Exploring the Intersected Influences of Sociocultural Norms and the Social Context on Alcohol and Substance Abuse in Hispanic Men

BACKGROUND: Maladaptive patterns of alcohol consumption can lead to clinically significant impairment or distress and have been established as a partial cause of a wide variety of health conditions, including neuropsychiatric disorders, cardiovascular diseases, hepatic inflammations, certain cancers, and infectious diseases. In the United States, Hispanic and non-Hispanic white (NHW) men have comparable rates of moderate alcohol consumption, however, Hispanic men are more likely to consume higher volumes of alcohol and with more frequency and experience disproportionate levels of adverse health and social consequences of alcohol abuse when compared to NHW men. Further, Hispanic men face greater barriers than NHW men in accessing, engaging, and completing alcohol abuse treatment services despite the contrasting burden of alcohol-related consequences they face. OBJECTIVES: This dissertation is composed from three studies addressing the following aims to: 1) synthesize the culturally- and gender-responsive components of alcohol and substance abuse and dependence treatment programs designed for Hispanic males in the United States; 2) explore Hispanic male perspectives and opinions regarding alcohol use and abuse patterns that may lead to disparate rates of alcohol abuse in Hispanic males in the United States; and 3) examine U.S. Hispanic male perspectives regarding the barriers to alcohol abuse treatment-seeking related behaviors that lead to disparate treatment engagement and completion rates. METHODS: A systematic literature search was conducted for Aim 1 in which articles reporting on culturally- and/or gender-adapted alcohol and/or substance abuse interventions designed exclusively for Hispanic males were identified. Aim 2 and Aim 3 used semi-structured interviews to elicit Hispanic male perspectives of alcohol abuse and alcohol abuse treatment seeking behaviors. Separate thematic analyses were conducted as per the objectives of Aims 2 and 3. Data analysis was based on a deductive process including a preliminary codebook that was supplemented with inductive codes that surfaced during iterative thematic analyses. RESULTS: Regarding Aim 1, literature searches yielded 2685 titles, resulting in 12 articles that fit the parameters of the review. The most scientifically rigorous findings suggest that cultural adaptations may outperform standard treatment for Hispanic men (n=6). Nevertheless, a fraction of the included interventions (n=4) did not improve outcomes compared to standard treatment. Considering the scarce number of publications, it is difficult to discern how much findings reflect ineffective interventions or methodological limitations. Findings for Aim 2 indicate that there are intersected effects of machismo, a culture of normalized overconsumption, social context stressors, and poor coping strategies that may influence maladaptive relationships with alcohol use. Findings for Aim 3 suggest that treatment seeking behaviors are highly influenced by; a) structural factors related to treatment accessibility, and linguistic and cultural-responsiveness of available treatment, b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of knowledge and cultural normalization of consumption, and societal stigmatization of alcohol abuse treatment, and c) individual factors related to machismo-bound pride as well as lack of knowledge. CONCLUSIONS: Given the rapid expansion of the Hispanic population in the United States, and the parallel growth of alcohol abuse implications in this population, it is imperative that we learn where these problems may be rooted to better understand how to diminish the existing gaps. Collectively, these findings point to the need for treatment providers to disseminate accurate information about treatment availability and eligibility, and the treatment process. This work also illustrates the need to for consciousness building efforts targeting the Hispanic male community regarding the detrimental effects of alcohol-related problems and treatment, in order to diminish the stigma. Increased or redistributed funding for linguistically and culturally responsive programs is also needed in communities with large Hispanic populations in order to meet the growing demand, particularly for the uninsured. Further research is needed to identify other potential barriers and recovery resources for this population and other Hispanic subgroups in other parts of the United States