Yonette F. Thomas · Leshawndra N. Price Editors Drug Use Trajectories Among Minority Youth Drug Use Trajectories Among Minority Youth

Yonette F. Thomas · LeShawndra N. Price Editors Drug Use Trajectories Among Minority Youth Drug Use Trajectories Among Minority Youth Yonette F. Thomas • 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 © Springer Science+Business Media Dordrecht 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Science+Business Media B.V. Dordrecht Not e : The views expressed are those of the authors and do not necessarily represent the views of the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institutes of Health, the US Census Bureau, the US Department of Commerce, the US Department of Health and Human Services, or the US Government. 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 substance 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 different 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 identifying similar patterns, while others have shown heterogeneity in the developmental course of substance use and substance use disorders across ethnic and racial groups, and this heterogeneity may be of etiological signifi cance. One 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. The 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 developmental 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 studies 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 disorders as explained by a cluster of risk and protective factors. These risk and protective 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 trajectories and serve as the rich material found within the chapters of this text. It 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 Past 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 function is the association between drug metabolizing genes and protection against substance 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 accumulation 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. Environmental 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) during 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.

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