Hispanic women seek detoxification and treatment for substance abuse disorders in lower
numbers than women from any other ethnic/cultural group.
90 percent of Hispanics are Catholic.
36 percent of Hispanic children live below the poverty level.
There is a clear increase in substance abuse as Hispanics become more acculturated (i.e.,
in second and third generations, and so on).
Hispanics are overrepresented among HIV/AIDS cases for men, women, and children.
Hispanics as a group may include aliens who are undocumented or carry immigrant visas
(green cards) and who avoid contact with the health care system because they fear
possible deportation.
Within the context of acculturation and socioeconomic status, providers should be aware of
specific cultural issues that can support interventions and improve a provider's ability to engage
Hispanic clients, such as the role of the family, the values of interdependence, respect, and
"personalismo" (i.e., importance of personal contact). Understanding these concepts will help
establish rapport and trust.
The Hispanic family is generally extended and has many members. A Hispanic client's support
system may be composed of siblings, godparents, aunts, and uncles who are all very involved
with the client. The family as a whole is of great importance, and often what is best for the
family will override what is best for one of its members. Because the family is so important to
most Hispanics, children are highly valued. This makes it easier to see how some Hispanic
women who are HIV positive grieve deeply about the decision not to have children and may feel
unfulfilled and inadequate as a result. This also sheds some light on the challenges of involving
Hispanics in substance abuse treatment. Leaving their children behind while in treatment or
turning guardianship over to a State agency may be unacceptable and create more conflict.
Often, families are aware of homosexual family members, but usually this is not discussed
openly. The reality is that many Hispanic men who prefer sex with other men do marry and have
children. This partly explains why Hispanics are at such high risk for HIV/AIDS. If the man has
married and fathered a child, he has been congruent with the values relating to family; if he then
goes out with men, or even with other women, this behavior may be tolerated as long as he
continues to provide for his family. Figure 7-7 offers additional considerations for working with
Hispanics.
African Americans
As is the case with members of other minority groups, the health and social repercussions of
substance abuse problems are magnified in the lives of African Americans (CSAT, 1999b). In
terms of past-year prevalence rates of illicit drug use, the 1998 NHSDA (SAMHSA, 1999) found
that the rate for African Americans (8.2 percent) was somewhat higher than for whites (6.1
percent) and Hispanics (6.1 percent). In addition, HIV/AIDS disproportionately affects African
Americans, and from July 1998 through June 1999, injection drug use accounted for 26 percent
of AIDS cases among African American males and 26 percent of cases among African American
