also increased in the United States, introduced by Chinese workers.

Drug Use From 1900 to 1930

Illegal drug use in the early 1900s was mostly limited to ex-convicts and criminals.
By the 1930s, African Americans were disproportionately represented in the known addict populations of major urban areas.
The expansion of clubs and bars in African American cities and communities during the 1930s. with this expansion came increased opportunity for alcohol and other drug use.

Drug Use in the 1940s and 1950s

During the late 1940s and 1950s, heroin use increased in urban African American communities.
Marijuana, which had previously been used only by specific subgroups of African Americans, such as prisoners, was also beginning to be used by more diverse groups of African Americans.
Options for those who wanted alcoholism treatment were very limited in the 1950s and 1960s. Hospital treatment programs were designed for middle-class Americans, and self-help programs such as Alcoholics Anonymous were not available in African American communities.
Organized drug syndicates gained control of drug production and distribution. With limited employment options available to them, many younger African Americans in urban communities became involved with drug preparation, packaging, and sales.

Drug Use From the 1970s to the Present

The 1970s, 1980s, and 1990s saw the rise of the use of powdered cocaine, which led to the appearance of crack cocaine, which has had a devastating impact on African American families and communities.
The Anti-Drug Abuse Act of 1986 created a disparity in sentencing those arrested for crack cocaine as opposed to those arrested for powdered cocaine.
In December 2007, the U.S. Supreme Court ruled that differences in the sentencing of crack cocaine and powdered cocaine offenders were unjust by a 7-2 vote.

Current Drug Use Among African Americans

The National Survey on Drug Use and Health provides data on patterns of drug use among different age, gender, and ethnic groups.
Across most drug and age categories, a smaller percentage of African Americans than Whites reported consuming drugs.
More Whites than African Americans reported smoking cigarettes and drinking alcohol.
The gap between African Americans and Whites in drug consumption and cigarette use decreases in the 26 and older group especially for illicit drugs where African Americans consume more illicit drugs than Whites.
African American and Hispanic youth show higher prevalence for drug-related social problems than do White youth.
African American men are at 47% more likely to develop lung cancer lung cancer than are White men.
African American smokers have more difficulty than members of other ethnic groups in quitting.
Among African Americans who are current smokers, about 84% report smoking mentholated cigarettes compared to about 24% and 32% for White and Hispanic smokers.
Smokers of mentholated cigarettes have higher nicotine dependence, which makes it more difficult to quit and increases adverse health effects.

Alcohol

Alcohol consumption and abuse is a major cause of morbidity, mortality, disability, and property destruction.
Among youth ages 12 to 17 in 2010, African Americans (10.8%) and Asians (4.8%) were least likely to report past-month alcohol use. Almost 15% of White youth reported past-month alcohol use.
The percentage of persons who reported alcohol consumption is lower for African Americans than for Whites in each age-group.

Cigarettes

Tobacco use is a leading contributor to disability, illness, and death in the United States.
Cigarette smoking was substantially less common among African Americans than among Whites ages 12 to 17 and 18 to 25. However, cigarette smoking among Whites decreases substantially after age 25 but only minimally among African Americans.
African Americans are more likely than other ethnic groups to smoke mentholated cigarettes, which may be more harmful and carcinogenic.
Contemporary Issues: African Americans and Mentholated Cigarettes:
- Tobacco accounts for more excess deaths and health disparities than all of the other drugs combined.
- Researchers found that for every 10 percentage point increase in the proportion of African American students at a school, the per-pack price of Newport (the leading brand of mentholated cigarettes) was 12 cents lower. At the same time, prices for the leading non-mentholated brand were not related to school demographics.
- Several anti-tobacco advocates have called for the U.S. Food and Drug Administration to ban mentholated cigarettes.

Illicit Drugs

Nine percent of persons ages 12 or older (an estimated 22.6 million persons) used an illicit drug in the past month, with 6.9% (17.3 million persons) using marijuana and 2.7% (6.9 million persons) using a prescription-type drug non-medically.
In 2010, the rate of illicit drug use for African Americans over the age of 12 was 10.7%, which was slightly higher than for Whites at 9.1%.
Among White youth ages 12 to 17 years old, males and females were about equally likely to be illicit drug users (9.7% for both groups). However, among African American youth the rate of illicit drug use was slightly higher among males (11.1%) than among females (10.4%).

Marijuana

Marijuana use in the United States is on the rise and the most commonly used illicit drug among adolescents.
Among those 12 to 17 years of age, African Americans and Whites reported equal 30-day use of marijuana, 7.5%. Among those ages 18 to 25, 30-day marijuana use was at 17.6% and 20.8% for African Americans and Whites, respectively.
More than half (54.9%) of African American youth age 12 to 17 reported that marijuana is fairly or very easy to obtain.
African American and Hispanic youth are less likely to believe that there are serious consequences associated with marijuana use as compared to other ethnic groups.
Marijuana use was also more likely to co-occur with alcohol use disorders among African Americans when compared to other ethnic or racial groups.

Cocaine

Use of cocaine, especially crack cocaine, has been incredibly destructive within African American communities.
Eighty-three percent of all federal crack cocaine cases in 2011 involved African Americans.
Cocaine is powerfully addictive and is characterized by a high frequency of relapse following treatment.
The prevalence of emergency room episodes is substantially higher for African Americans than for Whites.

Causes and Consequences of Drug Use

The etiology of drug use focuses on why people start using drugs. Experimentation with drug use most often begins during adolescence.
Factors that contribute to initial drug use are different from factors that contribute to continuing drug use and addiction.

Drug Use Initiation

Drug use is often initiated in early to mid-adolescence. During adolescence, one explores new activities, and drug experimentation may be one such activity.
Initiation often begins with cigarettes and alcohol, which are considered gateway drugs to other drugs such as marijuana. However, marijuana appears to be a gateway drug for cigarette use among African American youth.
African American youth were significantly more likely to initiate marijuana use before cigarette use. Over one-third of African Americans reported initiating marijuana before cigarettes (37.9%), compared to less than one-quarter of youth in the other ethnic groups (Caucasian = 17.3%, Latino/Latina = 21.7%, Biracial/Other = 20.8%).
Drug initiation starts around the age of 11 to 12 for youth of all ethnic groups.
Youth who do not use these substances during the adolescent period are less likely to use drugs as adults and to have adverse effects from such use.
African American youth tend to start drug use at a later age than youth from other ethnic groups.
Also, the progression of substance experimentation, or light use to heavy use, tends to be slower for African Americans than for other groups.

Co-Occurring Behaviors

Drug use among adolescents is often associated with other problem behaviors, such as low academic achievement, delinquency, and early, risky sexual activity.
Understanding the co-occurrence of problem behaviors has implications for preventing drug use and associated problem behaviors. Interventions that focus on a common set of risk factors may be better than those that focus on a singular risk factor.
There is a strong association between youth delinquency, violence, and drug use. The underlying cause of violence may be the same as the underlying cause of drug use.

Substance Use Disorders

Overall African Americans report fewer substance use disorders than most other racial/ethnic groups.

Consequences

Early use of drugs has been associated with serious consequences of drug use and problems in later life.
Youth who begin using drugs early are at increased risk for drug abuse in later adolescence and adulthood.
Other serious consequences of drug use are accidental overdose, motor vehicle accidents, injury, disability, and morbidity.
Early drug use is also correlated with victimization, including dating violence, especially among African American girls and women.
In fact, late onset is associated with greater cigarette use persistence into adulthood among African Americans than for Whites.
African American men especially are more likely to experience antisocial consequences due to drinking.

Risk and Protective Factors

Risk factors are those characteristics or circumstances that predispose youth to drug use. These could include individual attributes, situational conditions, or environmental contexts.
The greater the number of risk factors, the greater the probability of drug use.
Protective factors can be categorized in the same domains as risk factors and include the individual, family, peer, school, and community.
The following protective factors have been found to be associated with less drug use and anti-drug attitudes: (a) having a range of adaptive social coping skills; (b) self-efficacy and the ability to adapt to changing circumstances; (c) positive social interaction; (d) family cohesion, attachment, and bonding; (e) parental supervision and monitoring; (f) school and community norms and standards against substance use; and (g) school achievement and commitment.
Masten and Coatsworth (1998) defined resilience as "manifested competence in the context of significant challenges to adaptation or development"
There are ethnic differences in how risk and protective factors affect substance use among youth.

Individual Factors

Individual factors are those that characterize individual-level susceptibility to drug use. These include dispositional and psychological factors, demographic factors, and biological factors.
Several dispositional factors are associated with drug use. These include sensation seeking and rebelliousness, and lower achievement needs.
Low self-worth, aggression, rebelliousness, alienation, and delinquency are also associated with drug use in general. However, alienation and rebelliousness seem to be more strongly related to drug use for White than African American youth.
Individual-level protective factors against drug use include social skills, problem-solving skills, social responsiveness, cooperativeness, emotional stability, and a positive self-concept.
Studies of twins show that there may be a genetic predisposition for drug abuse and addiction.
Psychopathology is a major risk factor for substance use and abuse and poor mental health problems precede drug abuse or covary with it.
Studies suggest that African Americans absorb more nicotine from smoking than do White or Hispanic smokers.
The level of serum cotinine is higher among African American smokers than among White smokers consuming the same number of cigarettes.

Family Factors

Parental and family variables affect youth drug use.
Family conflict, poor communication, and negative interactions with parents have been associated with adolescent drug use.
Parental monitoring and supervision of adolescents' behavior have been linked to lower levels of substance use.
Family structure has also been associated with adolescent drug use. The assumption is that two parents can provide more supervision and serve as a buffer for problems and stressors youth may face. However, the impact of family structure on drug use differs between African American and White families.
Siblings, especially older siblings, influence drug use.

Peers

Peer influence is a strong predictor of drug use during adolescence.
Youth who have peers who use drugs are more likely to use drugs than those whose peers do not use drugs.
Peer cluster theory assumes that peers influence drug use both directly and indirectly.
Given the strong influence of peers, many drug prevention programs have been designed to increase skills to resist peer pressure for drug use.

School Factors

Lack of attachment with, commitment to, and interest in school have been associated with drug use among youth.
School-related problems, such as school failure, truancy, and special placements, are higher among drug users.
High academic performance and interest is a protective factor against drug use. However, school problems seem to be more related to drug use among White than African American youth.
Poor school management, characterized by disorganization and poor school morale, has been linked to increased drug use.
School policy also contributes to drug use. Schools that do not enforce drug policies tend to have higher levels of drug use among students than those schools where there are strictly enforced policies against drug use.

Community Factors

Access and availability of drugs are predictors of drug use.
Drug use is also prevalent in communities that have high levels of social disorganization and stress.
Economic and employment opportunities within a community play a role in drug use and associated negative behaviors.

Drug Use Vulnerability

Exposure to a risk factor involves the extent to which that risk factor is present to a greater or lesser degree among African Americans compared to youth in other ethnic groups.
Vulnerability is the extent to which a given risk factor differentially relates to drug use for different groups.
Drugs are more available in African American communities than in White communities.
While risk exposure may be greater for African American youth than youth from other ethnic groups, vulnerability may be actually lower.

Cultural Factors

There has been recent research on the positive role of cultural variables in preventing drug use and abuse among African American youth.
The findings from this research assume that spirituality, a positive ethnic identity, and strong cultural values serve as protective factors for African American youth.

Spirituality

One dimension of an Africentric worldview, spirituality (and religiosity), is linked to less drug use.

Ethnic Identity

Ethnic identity has been defined as feelings of belongingness, attachment, and behavioral dispositions toward one's own ethnic group.
Several studies have shown a relationship between ethnic identity and reduced problem behaviors among youth.

Africentric Values

Africentric values, on the other hand, have to do with the beliefs, values, and cultural dispositions of people of African descent.
Like ethnic identity, Africentric values have been associated with pro-social behavior and good coping strategies.
Africentric values had both a direct and protective effect on alcohol use among African American youth.

Institutional and Societal Factors

In addition to cultural and identity factors that operate on an individual level, there are several institutional and societal influences on drug use among African Americans.

Poverty

Poverty is a risk factor for drug use.
Social support and ties to employed people were protective factors against drug use.

Racism and Discrimination

Racism and discrimination have been shown to influence substance use and abuse in several studies.
Drugs may be used as a coping strategy for racism and discrimination.

Crack Cocaine-Powdered Cocaine Discrepancy

Previous differences in mandatory minimum sentences for crack cocaine and powdered cocaine illustrate the role of race in convictions and lengths of sentencing.
In December 2007, the U.S. Supreme Court ruled that these differences in sentencing for crack and powdered cocaine were unjust.

Methodological and Research Issues

We discuss three methodological issues to consider when conducting research on drugs and African Americans:
- the validity of self-reports of drug use,
- the identification of appropriate and relevant constructs and measures in drug research, and
- the recruitment of African American participants in drug research.

Validity of Self-Reports of Drug Use

When respondents are asked to report any illicit or stigmatizing behavior, there is always a concern as to whether the respondent will answer truthfully.

Identification of Appropriate and Relevant Constructs and Measures in Drug Research

Identifying the appropriate and relevant constructs and measures to understand predictors of or contributors to drug use are also methodological concerns.

Recruitment of African American Participants in Drug Research

Good recruitment and retention is critical to successful drug research and prevention interventions.
More research on effective recruitment strategies for engaging African American youth in drug prevention studies is needed.

Best Practices for Preventing and Treating Drug Use

The best way of dealing with substance and drug use is to prevent it from occurring.
Universal approaches to substance abuse prevention, and then we offer an overview of culturally specific approaches.
Knowledge-based programs are designed to provide information about drugs and the negative consequences of drugs. Knowledge-based programs, when used alone, have not shown effectiveness in changing drug behaviors.
Personal, interpersonal, and enhancement programs promote feelings of self-worth and competence that make the individual less likely to engage in drug use.
Life skills and social skills programs teach youth skills for refusing drugs, make youth aware of the social context of drug use, and provide youth with skills for coping with anxiety and interpersonal relationships that may lead to drug use.
Family programs improve parenting skills and family cohesiveness and foster competence and connections among children to deter drug use.
Community programs target aspects of the environment that affect drug accessibility and attitudes. Actions can include removal of liquor stores, policing of drug trade, and advertising.
Alternative programs provide youth with constructive and healthy activities that offset the attractiveness of drugs. These may include community service programs for youth, athletic and recreational programs, and tutoring and educational enhancement programs.
Cultural enhancement programs focus on the infusion of cultural values, attitudes, and behaviors that are protective against drug use.
Most programs use a combination of these strategies and approaches for drug prevention.

Life Skills Training Program

One prevention program with demonstrated effectiveness is the Life Skills Training Program. This program involves teaching youth skills for resisting social and peer influences.
The Life Skills Training Program has shown successful outcomes among many youth populations, including African Americans.

Culturally Focused Approaches to Drug Prevention and Treatment

Considering how important cultural beliefs and behaviors are in drug prevention and intervention, programs that consider culture in such efforts should be beneficial.
Culturally focused prevention programs funded by the Center for Substance Abuse Prevention can be categorized into three broad categories:
- addresses the potential of cultural tradition, values, and spirituality as protective factors.
- explores African American and African history and the contributions of Blacks as sources of identity and positive affirmation.
- focuses on contemporary cultural experiences among African Americans and addresses a range of topics related to external risk.

A Culturally Appropriate Drug Prevention Program

The Strong African American Families-Teen (SAAF-T) program is a culturally specific drug prevention program for African American youth. This evidenced-based substance abuse prevention program also deters conduct disorders.
Data collected 22 months after program completion showed that participation in the SAAF-T resulted in a significant decrease in the frequency of conduct problems, substance use, and substance use problems.

Africentric Approaches to Substance Abuse Treatment

This program, called the Iwo San (Swahili for house of healing), was a residential treatment program for drug and alcohol abusing African American women and their dependent children.
The program was based on the assumption that addiction arises as a coping mechanism for escaping stressors and the problems of daily life.
Iwo San incorporated a rites-of-passage component engendering the African-centered perspective. The rites of passage fostered a sense of responsibility for self, family, and community. Spirituality played a key role in this program and was interwoven throughout the treatment in Iwo San.
Another culturally focused substance abuse prevention program used members of African American Churches as mentors for women in recovery.

Critical Analysis

Drug use is less prevalent among African Americans than in most other ethnic groups. Yet African Americans continue to face worse social, economic, and health consequences from such use.
The likely culprit is racism and discrimination: access to prevention programming and fair and equitable treatment of drug infractions are less likely to occur for African Americans than other ethnic groups.
We need to examine closely drug prevention programs that target all types of problem behaviors. In doing so we simultaneously reduce risk for many problem behaviors, including violence.
More research is needed to understand the etiology and consequences of drug use among African Americans.

Summary

Africans drank alcohol during celebrations and special events, and alcohol was also used as currency in the slave trade. The use of alcohol and other drugs continued among enslaved Africans in the New World. Following the Civil War, increased use of drugs occurred as African Americans began migrating North and to urban areas.
Surveys of the prevalence of drug use among youth show that African American teenagers use less alcohol, cigarettes, and other drugs than White youth. However, patterns of use change with age, and African Americans are more likely to increase their drug use as they get older.
Drug initiation begins during early adolescence and tends to co-occur with other social problems. There are several risk and protective factors for drug use. These include risk and protective factors at the individual, family, peer, school, and community levels.
Poverty is a contributor to drug use. Drug incarceration policies result in higher rates of incarceration among African Americans than among other ethnic groups because of differentials in crack cocaine and powdered cocaine sentencing.
Cultural beliefs and values may reduce risk for drug use. Strong spirituality, ethnic identity, and Africentric values have been found to correlate with less drug use and more-negative drug attitudes. Programs that infuse cultural values, beliefs, and ethnic consciousness enhance these protective factors against drug use.
There are several approaches to preventing drug use. These include life skills training approaches and cultural approaches, or a combination of these.